The Use of Herbal Therapies to Relieve Pain Chamomile Extract

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					                                                      Herbal Therapies for the Relief of Pain

    Agent              Possible Uses               Dose/Routes                         Studies                          Safety/Adverse Reactions

• Arnica*           • Used for general           • Topically: Used as    • Arnica gave rise to greater pain than    • Considered poisonous if injected
(Arnica montana)      counterirritant, anti-       a cream, 15%            a placebo and caused more swelling         (Skidmore-Roth L, 2004)
• Also known as:      inflammatory, and pain       arnica oil (Natural     when used to treat impacted wisdom       • Serious liver and kidney damage can
Arnica flos,          reliever (Koenig, 2003)      Medicine                teeth (Kaziro, 1984).                      occur (Skidmore-Roth L, 2004)
  Leopard’s bane,   • Topically, to decrease       Comprehensive         • Topical application of Arnica            • Interacts with antihypertensive drugs
Mountain              inflammation in              Database, 2003)         Montana gel was a safe, well-              (Skidmore-Roth L, 2004)
  tobacco,            bruises, sprains,          • Typical strength is     tolerated, and effective treatment of
  Wundkraut           wounds, acne, boils,         2 grams of              mild to moderate osteoarthritis of the
                      and rashes (Skidmore-        flowerheads in 100      knee (Knuesel, Weber, & Suter,
                      Roth L, 2004)                mL water                2002).
                                                                         • Significant reduction of pain
                                                                           experienced by hand surgery
                                                                           patients (Sindrup et al., 2001).
                                                                         • Analysis of eight trials found, on
                                                                           balance, homeopathic arnica is no
                                                                           more effective than placebo (Ernst &
                                                                           Pittler, 1998).

• Black Cohosh      • It is a smooth-muscle      • Oral: 300-2000 mg     • No published research related to         • Likely safe when used orally and
  (Cimicifuga         relaxant, an                 of the dried            pain                                       appropriately, safe in studies lasting up
  racemose)           antispasmodic, an            rhizome or root                                                    to 6 months (Natural Medicine
• Also known as:      antitussive, a diuretic,     three times daily                                                  Comprehensive Database, 2003)
  Baneberry,          an antidiarrheal, and        (Natural Medicine                                                • Adversely interacts with hormone
  Cimicifuga,         an antiarthritic             Comprehensive                                                      sensitive cancers/conditions, but has no
  Bugbane             (Skidmore-Roth L,            Database, 2003)                                                    known drug interactions (Natural
                      2004)                                                                                           Medicine Comprehensive Database,
• Camphor           • Applied topically as an    • Topically: 0.1%-      • No published research related to         • Likely safe when used topically in low
  (Cinnamomum         analgesic and an             0.3%, 3 to 4 times      pain                                       concentrations short-term. Unsafe when
  camphora)           antipruritic (Natural        daily (Natural                                                     used orally (Natural Medicine
• Also known as:      Medicine                     Medicine                                                           Comprehensive Database, 2003)
  Camphora,           Comprehensive                Comprehensive                                                    • Orally, camphor can cause significant
 Cemphire,             Database, 2003)             Database, 2003)                                                     toxicity, symptoms can occur rapidly
 Camphor tree        • Muscle rheumatism,        • Inhalation:                                                         starting with nausea and vomiting, oral
                       respiratory tract           tablespoon of                                                       and intestinal burning, feeling of warmth,
                       diseases, circulatory       solution per quart                                                  and headache (Natural Medicine
                       regulation disorders        of water,                                                           Comprehensive Database, 2003)
                       (The Complete               medicated vapors                                                  • Oral preparations are no longer available
                       German Commission           are breathed                                                        in the U.S. (Natural Medicine
                       E Monographs:               (Natural Medicine                                                   Comprehensive Database, 2003)
                       Therapeutic Guide to        Comprehensive
                       Herbal Medicines,           Database, 2003)

• Capsaicin          • Stimulate digestion       • Oral: Capsicum        • Systemic capsaicin is effective for        • Likely safe when used orally in amounts
  (Capsicum            when used orally, as        fruit is usually in     short-term treatment of Burning              typically found in food (Natural Medicine
  frutescens)          an antiflatulent, for       doses of 30-120         Mouth Syndrome but with major                Comprehensive Database, 2003)
• Also known as:       colic, diarrhea,            mg, 3 times daily       gastrointestinal side effects (Petruzzi    • May cause gastrointestinal irritation,
  African              cramps, to improve          (Natural Medicine       et al., 2004)                                sweating and flushing of the head and
  Chillies,            peripheral circulation,     Comprehensive         • Topically applied capsaicin cream            neck when taken orally (Natural
  African Pepper,      reducing blood clotting     Database, 2003)         may decrease subjective neck pain            Medicine Comprehensive Database,
  Capsaicin Fruit,     tendencies, and           • Topical: For pain       (Mathias et al., 1995)                       2003)
  Garden Pepper,       preventing heart            syndromes,            • Capsaicin is ineffective in relieving      • Interferes with the activity of acid-
  Sweet Pepper,        disease (Natural            creams can be           pain associated with HIV-associated          inhibiting drugs, antihypertensive drugs
  Mexican              Medicine                    applied 3-4 times       Peripheral Neuropathy (Paice et al.,         (Natural Medicine Comprehensive
  Chilies, Grains      Comprehensive               daily (Natural          2000).                                       Database, 2003)
  of paradise          Database, 2003)             Medicine              • Topical 0.075% capsaicin cream             • May increase the effects of antiplatelet
                     • Topically to reduce         Comprehensive           appeared to be more effective than           drugs, barbiturates, cocaine, and drugs
                       pain                        Database, 2003)         the vehicle cream in relief of               with sedative properties (Natural
                                                 • Available in            postmastectomy pain syndrome in a            Medicine Comprehensive Database,
                                                   0.075% and              double-blind study (Watson, 1994).           2003)
                                                   0.025% creams         • Open-label trial where 68.4% of            • Topically, may increase pain, may
                                                                           patients received good pain relief           cause burning of the eye or mucous
                                                                           from 0.025% capsaicin administered           membrane if accidentally applied
                                                                           to treat post-mastectomy pain
                                                                           syndrome (Dini et al., 1993).
