Herbal Supplements for Pain

Now that I’ve relocated my practice to Manhattan, I’ve noticed that many of my patients are interested in alternative options to conventional medical treatments. I love talking with people about these kinds of options because my priority is to develop a treatment plan that is right for each individual patient. If someone is really uncomfortable with taking conventional medications, and is going to go home and not fill their prescription (this happens!), it’s better that we’re on the same page to start and we can find a plan that will be a good fit.

I get asked a lot of questions about diet (which I’ll come back to in another post) and herbal supplements.  I thought it might be useful to go over some common herbs that are used for pain, and to review the evidence for their use.  

I have a few caveats before I get going with discussing some specific herbs.  First, there are very few high quality studies evaluating herbal supplements for pain.  By high quality, I mean large, randomized controlled trials, which take a lot of resources and time to set up, and require a lot of patients to be enrolled. To be perfectly honest, there’s less money to be made off of these types of therapies than developing a new drug, so the motivation just isn’t there to do a lot of these studies.  Second, you should treat an herbal supplement as you would any other medication. This means, telling everyone involved in your medical care that you are taking it so that they can monitor for interactions. We have a tendency to think that because something is “natural” it can’t have side effects. Not true! These herbs are biologically active in a variety of different ways, and some of them can interfere with other medications or be bad choices for patients with certain medical conditions.  

The herb I recommend the most for pain is turmeric, which is structurally related to ginger and used often in cooking (it is a main ingredient in curry). I actually recommend curcumin, which is the active pain relieving part of turmeric, so that patients get more benefit from the herb. Curcumin is an anti-inflammatory compound and probably has effects on COX-2, which is the same enzyme that a lot of traditional anti-inflammatory medications work on.  In a study that looked at curcumin vs. ibuprofen, it was essentially equivalent in terms of pain relief for knee pain, with slightly fewer stomach side effects. High doses can still cause stomach upset the way traditional anti-inflammatory medications do. The major downside of curcumin- and really most herbs- is that it is not very bioavailable when taken by mouth. This means the stomach and liver break down a lot of the active ingredients before they even have a chance to make it to the rest of the body.  Taking curcumin with piperine, which is in black pepper, appears to improve how well it is absorbed.

Another herb that people use often for pain is called Devil’s Claw, also known as the hook plant.  Studies evaluating this herb showed that it is about as effective as traditional anti-inflammatory medications for low back pain and osteoarthritis.  Downsides of Devil’s Claw are that sometimes it can cause diarrhea, and that it can have side effects on the cardiovascular system. So, if you’re thinking about adding this onto your regimen, you really need to discuss it with your primary care doctor or cardiologist first.  

Ginger is a popular herbal remedy, more so for nausea and vomiting than for pain.  But an analysis of several smaller studies did find that it has some benefit for knee arthritis compared to a placebo.  The benefit is probably comparable to taking Tylenol, and not as good as the anti-inflammatory medications. Ginger may also be helpful for migraines and is under investigation as an emergency rescue medication for when people have a severe migraine that they want to stop.

The last herb I am going to discuss is called capsaicin, which is a compound derived from chili peppers.  Capsaicin works by interfering with molecules that are required for pain signal transmission, and is usually applied topically on the skin.  It comes in a lot of different strengths, including a very strong patch that is prescription only and used for pain after shingles. Downsides are that when it starts working, it can burn and tingle- like your tongue/mouth after eating a chili pepper!

I hope this review helped to explain some common herbal supplements that can be used for pain control.  It is always best to discuss them in person with a pain management physician before adding them into your routine, as they can have side effects or interactions with other medications you may be taking.  The National Center for Complementary and Integrative Health (NCCIH), which is part of the NIH, has a lot of nice resources online about herbal supplements that I encourage you to check out.