By: Brianna Choyce and Nicholas Micciche (Doctor of Pharmacy candidates – University of South Florida)

 

Back pain is the fifth most common healthcare complaint in the US, with 80% of Americans experiencing back pain at some point during their lifetime. Not only is back pain uncomfortable but it can affect exercise, sleep, and other daily activities as well as cost Americans almost $50 billion annually in treatment expenditures. An additional $100 billion is spent in indirect costs such as lost wages and family impact. With the high cost of physician visits and potential surgeries, many Americans resort to using traditional over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) to relieve their pain. NSAIDs, such as ibuprofen or naproxen, may offer temporary relief, but leave users with unwanted side effects such as stomach upset or constipation. These products may also prove harmful to the kidneys and/or liver with long-term use.  Many chronic pain sufferers are looking for a more natural approach to pain relief and supplements could be the answer.

 

Why is inflammation so harmful?

Health and science communities have identified chronic inflammation as one of the greatest contributors to disease and illness. Seemingly diverse health concerns including: migraines, skin conditions, depression, heart disease, cancer, certain autoimmune diseases, degenerative conditions of the brain, muscle, and skeletal systems, arthritis, diabetes, and pain can all be attributed at least in-part to inflammation.

 

Pain is classified as chronic if lasting longer than 12 weeks. Sometimes it may be the result of an injury or causative agent or it may occur for seemingly no reason at all. Chronic pain is very serious because it does more than just hurt. Persistent, unremitting pain has adverse effects on the body’s endocrine, immune, musculoskeletal, and neurological systems. When the body senses chronic pain, it will decondition and cease to perform the usual activity that is perceived to cause the pain. This can lead to serious complications such as muscle wasting, nerve deterioration and joint pain. Often times the body will compensate for the area of chronic pain, putting extra strain or workload on another area leading to even more inflammation. This chronic inflammation cycle can cause myopathies (muscle-related diseases), neuropathies (nerve-related diseases), and arthropathies (diseases of the joints).

 

What supplements will help with back pain?

 

Devil’s Claw

Devil’s claw, an herb from the African plant Harpagophytum procumbens, has been proven to reduce pain in several clinical trials.[1][2][4] Devil’s claw has also been shown to significantly reduce muscle stiffness without causing serious adverse effects.[2] Another study showed that Devil’s claw, when given twice daily for 8 weeks, significantly improved back pain symptoms and mobility of the affected sections of the spine.[3] Devil’s claw has proven effectiveness in treatment of osteoarthritis of the spine, hip, and knee as well as in chronic lower back pain.[4]

 

Willow Bark

Willow bark is an herbal medication that has been used throughout history for pain relief. During the age of Hippocrates, people chewed on willow bark to help relieve pain and fever. Willow bark has also proven to be effective in treating chronic lower back and joint pain, as well as osteoarthritis. Willow bark extracts are widely used in sports performance because of their anti-inflammatory and analgesic (pain relieving) properties. The mechanism by which willow bark exhibits its’ anti-inflammatory properties is not yet fully understood. It is hypothesized that willow bark aids in the down regulation of an inflammatory chemical in the body called tumor necrosis factor (TNF).[5] TNF is identified as a major factor in a multitude of diseases such as rheumatoid arthritis, psoriasis, and inflammatory bowel disease (IBD). A study was conducted to test the efficacy and safety of willow bark extract. Results showed that willow bark was effective and can be used as a supplemental therapy in long-term treatment of painful musculoskeletal disorders. It can also be combined with NSAIDs and/or opioids if needed.[6] White willow bark is also effective when used as a rescue medication for short-term or breakthrough pain.[1][7]

 

Turmeric

Turmeric, a member of the ginger family, is most widely recognized as a cooking spice traditionally used in South Asian and Middle Eastern dishes. While turmeric has its’ applications in culinary culture, turmeric has also been shown to have countless health benefits. Curcumin, the medicinal active ingredient in turmeric, has been shown to decrease inflammation, making it an attractive treatment option for back pain. Curcumin significantly reduces inflammatory chemicals, such as TNF and interleukins (IL), in the body.[8] A study comparing curcumin to ibuprofen for treatment of osteoarthritis produced surprising and monumental results. Curcumin was shown to be as effective as ibuprofen, with less risk of potential side effects.[9] Several randomized controlled trials are now supporting the overwhelming evidence that curcumin is efficacious in the treatment of arthritic pain and inflammation.[10]

 

Bromelain       

Bromelain, a naturally occurring enzyme found in pineapples, is a powerful anti-inflammatory that can help pain sufferers. Bromelain fights inflammation by preventing the formation of kinin, which acts on tissues to cause vasodilation and unwanted contractions of smooth muscle. It is by this mechanism that bromelain has been used successfully to reduce swelling and significantly reduce pain.[11] Bromelain was also compared with diclofenac, a prescription-only NSAID, and was shown to reduce the symptoms of mild-to-moderate osteoarthritis with equal efficacy. Pain, stiffness, and function scores were also improved with bromelain.[12] Not only is this promising for back pain sufferers, but other pain-associated conditions as well. Bromelain has proven to be effective in treating knee pain and Achilles tendon injury.[12][13]

 

Boswellia

Boswellia, also known as frankincense, is considered a super-herb due to its’ powerful anti-inflammatory properties. Boswellia has been proven to significantly increase the pain threshold and tolerance compared to placebo.[14] Supplementation with Boswellia significantly decreased pain and stiffness and improved function and walking distance in patients with osteoarthritis.[15][16] In addition to relieving back pain, Boswellia can help with arthritis, asthma, allergies, ulcerative colitis, and other inflammatory conditions.[17]

 

It is important to talk with your doctor or pharmacist before starting any new supplement to ensure that there are no interactions with your current medications or health conditions.