                                                                         • Double-blind, 8-week trial found
                                                                           topical capsaicin 0.075% cream is
                                                                           safe and effective in managing painful
                                                                           diabetic neuropathy (Scheffler,
  Sheitel & Lipton, 1991).
• Analysis of several trials found topical
  capsaicin is generally not satisfactory
  as a sole therapy for chronic painful
  conditions; it may serve as an
  adjuvant (Watson, 1994).
• Long-term, open, non-randomized
  study might indicate that the
  analgesic effect of capsaicin in post-
  herpetic neuralgia is mediated by
  both interference with neuropeptide
  metabolism and morphological
  changes of nociceptive afferents
  (Peikert, Hentrich, & Ochs, 1991).
• After two week 80% of capsaicin-
  treated patients with osteoarthritis or
  rheumatoid arthritis in a double-blind
  randomized study experienced a
  reduction in pain after two week of
  treatment (Deal et al., 1991).
• A two-arm, double-blind, placebo-
  controlled, crossover study found
  topical capsaicin cream decreases
  postsurgical neuropathic pain to a 3
  to 1 margin over placebo. There
  were some toxicities (Ellison et al.,
• A vehicle controlled, double-blind,
  multicenter study found 0.075%
  capsaicin cream is safe and effective
  in treating painful diabetic neuropathy
  (Treatment of Painful Diabetic
  Neuropathy with Topical Capsaicin,
• In a 12-week, double-blind, placebo-
  controlled randomized study of
  capsaicin cream on distal painful
  polyneuropathy found no difference
  between capsaicin cream and the
  placebo (Low et al., 1995).
                                                                        • In a double-blind, randomized,
                                                                          placebo-controlled multicenter parallel
                                                                          group study, treatment of low back
                                                                          pain with capsicum plaster was
                                                                          statistically and clinically beneficial
                                                                          compared to a placebo (Frerick et al.,
                                                                          2003). Type II, B
                                                                        • Meta-analysis found capsaicin cream
                                                                          to be effective in easing pain
                                                                          associated with diabetic neuropathy
                                                                          and osteoarthritis. Capsaicin’s
                                                                          effectiveness may be attributed to
                                                                          placebo effects (Zhang & Li Wan Po,
• Chamomile        • Skin and mucous           • Oral: 2-8 grams of     • Chamomile extract spray does not          • Has a Generally Recognized as Safe
  (matricaria        membrane                    the dried flower         significantly ameliorate pain               status for food use in the US (Natural
  recutita)          inflammations,              head (Natural            associated with post-operative sore         Medicine Comprehensive Database,
• Also known as:     irritations of the          Medicine                 throat (Kyokong et al., 2002).              2003)
  Cammilla,          respiratory tract (The      Comprehensive                                                      • Generally safe when consumed in
  Kamillen, Pin      Complete German             Database, 2003)                                                      amounts commonly found in foods
  Heads,             Commission E              • Topical: Used as a                                                   (Natural Medicine Comprehensive
  Camomilla,         Monographs:                 rinse. No known                                                      Database, 2003)
  Allemande,         Therapeutic Guide to        typical dosage                                                     • Theoretically, large doses may increase
  Manzanilla         Herbal Medicines,         • Tea: Steep 3                                                         the risk of bleeding when used with
                     1998)                       grams in 150 mL                                                      anticoagulants (Nutrition in Cancer
                   • Reduces                     boiling water for 5-                                                 Care, 2004)
                     gastrointestinal            10 minutes                                                         • Theoretically, may increase additive
                     spasms and                  (Natural Medicine                                                    and side effects of benzodiazepines
                     inflammatory diseases       Comprehensive                                                        (Nutrition in Cancer Care, 2004)
                     of the gastrointestinal     Database, 2003)
                     tract (The Complete
                     German Commission
                     E Monographs:
                     Therapeutic Guide to
                     Herbal Medicines,
                   • Antispasmodic for
                     menstrual cramps
                     (The Complete
                     German Commission
                      E Monographs:
                      Therapeutic Guide to
                      Herbal Medicines,
• Cinnamon          • Improve appetite (The     • Oral: 2-4 grams of     • No published research related to pain   • Has a Generally Recognized as Safe
  (Cinnamomum)        Complete German             cinnamon bark                                                      status for food use in the US (Natural
• Also known as:      Commission E                (Natural Medicine                                                  Medicine Comprehensive Database,
  Cinnamon bark,      Monographs:                 Comprehensive                                                      2003)
  Batavia cassia,     Therapeutic Guide to        Database, 2003)                                                  • Likely safe when consumed in amounts
  Ceylon              Herbal Medicines,         • Topical: No known                                                  commonly found in foods and possibly
  Cinnamon,           1998)                       typical dosage                                                     safe when used orally and appropriately
  Panang            • Treat dyspepsia,          • Tea: 0.5-1 grams                                                   in amounts slightly greater than those
  Cinnamon,           abdominal pain,             of the bark in 150                                                 found in food (Natural Medicine
  Saigon              nausea, and other           mL of boiling                                                      Comprehensive Database, 2003)
  Cinnamon            digestive complaints        water, for 5-10                                                  • Might interfere with antacids (Natural
                      (Koenig, 2003)              min., then strain                                                  Medicine Comprehensive Database,
                    • Thought to be,              (Natural Medicine                                                  2003)
                      antispasmodic,              Comprehensive
                      antiflatulent,              Database, 2003)
                      antimicrobial, and
                      anthelmintic (Natural
                      Database, 2003)
