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, 2003) • 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) 1998) • 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., 1997). • 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, 1991). • 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, 1994). • 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, 1998) • Antispasmodic for menstrual cramps (The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines, 1998) • 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) antidiarrheal, antimicrobial, and anthelmintic (Natural Medicine Comprehensive 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, 1998) • Used for toothache or mouth and throat inflammation (The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines, 1998) • 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 Medicine Comprehensive 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 Comprehensive 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, 2003) • 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 Medicine Comprehensive 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, 2003) • 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 Comprehensive 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) 2004) • 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) Comprehensive 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, 2004) • 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.