 

Resources:

1: Oltean H, et al. Herbal medicine for low-back pain. Cochrane Database Syst Rev. 2014 Dec 23;(12):CD004504. doi: 10.1002/14651858.CD004504.pub4. Review. PubMed PMID: 25536022.

2: Göbel H, Heinze A, Ingwersen M, Niederberger U, Gerber D. [Effects of Harpagophytum procumbens LI 174 (devil’s claw) on sensory, motor und vascular muscle reagibility in the treatment of unspecific back pain]. Schmerz. 2001 Feb;15(1):10-8. German. PubMed PMID: 11810324.

3: Laudahn D, Walper A. Efficacy and tolerance of Harpagophytum extract LI 174 in patients with chronic non-radicular back pain. Phytother Res. 2001 Nov;15(7):621-4. PubMed PMID: 11746846.

4: Gagnier JJ, Chrubasik S, Manheimer E. Harpagophytum procumbens for osteoarthritis and low back pain: a systematic review. BMC Complement Altern Med. 2004 Sep 15;4:13. Review. PubMed PMID: 15369596; PubMed Central PMCID: PMC520753.

5: Shara M, Stohs SJ. Efficacy and Safety of White Willow Bark (Salix alba) Extracts. Phytother Res. 2015 Aug;29(8):1112-6. doi: 10.1002/ptr.5377. Epub 2015 May 22. Review. PubMed PMID: 25997859.

6: Uehleke B, Müller J, Stange R, Kelber O, Melzer J. Willow bark extract STW 33-I in the long-term treatment of outpatients with rheumatic pain mainly osteoarthritis or back pain. Phytomedicine. 2013 Aug 15;20(11):980-4. doi: 10.1016/j.phymed.2013.03.023. Epub 2013 Jun 2. PubMed PMID: 23731658.

7: Bogduk N. Pharmacological alternatives for the alleviation of back pain. Expert Opin Pharmacother. 2004 Oct;5(10):2091-8. Review. PubMed PMID: 15461544.

8: Klawitter M, et al. Curcuma DMSO extracts and curcumin exhibit an anti-inflammatory and anti-catabolic effect on human intervertebral disc cells, possibly by influencing TLR2 expression and JNK activity. J Inflamm (Lond). 2012 Aug 21;9(1):29. doi: 10.1186/1476-9255-9-29. PubMed PMID: 22909087; PubMed Central PMCID: PMC3506446.

9: Ross SM. Turmeric (Curcuma longa): Effects of Curcuma longa Extracts Compared With Ibuprofen for Reduction of Pain and Functional Improvement in Patients With Knee Osteoarthritis. Holist Nurs Pract. 2016 May-Jun;30(3):183-6. doi: 10.1097/HNP.0000000000000152. PubMed PMID: 27078813.

10: Daily JW, Yang M, Park S. Efficacy of Turmeric Extracts and Curcumin for Alleviating the Symptoms of Joint Arthritis: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. J Med Food. 2016 Aug;19(8):717-29. doi: 10.1089/jmf.2016.3705. Review. PubMed PMID: 27533649; PubMed Central PMCID: PMC5003001.

11: Majid OW, Al-Mashhadani BA. Perioperative bromelain reduces pain and swelling and improves quality of life measures after mandibular third molar surgery: a randomized, double-blind, placebo-controlled clinical trial. J Oral Maxillofac Surg. 2014 Jun;72(6):1043-8. doi: 10.1016/j.joms.2013.12.035. Epub 2014 Jan 16. PubMed PMID: 24589242.

12: Kasemsuk T, Saengpetch N, Sibmooh N, Unchern S. Improved WOMAC score following 16-week treatment with bromelain for knee osteoarthritis. Clin Rheumatol. 2016 Oct;35(10):2531-40. doi: 10.1007/s10067-016-3363-1. Epub 2016 Jul 28. PubMed PMID: 27470088.

13: Aiyegbusi AI, Duru FI, Anunobi CC, Noronha CC, Okanlawon AO. Bromelain in the early phase of healing in acute crush Achilles tendon injury. Phytother Res. 2011 Jan;25(1):49-52. doi: 10.1002/ptr.3199. PubMed PMID: 20623610.

14: Prabhavathi K, Chandra US, Soanker R, Rani PU. A randomized, double blind, placebo controlled, cross over study to evaluate the analgesic activity of Boswellia serrata in healthy volunteers using mechanical pain model. Indian J Pharmacol. 2014 Sep-Oct;46(5):475-9. doi: 10.4103/0253-7613.140570. PubMed PMID: 25298573; PubMed Central PMCID: PMC4175880.

15: Belcaro G, et al. FlexiQule (Boswellia extract) in the supplementary management of osteoarthritis: a supplement registry. Minerva Med. 2014 Dec;105(6 Suppl 2):9-16. PubMed PMID: 26076376.

16: Cameron M, Chrubasik S. Oral herbal therapies for treating osteoarthritis. Cochrane Database Syst Rev. 2014 May 22;(5):CD002947. doi: 10.1002/14651858.CD002947.pub2. Review. PubMed PMID: 24848732; PubMed Central PMCID: PMC4494689.

17: Boswellia serrata. Monograph. Altern Med Rev. 2008 Jun;13(2):165-7. Review. PubMed PMID: 18590352.


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