• Cloves            • Used for                  • Oral: 120-300 mg,      • No published research related to pain   • Has a Generally Recognized as Safe
  (Syzgium            gastrointestinal upset,     limit ingestion to                                                 status for food use in the US (Natural
  aromaticum)         including flatulence,       3.6 mg/kg clove oil                                                Medicine Comprehensive Database,
• Also known as:      nausea, and vomiting        per day (Natural                                                   2003)
  Clove,              (Natural Medicine           Medicine                                                         • Likely safe when consumed in amounts
  Caryophylli,        Comprehensive               Comprehensive                                                      commonly found in food and possibly
  Caryophyllus,       Database, 2003)             Database, 2003)                                                    safe when taken orally in higher doses
  Clous de          • Reduces inflammatory      • Topical:                                                           for medicinal purposes (Natural
  Girolfe, Flores     changes of the oral         Commonly used in                                                   Medicine Comprehensive Database,
  Caryophyllum        and pharyngeal              mouthwash, 15%                                                     2003)
                      mucosa (The                 clove tincture can                                               • May be irritating to respiratory tract
                      Complete German             treat athletes’ foot                                               when smoked (clove cigarettes)
                      Commission E                (Natural Medicine                                                  (Natural Medicine Comprehensive
                      Monographs:                 Comprehensive                                                      Database, 2003)
                      Therapeutic Guide to        Database, 2003)                                                  • Concomitant use of anticoagulants and
                       Herbal Medicines,                                                                               antiplatelets could theoretically increase
                       1998)                                                                                           the risk of bleeding and the effects of
                     • Counterirritant for pain                                                                        these drugs (Natural Medicine
                       (The Complete                                                                                   Comprehensive Database, 2003)
                       German Commission
                       E Monographs:
                       Therapeutic Guide to
                       Herbal Medicines,
                     • Used for toothache or
                       mouth and throat
                       inflammation (The
                       Complete German
                       Commission E
                       Therapeutic Guide to
                       Herbal Medicines,
• Cod-liver Oil      Used for hyperlipidemia,     • Oral: For lowering    • n-3 polyunsaturated fatty acids           • Likely safe when used orally and
Also known as: n-    hypertriglyceridemia,          triglycerides, 20       directly attenuate the neuronal and         appropriately (Natural Medicine
3 Fatty Acids,       hypertension, coronary         mL a day. For           glial process that underlie neuropathic     Comprehensive Database, 2003)
Cod Oil, Fish Oil,   heart disease,                 lowering blood          and inflammatory pain (Shapiro,           • Increased risk of bleeding when used
Liver Oil, Omega-    osteoarthritis, and            pressure, 20 mL a       2003).                                      with anticoagulants/antiplatelet drugs
3 Fatty Acids,       systemic lupus                 day (Natural          • People with musculoskeletal pain            (Natural Medicine Comprehensive
Polyunsaturated      erythematosus (Natural         Medicine                experience less pain if they take cod       Database, 2003)
Fatty Acids          Medicine                       Comprehensive           liver oil (Eriksen, Sandvik, &            • Decreased effectiveness of antidiabetes
                     Comprehensive                  Database, 2003)         Bruusgaard, 1996).                          drugs (Natural Medicine
                     Database, 2003)                                      • Cod liver oil as supplement to NSAID        Comprehensive Database, 2003)
                                                                            therapy in treating osteoarthritis        • May have additive effects on
                                                                            showed no significant benefit vs            antihypertensive drugs (Natural
                                                                            placebo (Stammers, Sibbald, &               Medicine Comprehensive Database,
                                                                            Freeling, 1992).                            2003)
                                                                                                                      • May cause nosebleeds, halitosis, and
                                                                                                                        heartburn (Natural Medicine
                                                                                                                        Comprehensive Database, 2003)
• Devil’s Claw       • Used to treat joint pain   • Oral: To stimulate    • Devil’s Claw lacks the anti-              • Possibly safe when used orally and
  (Harpagophytu        and inflammation             appetite, 1.5           inflammatory properties possessed by        appropriately for short term. Well
  m procumbens)        (Skidmore-Roth L,            grams of root per       NSAIDS (Whitehouse, Znamirowska,            tolerated for up to 16 weeks (Natural
                       2004)                        day: 1-4.5 grams        & Paul, 1983). Type II, B                   Medicine Comprehensive Database,
                                                    of root per day for                                                 2003)
                   • Loss of appetite,             other uses           • Devil’s Claw extract is effective in      • May decrease blood glucose levels in
                     dyspepsia, supportive       • Tea: 4.5 grams in      treating pain associated with arthrosis     diabetes (Natural Medicine
                     therapy of                    300 mL water           of the hip or knee (Wegener & Lupke,        Comprehensive Database, 2003)
                     degenerative disorders        boiled for 8 hours     2003).                                    • May increase bile production in
                     of the musculoskeletal                             • Effective in treatment of slight to         gallstones patients (Natural Medicine
                     system (The Complete                                 moderate muscular pain (Gobel et al.,       Comprehensive Database, 2003)
                     German Commission                                    2001) Type II, B                          • Adversely effects acid-inhibiting drugs,
                     E Monographs:                                      • Effective in treatment of chronic non-      blood pressure therapy, and cardiac
                     Therapeutic Guide to                                 radicular back pain (Laudahn &              drugs (Natural Medicine
                     Herbal Medicines,                                    Walper, 2001).                              Comprehensive Database, 2003)
                     1998)                                                                                          • Orally, devil’s claw is well tolerated.
