Pain: Botanicals and chronic pain

by Paul Bergner

Medical Herbalism 3(2):1,6

In the Merck Manual, a standard medical text on illnesses and their treatment, more listings appear under the index category “pain” than for any other complaint. This bears testimony that we usually don’t call a doctor or reach for the medicine cabinet until we’re in pain, and that much of a doctor’s job is to alleviate that pain.

Chronic pain, such as that accompanying arthritis, migraine, severe recurrent menstrual disorders or permanent injury, presents a great challenge to the herbal practitioner. The challenge is threefold: first to effectively palliate the pain; second to remove, if possible, the cause of the pain; and finally to avoid causing injury through side effects of the pain medication.

Conventional medicine is clearly superior for the palliation of severe and acute pain, but with conventional treatment of chronic pain serious and even life-threatening side effects to the medication may occur. Conventional medicines fall into two categories: non-steroidal anti-inflammatory drugs (NSAIDS) which include aspirin and other salicylates, and opiates. The opiates are habit forming, and inappropriate for long-term use. NSAIDS, besides suppressing many normal functions in the body, present the possibility of serious, and even fatal side effects. The most common of these is gastrointestinal irritation and bleeding. Between one and three percent of patients who take NSAIDS experience gastrointestinal bleeding—about 200,000 cases each year in the U.S. lead to between 10,000 and 20,000 deaths. Every three years as many Americans die from their use as were killed during the Vietnam War, or are killed in a single year in traffic accidents in the U.S.

Botanical medicines may not be as effective as pharmaceutical drugs in combating severe pain, but they will often “take the edge off” the pain. This may be sufficient for patients, allowing them to sleep, to exercise, or to engage in routine activities. Botanicals offer two very important advantages over other drugs for moderate or mild chronic pain. One advantage is their lower potential for side effects. The most important advantage of herbs over conventional drugs for treating pain is that they have a broader range of possible actions, especially when given in combination. The herbal practitioner has a wider range of healing tools than is available to the conventional doctor. Combinations of such herbs with both overlapping and complementary actions may address several causes and complications of pain simultaneously. [See the accompanying case study] This is especially important in chronic pain, because such pain is universally complicated by other problems, such as insomnia, anxiety, depression, fatigue, or irritability.

Herbal actions in treating pain are as follows:

Analgesic or Anodyne Reducing pain, usually through the same mechanism as aspirin or other salicylates.
 

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Antispasmodic Reducing spasm either in skeletal muscle or the smooth muscle of the hollow organs.

Sedative Affecting the higher brain centers (as opposed to tranquilizers, which affect the limbic system)

Anti-inflammatory Moderating an inflammatory or allergic response.

Nervine Sedating, but also nourishing and tonifying to the nerves, as opposed to synthetic drugs which are generally sedating but progressively exhausting to the nerves.

    The following are some of the chief herbs used in the treatment of pain. The practitioner learning these well will be able to treat most cases of chronic pain. In all cases care must be extended to obtain high quality plant material or extracts.

Willow Bark Salix spp. This is the medicinal plant genus after which the salicylates were named. It is the classic anti-inflammatory herb. Its chief active ingredients are the glycosides salicin and salicortin. These are converted to salicylic acid in stages in the intestine and liver. It is ironic that in attempting to improve on this plant, pharmacologists eliminated one of its chief virtues—that it produces salicylic acid in the body safely past the digestive tract, where the acid itself can cause ulceration. Willow bark is slower acting than aspirin, sometimes taking several days before the conversion to salicylic acid is sufficient to relieve pain. The salicylic acid is excreted in the urine, making this an herb of choice for urinary tract inflammations.

Meadow Sweet Spiraea ulmaria, Filipendula ulmaria This is the anti-inflammatory herb in which salicylic acid was first discovered. It has a number of other anti-inflammatory constituents with slightly different actions, including gaultherin and spiraein. The name aspirin was derived from spiraein.

Valerian Valeriana off. This sedative also has analgesic and antispasmodic properties. It is ideally suited to pain that causes insomnia. The chief error practitioners make in its use is not to use a high enough dose. German physician and phytotherapist R.F. Weiss recommends taking ½ to 2 teaspoons per dose. Doses may be taken every two hours. Patients sometimes complain of a valerian hangover; by adjusting the dose downward, they will usually be able to achieve the same sedative effect without the hangover.

Wild Yam Dioscorea villosa This herb is antispasmodic and anti-inflammatory. It is specifically suited to spasm of the hollow organs, especially the gall bladder and uterus, but may also be useful in neuralgia.

Hypericum Hypericum perforatum This plant is traditionally specific to pain caused by nerve damage. It is often given for this purpose in homeopathic doses, but may be effective in the tincture or solid extract form. It is likewise a mild sedative and antidepressant, and may be especially useful when anxiety and depression accompany chronic pain from traumatic injury.
 

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Cramp Bark, Black Haw Viburnum prunifolium, V. opulus These plants may be used interchangeably. They are mostly indicated for menstrual cramps, but are useful for any spasmodic pain, especially of the lower back and legs.

Case Study

Patient

Thirty-four year old female. 5’7" 145 lbs. Strong build and constitution. Regular exercise. Better than average diet, but high fat. Drinks two cups of coffee a day. Stopped all alcohol and drugs about 12 months ago. A history of brief, unsatisfactory love relationships. Unusual stress on the job.

Chief complaint

Chronic neck pain and shoulder pain.

History

Patient is diagnosed with post-traumatic stress disorder related to life-threatening situations associated with her work. Chronic pain for eighteen months. Onset after traumatic event at work. She has been seeing a chiropractor since the onset of pain, and a psychotherapist for four months.

Medications

Took motrin and advil until about two months ago. Began taking an herbal product containing willow bar, wild yam, passion flower, valerian, and black cohosh about two months ago, and this works “about half the time.” The formula also includes calcium, magnesium, potassium, copper, vitamin B-6, Niacinamide, Bromelain, and L-Glutamic Acid. She requires a special pillow and some medication each night in order to sleep.

Treatment

She is partly happy with the present product, which is in the form of tablets made from powdered herbs. Substitute a tincture of the same herbs, with equal parts of each. Start with forty drops during the day as needed, up to three times, and again at bedtime, for a day or two. If there is no idiosyncratic reaction, increase the dose at bedtime to one teaspoon. If hangover occurs, adjust the dose downwards.

Follow up: four days

She had a mild hangover the second day, and cut dose to half a teaspoon.
 

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Medical Herbalism: Clinical Articles and Case Studies

Follow up: three weeks

The stronger herb formula has completely replaced the need for synthetic drugs. She is taking it only occasionally during the day, and four or five nights a week.

Discussion

This case shows how an herbal formula can have much broader action than a single synthetic drug. In this case the pain was complicated by mental stress, difficulty sleeping and resulting fatigue, muscle tension, fundamental emotional issues, and depression and frustration with the chronic nature of the problem. The following chart shows how overlapping and complementary properties of herbs create a broad-spectrum formula which addressed all these causes.

        Anti        Anti

        inflam-        spas-

        matory        modic        sedative    nervine        analgesic

Willow        X                                     X

Wild        X           X                             X

Yam

Passion                        X            X

Flower

Valerian                        X            X             X

Black        X            X                             X

Cohosh
 
 
 

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