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Review advises herbal remedies for back pain

By Emma Wilkinson

Herbal medicines such as willow bark and devil's claw are

effective for treating low back pain and should be considered as 'the first course of action',

a new Cochrane review concludes.

Researchers found white willow bark (Salix alba) and devil's claw (Harpagophytum procumbens) were better than placebo and as good as 12.5mg rofecoxib for short-term or rescue treatment.

Topical preparations with cayenne (Capsicum frutescens) were also found to be more effective than placebo and similar in effectiveness to a homoeopathic gel.

But the researchers warned that the 10 trials they identified only looked at the herbal treatments in the short-term ­ for around four to six weeks ­ and more research was needed to assess long-term effectiveness.

Study leader Dr Joel Gagnier, postgraduate fellow in the faculty of medicine at the University of Toronto, Canada, said: 'For non-specific low back pain, standardised herbal medicine interventions, as described in our review, should be considered the first course of action.'

He added: 'There is no evidence for or against long-term use. GPs should be sure to check for any potential herb-drug interactions.'

Dr Peter Stott, member of the National Osteoporosis Society Scientific Committee and a GP in Tadworth, Surrey, said: 'These are not normally things that GPs prescribe but we can advise patients and patients will tell you they are taking this stuff.

'The most important thing for GPs to understand is whether there's any interaction with other medications.'

He added that it was likely that patients needed a range of approaches in order to manage back pain. 'These Cochrane reviews are very helpful because at least we can say to patients you are not doing any harm and you may be doing some good.'

Dr Graham Archard, vice-chair of the RCGP and a GP in Dorset, said: 'We still need further data. Having said that, as aspirin was found from a herbal product, it's hardly surprising that analgesic properties of other plant extracts will be found.'

Evidence for herbal benefits

Devil's claw

· A standardised daily dose of 50mg or 100mg harpagoside reduced pain more than placebo

· A standardised daily dose of 60mg had a similar effect to 12.5mg rofecoxib

White willow bark

· A standardised daily dose of 120mg and 240mg of salicin reduced pain more than placebo

· A standardised daily dose of 240mg reduced pain about the same as 12.5mg rofecoxib


In plaster form, it reduced pain more than placebo and to the same level as the homoeopathic gel Spiro or SLR

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