                                                                                                                      Most common adverse effect is
                                                                                                                      diarrhea (Natural Medicine
                                                                                                                      Comprehensive Database, 2003)
• Dong Quai        • Used primarily for          • Oral: 3-4 grams      • No published research related to pain     • Orally, dong quai is well-tolerated
  (Angelica          gynecological ailments        daily with meals                                                   (Natural Medicine Comprehensive
  sinensis)          including menstrual           (Natural Medicine                                                  Database, 2003)
• Also known as:     cramps, irregularity,         Comprehensive                                                    • Theoretically, may increase effects of
  Chines             retarded flow,                Database, 2003)                                                    warfarin and may potentiate the effects
  Angelica, Dang     weakness during the         • Tea: Extract of                                                    of other anticoagulants and antiplatelet
  Gui, Dong Qua,     menstrual period, and         dong quai in a                                                     drugs (Nutrition in Cancer Care, 2004;
  Dong-Quai,         symptoms of                   dose of 1 mL three                                                 Paice et al., 2000)
  Tang Kuei, Tan     menopause (Natural            times daily                                                      • Interacts with hormone sensitive
  Kue Bai Zhi        Medicine                      (Natural Medicine                                                  cancers/conditions, especially for
                     Comprehensive                 Comprehensive                                                      women with hormone sensitive
                     Database, 2003)               Database, 2003)                                                    conditions (Natural Medicine
                   • It is also used orally as                                                                        Comprehensive Database, 2003)
                     a “blood purifier” to
                     manage hypertension,
                     rheumatism, ulcers,
                     anemia, and
                     constipation (Natural
                     Database, 2003)
• Echinacea        • Supportive therapy for      • Oral: Varying        • No published research related to pain     • Orally, echinacea is usually well
  (echinacea         colds and chronic             dosages for                                                        tolerated (Natural Medicine
  angustifolia)      infections of the             various illnesses                                                  Comprehensive Database, 2003)
• Also known as:     respiratory tract and         (Natural Medicine                                                • Has been used safely in trials lasting up
  American Cone      lower urinary tract           Comprehensive                                                      to 12 weeks when used topically and
 Flower, Indian        (The Complete               Database, 2003)                                                      appropriately (Natural Medicine
 Head, Purple          German Commission         • Topical: Semi-solid                                                  Comprehensive Database, 2003)
 Cone Flower,          E Monographs:               preparation                                                        • Theoretically, may interfere with
 Black Sampson,        Therapeutic Guide to        containing at least                                                  immunosuppressive therapy (Nutrition
 Kansas                Herbal Medicines,           15% pressed juice                                                    in Cancer Care, 2004)
 Snakeroot, Red        1998)                       of Echinacea                                                       • May experience allergic reactions,
 Sunflower           • Externally for poorly       purpurea herb                                                        fever, nausea, vomiting, unpleasant
                       healing wounds and        • Tea: Prepared by                                                     taste, abdominal pain, diarrhea, sore
                       chronic ulcerations         pouring 8 oz. of                                                     throat, and dizziness (Natural Medicine
                       (The Complete               boiling water over                                                   Comprehensive Database, 2003)
                       German Commission           a tea bag and                                                      • Theoretically may increase
                       E Monographs:               steeping for 10-15                                                   hepatotoxicity risk when co-
                       Therapeutic Guide to        minutes (Natural                                                     administered with acetaminophen
                       Herbal Medicines,           Medicine                                                             (Paice et al., 2000)
                       1998)                       Comprehensive
                     • Also used for               Database, 2003)
                       migraines, dyspepsia,
                       pain, and dizziness
                       (Natural Medicine
                       Database, 2003)
• Epsom Salt         • Used for treating and     • Oral, topical, or      • Infusion may be used as an adjunct        • Likely safe when used orally and
  (Magnesium)          preventing                  parenteral               for reducing analgesic consumption          appropriately.
• Also know as:        hypomagnesemia,           • Dosages are very         after spinal anaesthesia (Apan et al.,    • Parenteral magnesium sulfate is a FDA-
  Chelated             may also be used            illness specific and     2004).                                      approved prescription product (Natural
  Magnesium,           orally as a laxative or     varies (Natural        • Use as an adjuvant analgesic in             Medicine Comprehensive Database,
  Magnesium            for treating symptoms       Medicine                 patients undergoing open                    2003)
  Sulfate, Milk of     of asthma (Natural          Comprehensive            cholecystectomy resulted in better        • Interacts with malabsorption
  Magnesia             Medicine                    Database, 2003)          pain relief during first postoperative      syndromes, renal disease, excretion-
                       Comprehensive             • Tea: Steep 4.5           hour but did not significantly decrease     enhancing/reducing drugs, and skeletal
                       Database, 2003)             grams of root in         postoperative morphine requirement          muscle relaxants (Natural Medicine
                     • Reduces swelling,           300 mL boiled            (Bhatia et al., 2004).                      Comprehensive Database, 2003)
                       muscle ache, and pain       water for 8 hours      • Using a rat model, magnesium              • Orally, magnesium can cause
                       resulting from bruised      at room                  amplifies the analgesic effect of low-      gastrointestinal irritation, nausea,
                       or irritated tissues        temperature and          dose morphine in conditions of              vomiting, and diarrhea (Natural
                       (Koenig, 2003)              then strain              sustained pain (Begon et al., 2002).        Medicine Comprehensive Database,
                     • Topically, used for         (Natural Medicine      • Found magnesium can be an                   2003)
                       treating infected skin      Comprehensive            adjuvant for perioperative analgesic
                       ulcers (Natural             Database, 2003)          management to reduce perioperative
                       Medicine                                             pain (Kara et al., 2002).
                      Comprehensive                                   • For patients with chronic limb pain,
                      Database, 2003)                                   the addition of magnesium to a Bier’s
                    • Reduce neuropathic                                block with lignocaine improves and
                      and other pain when                               prolongs pain relief (Tramer & Glynn,
                      pure magnesium is                                 2002).
                      used IV                                         • The addition of magnesium sulfate to
                                                                        the opioid fentanyl prolonged
                                                                        analgesia with no increase of side
                                                                        effects (Buvanendran et al., 2002).
                                                                      • 500-mg and 1-g bolus doses of IV
                                                                        magnesium were well tolerated and
                                                                        potentially effective in patients with
                                                                        neuropathic pain due to cancer
                                                                        (Crosby, Wilcock, & Corcoran, 2000).
• Gamma             • Rheumatoid arthritis,   • Oral: For             • Control group, placebo study found        • Appears safe when taken in oral doses
  Linolenic Acid      hyperlipidemia, heart     rheumatoid              GLA may produce mild improvement            of 2.8 grams per day or less for up to a
  (Octadeca-          disease, syndrome-X,      arthritis 1.1 grams     in rheumatoid arthritis, but the            year (Natural Medicine Comprehensive
  6,9,12-trienoic     systemic sclerosis,       daily, for diabetic     placebo, olive oil, may have                Database, 2003)
  acid)               diabetic neuropathy,      neuropathy 360 to       unrecognized benefits (Brzeski,           • May interact with herbs that have
• Also known as:      and cancer prevention     480 mg per day,         Madhok, & Capell, 1991).                    coumarin constituents or affect platelet
  Gamolenic           (Natural Medicine         for hyperlipidemia    • Meta-analysis of a small number of          aggregation to theoretically increase the
  Acid, GLA           Comprehensive             1.5-6 grams daily       studies suggests that GLA is effective      risk of bleeding (Natural Medicine
                      Database, 2003)           (Natural Medicine       treatment for rheumatoid arthritis          Comprehensive Database, 2003)
                    • Also used for ADHD,       Comprehensive           patients (Rothman, DeLuca, & Zurier,      • Taking with other anticoagulants or
                      depression,               Database, 2003)         1995).                                      antiplatelet drugs might increase risk of
                      postpartum                                      • A review of 11 studies found there is       bruising and bleeding (Natural Medicine
                      depression, chronic                               some potential benefit for the use of       Comprehensive Database, 2003)
                      fatigue syndrome                                  GLA in rheumatoid arthritis. More
                      (Natural Medicine                                 studies on dosage and duration are
                      Comprehensive                                     needed (Little & Parsons, 2001).
                      Database, 2003)                                 • Meta-analysis found moderate
                                                                        support for GLA for reducing pain,
                                                                        tender joint count and stiffness. In
                                                                        general, GLA herbal medicines were
                                                                        relatively safe to use (Soeken, Miller,
                                                                        & Ernst, 2003).
• Ginger            • Motion sickness,        • Oral: 550-1100 mg     • Extract as effective as placebo during    • Has Generally Recognized as Safe
  (Zingiber           nausea, dyspepsia,        three times daily       first three months of study, but at end     Status in the US (Altman & Marcussen,
  Officinale)         flatulence,               (Natural Medicine       of 6 months, extract group                  2001)
                      chemotherapy-induced      Comprehensive           experienced better relief from pain
• Also known as:      nausea (Natural              Database, 2003)         associated with symptomatic                • Usually well tolerated when used in
  African Ginger,     Medicine                   • Topical: No typical     gonarthritis (Wigler et al., 2003).          typical doses (Altman & Marcussen,
  Black Ginger,       Comprehensive                dosage                • Randomized, placebo-controlled,              2001)
  Gingembre,          Database, 2003)                                      cross-over study found no difference       • Theoretically, may increase the risk of
  Ginger Root,      • Can be used for                                      between ginger extract and a placebo         bleeding, or interfere with diabetic,
  Zingiberis          treating thermal burns                               in treating osteoarthritis of the hip or     cardiac, therapy for heart conditions
  rhizoma             (Natural Medicine                                    knee. Ibuprofen was significantly            and acid-inhibiting drugs (Altman &
                      Comprehensive                                        more effective than ginger extract           Marcussen, 2001)
                      Database, 2003)                                      (Bliddal et al., 2000).
                    • The essential oil of                               • Randomized, double-blind, placebo-
                      ginger is used topically                             controlled, 6-week study found highly
                      as an anlgesic (Natural                              purified ginger extract had a
                      Medicine                                             statistically significant effect of
                      Comprehensive                                        reducing pain in patients with
                      Database, 2003)                                      osteoarthritis of the knee compared to
                                                                           a control group that received a
                                                                           placebo (Altman & Marcussen, 2001).
• Ginkgo Biloba     • Used as an antitussive     • Oral: 120-240 mg      • A study of rats looked at several          • May increase bleeding with NSAIDS
  (Ginkgo biloba)     and expectorant              ginkgo tablets or       models of nociceptive pain, tail-            (Abebe, 2002), acetaminophen (Abebe,
• Also known as:      (Altman & Marcussen,         capsules in 2 or 3      electric stimulation assay, and              2002), dipyridamole, and warfarin
  Baiguo, Fossil      2001)                        divided doses           capsaicin-induced paw licking, results       (Nutrition in Cancer Care, 2004)
  Tree, Ginkyo,     • Fatigue (The Complete        (Altman &               suggest Ginkgo biloba extract may be       • Ginkgo fruit and pulp can cause
  Yinhsing, Kew       German Commission            Marcussen, 2001)        of clinical value as an anti-                redness of the mouth, rectal burning,
  Tree,               E Monographs:                                        inflammatory and analgesic alone or          and painful anal sphincter spasms
                      Therapeutic Guide to                                 in conjunction with NSAIDs (Abdel-           (Natural Medicine Comprehensive
                      Herbal Medicines,                                    Salam et al., 2004).                         Database, 2003)
                      1998)                                                                                           • May increase blood pressure when
                    • Thought to increase                                                                               used with thiazide diuretics (Nutrition in
                      blood flow to the brain                                                                           Cancer Care, 2004)
                      and to treat/prevent                                                                            • Reportedly causes seizures (Natural
                      Alzheimer’s/dementia                                                                              Medicine Comprehensive Database,
                                                                                                                      • Theoretically, might interfere with the
                                                                                                                        effectiveness of anticonvulsants
                                                                                                                        (Natural Medicine Comprehensive
                                                                                                                        Database, 2003)
                                                                                                                      • Can cause coma when combined with
                                                                                                                        trazodone (Hu et al., 2005)
• Ginseng           • For symptomatic            • Oral: 0.25-0.5        • No published research related to pain      • No adverse reactions have been
  (Panax             treatment of: memory       grams of the root 2                                                 reported specifically with the use of
  quinquefolius)     deficits, disturbances     times daily                                                         American ginseng (Natural Medicine
• Also known as:     in concentration,          (Natural Medicine                                                   Comprehensive Database, 2003)
  American           depressive emotional       Comprehensive                                                     • Expected to increase risk of bleeding if
  Ginseng, Ren       condition, dizziness,      Database, 2003)                                                     taken with NSAIDS (Abebe, 2002)
  Shen, Sang,        and headache (The                                                                            • Varying dosages for various illnesses
  Red Berry          Complete German                                                                                (Natural Medicine Comprehensive
                     Commission E                                                                                   Database, 2003)
                     Monographs:                                                                                  • May interfere with antipsychotic drugs,
                     Therapeutic Guide to                                                                           hormones, MAOIs (Nutrition in Cancer
                     Herbal Medicines,                                                                              Care, 2004)
                     1998)                                                                                        • Ginseng may diminish the effect of
                   • Increase physical                                                                              immunosuppressants (Skidmore-Roth
                     endurance and lessen                                                                           L, 2004)
                     fatigue, to improve                                                                          • May cause anxiety, insomnia,
                     ability to cope with                                                                           restlessness, headache (Skidmore-
                     stress (Skidmore-Roth                                                                          Roth L, 2004)
                     L, 2004)                                                                                     • May reduce concentration of blood
                                                                                                                    alcohol(Lee, 1987; Lee, 1993) and
                                                                                                                    warfarin (Hu et al., 2005)
                                                                                                                  • May reduce opioid-induced analgesia
                                                                                                                    (Abebe, 2002)
                                                                                                                  • May induce mania when used
                                                                                                                    concomitantly with phenelzine (Hu et
                                                                                                                    al., 2005)
• Japanese Mint    • Orally to reduce          • Oral: 3-6 drops of     • No published research related to pain   • Possibly safe when the oil is used orally
  (Mentha            flatulence (Natural         oil daily (Natural                                                 or topically and appropriately (Natural
  arvensis)          Medicine                    Medicine                                                           Medicine Comprehensive Database,
• Also known as:     Comprehensive               Comprehensive                                                      2003)
  Brook mint,        Database, 2003)             Database, 2003)                                                  • May worsen bronchial spasms,
  Chinese Mint     • Topically, for            • Topically: Rub                                                     gallbladder conditions, or liver disease
  Oil, Cornmint      musculoskeletal or          several drops of oil                                               (Natural Medicine Comprehensive
  Oil, Minzol        neuropathic pain,           in affected areas                                                  Database, 2003)
                     pruritus, and urticaria     of skin (Natural                                                 • No known interactions with drugs
                     (Natural Medicine           Medicine                                                           (Natural Medicine Comprehensive
                     Comprehensive               Comprehensive                                                      Database, 2003)
                     Database, 2003)             Database, 2003)                                                  • Can cause upset stomach when taken
                                               • Inhalation: 3-4                                                    orally (Natural Medicine
                                                 drops of oil in hot                                                Comprehensive Database, 2003)
                                                  water (Natural
                                                  Database, 2003)

• Kava Kava         • Treat anxiety              • Oral: 100 mg 3       • No published research related to pain   • Taken orally, may induce hepatotoxicity
  (Piper              disorders, stress,           times a day                                                      and liver failure (Natural Medicine
  methysticum)        insomnia, and                (Natural Medicine                                                Comprehensive Database, 2003;
• Also known as:      restlessness (Natural        Comprehensive                                                    Nutrition in Cancer Care, 2004)
  Ava, Ava            Medicine                     Database, 2003)                                                • Banned in Switzerland, Germany, and
  Pepper, Awa         Comprehensive              • Tea: 2-4 grams in                                                Canada (Natural Medicine
  Root, Kava,         Database, 2003)              150 mL boiling                                                   Comprehensive Database, 2003)
  Yagona            • Orally, for depression,      water for 5-10                                                 • Decreases platelets, lymphocyte,
                      headaches, common            minutes, then                                                    bilirubin, protein, increased red blood
                      cold, cancer                 strain (Natural                                                  cell volume (Skidmore-Roth L, 2004)
                      prevention, and              Medicine                                                       • Adverse interactions with alprazolam, ,
                      musculoskeletal pain         Comprehensive                                                    hepatotoxic drugs, and levodopa
                      (Natural Medicine            Database, 2003)                                                  (Natural Medicine Comprehensive
                      Comprehensive                                                                                 Database, 2003)
                      Database, 2003)                                                                             • Given hepatotoxic affects, avoid
                                                                                                                    concurrent use with acetaminophen
                                                                                                                    (Natural Medicine Comprehensive
                                                                                                                    Database, 2003) .
                                                                                                                  • Expected to enhance CNS
                                                                                                                    depression/sedation caused by opoids
                                                                                                                    (Natural Medicine Comprehensive,
• Ma Huang          • Used for weight loss       • Oral: 15-20 mg of    • No published research related to pain   • FDA recently banned ephedra
  (Ephedra            and enhancing athletic       ephedrine taken                                                  (1/1/2004)
  distachya)          performance (Natural         up to three times                                              • Increases toxicity with beta-blockers,
• Also known as:      Medicine                     daily (Natural                                                   monoamine oxidase inhibitors, caffeine,
  Ephedra, Cao        Comprehensive                Medicine                                                         and St. John’s Wort (Nutrition in Cancer
  Mahuang,            Database, 2003)              Comprehensive                                                    Care, 2004)
  Herbal Ecstasy,   • Also used for allergies,     Database, 2003)                                                • Side effects-insomnia, motor
  Sea Grape           allergic rhinitis,         • Tea: 1-4 grams in                                                restlessness, irritability, headaches,
                      respiratory tract            150 mL boiling                                                   nausea, vomiting, disturbances of
                      conditions, colds, flu,      water for 5-10                                                   urination, tachycardia; in high doses,
                      fever, headache, joint       minutes and then                                                 increase in blood pressure, cardiac
                      and bone pain (Natural       straining (Natural                                               arrhythmia, herb dependency (The
                      Medicine                     Medicine
                     Comprehensive                Comprehensive                                                     Complete German Commission E
                     Database, 2003)              Database, 2003)                                                   Monographs: Therapeutic Guide to
                                                                                                                    Herbal Medicines, 1998)
                                                                                                                  • Reports of serious life-threatening or
                                                                                                                    debilitating adverse effects, psychosis,
                                                                                                                    and hepatitis (Natural Medicine
                                                                                                                    Comprehensive Database, 2003)
• Mustard           • Topically, used as a       • Topical: Prepare a   • No published research related to pain   • Has Generally Recognized as Safe
  (Brassica)          poultice for bronchial       mustard plaster;                                                 (GRAS) status in the US (Natural
                      pneumonia, pleurisy,         100 grams of                                                     Medicine Comprehensive Database,
                      arthritis, lumbago,          mustard flour                                                    2003)
                      aching feet,                 mixed with warm                                                • Can irritate asthma, and the GI tract
                      rheumatism, and as a         water to make a                                                  (Natural Medicine Comprehensive
                      counterirritant (Natural     paste. Put                                                       Database, 2003)
                      Medicine                     mustard paste into                                             • Orally, large amounts of black mustard
                      Comprehensive                a linen and apply                                                seed can lead to vomiting, stomach
                      Database, 2003)              for 10 minutes                                                   pain, diarrhea, somnolence, cardiac
                    • To treat inflammation        (Natural Medicine                                                failure, breathing difficulties, coma, and
                      and joint pain               Comprehensive                                                    possibly death (Natural Medicine
                      (Skidmore-Roth L,            Database, 2003)                                                  Comprehensive Database, 2003)
                      2004)                      • Orally: No known
                                                   suggested dose
                                                   (Natural Medicine
                                                   Database, 2003)
• Oil of            • Topically, wintergreen     • Topical: Apply as    • No published research related to pain   • Symptoms of toxicity include tinnitus,
  Wintergreen         oil is used as a             gels, lotion, or                                                 nausea, and vomiting (Natural Medicine
  (Gaultheria         counterirritant for          ointments 3-4                                                    Comprehensive Database, 2003)
  Proxumbens)         musculoskeletal pain         times daily                                                    • May aggravate gastrointestinal
• Also known as:      and as an antiseptic         (Natural Medicine                                                inflammation, and increases INR and
  Boxberry,           (Natural Medicine            Comprehensive                                                    bleeding if used with warfarin (Natural
  Canada Tea,         Comprehensive                Database, 2003)                                                  Medicine Comprehensive Database,
  Deerberry,          Database, 2003)            • Orally: No known                                                 2003)
  Mountain Tea,     • May be useful in the         suggested dose                                                 • Likely unsafe when used orally for
  Partridge Berry     treatment of                 (Natural Medicine                                                medicinal purposes (Natural Medicine
                      neuropathic pain             Comprehensive                                                    Comprehensive Database, 2003)
                      (Skidmore-Roth L,            Database, 2003)
• St. John’s Wort   • Depressive moods,          • Oral: for mild       • Found no significant effect of St.      • Likely safe when used orally and
  (Hypericum          anxiety and/or nervous       depression, 300        John’s Wort on painful                    appropriately, short term for up to 8
  perforatum)        unrest (The Complete       mg three times      polyneuropathy or measures of pain        weeks (Natural Medicine
• Also known as:     German Commission          daily (Natural      processing (Sindrup et al., 2001).        Comprehensive Database, 2003)
  Amber, Demon       E Monographs:              Medicine                                                    • May cause serotonin syndrome when
  Chaser,            Therapeutic Guide to       Comprehensive                                                 used with some selective serotonin
  Goatweed,          Herbal Medicines,          Database, 2003)                                               reuptake inhibitors (Nutrition in Cancer
  Tipton Weed,       1998)                    • For long-term                                                 Care, 2004)
  Hypericum,       • No studies have yet        maintenance                                                 • Increases the effects of triptans and
  Millepertuis,      examined the effects       therapy, 300-600                                              opioids (Natural Medicine
  Johns Wort         of St. John’s wart on      mg have been                                                  Comprehensive Database, 2003)
                     chronic pain in the        used (Natural                                               • Decreases the effects of amitriptyline,
                     absence of depression      Medicine                                                      barbiturates, digoxin, irinotecan, and
                     (Koenig, 2003)             Comprehensive                                                 protease inhibitors (Natural Medicine
                   • Also used for              Database, 2003)                                               Comprehensive Database, 2003)
                     dysthymia, exhaustion,                                                                 • Increase side effects of
                     fibrositis, headache,                                                                    antidepressants, cyclosporine,
                     heart palpitations,                                                                      nefazodone, paroxetine, and sertraline
                     muscle pain, OCD,                                                                        (Natural Medicine Comprehensive
                     and neuralgia (Natural                                                                   Database, 2003)
                     Medicine                                                                               • Side effects can include insomnia,
                     Comprehensive                                                                            restlessness, anxiety, irritability, fatigue,
                     Database, 2003)                                                                          headache (Natural Medicine
                                                                                                              Comprehensive Database, 2003)
                                                                                                            • Avoid with all concurrent chemotherapy
                                                                                                            • May decrease blood concentrations of
                                                                                                              cyclosporine, midazolam, tacrolimus,
                                                                                                              amitriptyline, indinavir, warfarin,
                                                                                                              phenprocoumon and theophylline (Hu
                                                                                                              et al., 2005)
                                                                                                            • May cause breakthrough bleeding and
                                                                                                              unplanned pregnancy when used
                                                                                                              concomitantly with oral contraceptives
                                                                                                              (Hu et al., 2005)
• White Willow     • Diseases                 • Oral: 1-3 grams    • Willow bark extract may be a useful    • Possibly safe when used orally and
  (Salix alba),      accompanied by fever,      dried bark 3-4       and safe treatment for low back pain     appropriately, short term (Natural
• Also known as:     rheumatic ailments,        times (Natural       (Chrubasik et al., 2000).                Medicine Comprehensive Database,
  Willow Bark,       headaches (The             Medicine           • No efficacy shown for use of willow      2003)
  Bay Willow,        Complete German            Comprehensive        bark extract in treatment of osteo-    • Theoretically, may interact with kidney
  Reifweide,         Commission E               Database, 2003)      and rheumatoid arthritis (Biegert et     or liver dysfunction and an
  Violet Willow      Monographs:              • Tea: 1-3 grams       al., 2004).                              anticoagulant/antiplatelets and oral
                     Therapeutic Guide to
                      Herbal Medicines,         bark in 150 mL of                                                 drugs (Natural Medicine
                      1998)                     boiling water, then                                               Comprehensive Database, 2003)
                    • For pain caused by        strain (Natural                                                 • Salicylates are part of the compound
                      inflammation, muscles,    Medicine                                                          that makes up aspirin
                      and joint aches           Comprehensive
                      (Natural Medicine         Database, 2003)
                      Database, 2003)
 • Yohimbe          • Used to treat            • Oral: 15-30 mg                                        • Not recommended because of
                                                                      • No published research related to pain
   (Pausinystalia     impotence, fatigue,        daily (Natural                                          insufficient proof of efficacy and
   yohimbe)           hypertension, diabetic     Medicine                                                significant adverse effects (The
 • Also known as:     neuropathy, and            Comprehensive                                           Complete German Commission E
   Johimbi,           postural hypotension       Database, 2003)                                         Monographs: Therapeutic Guide to
   Yohimbehe,         (Natural Medicine                                                                  Herbal Medicines, 1998)
   Yohimbine          Comprehensive                                                                    • Decreases effects of antidepressants,
                      Database, 2003)                                                                    antihypertensives, hyperglycemic
                                                                                                         agents, and monoamine oxidase
                                                                                                         inhibitors (Nutrition in Cancer Care,
                                                                                                       • Can cause excitation, tremor, insomnia,
                                                                                                         anxiety, hypertension, tachycardia,
                                                                                                         dizziness, gastric intolerance,
                                                                                                         salivation, sinusitis, irritability,
                                                                                                         headache, urinary frequency, fluid
                                                                                                         retention, nausea, and vomiting
                                                                                                         (Natural Medicine Comprehensive
                                                                                                         Database, 2003)
                                                                                                       • Higher doses have significantly more
                                                                                                         adverse effects (Natural Medicine
                                                                                                         Comprehensive Database, 2003)
* This table includes only herbal supplements, dietary supplements or other forms of CAM therapy were not included.

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Description: The Use of Herbal Therapies to Relieve Pain Chamomile Extract