A wide range of herbs for pain conditions are discussed, with detailed information on their safe clinical application. Aconitum spp. (aconite, fū zǐ) and a formula featuring it, Gosha-jinki-gan (Niú Chē Shèn Qì Wán), are particularly good examples of powerful analgesics that are far too little used in North American prescribing. The global use of various species of aconite is particularly compelling. However, this herb should only be recommended by experienced clinicians (as with most of the other herbs discussed herein). Similarly, Clematis spp. (clematis, virgin's bower) and Anemone spp. (pasque flower) of various types are used for pain around the world. Actaea racemosa (black cohosh) is yet another analgesic from the Ranunculaceae family (along with aconite, clematis, and pasque flower). Corydalis yanhusuo (corydalis, yán hú suǒ) and its American cousin Corydalis aurea (golden smoke) are opium family plants discussed for pain relief. Other diverse analgesic herbs discussed include Bryonia alba (white bryony), Bryonia cretica ssp. dioica (Cretan or red bryony), capsaicin, and Cannabis sativa (cannabis, marijuana). Finally, herbs that both relax skeletal muscle and reduce pain are described, including Piper methysticum (kava), Pedicularis bracteosa (bracted lousewort), Stachys officinalis and Stachys betonica (wood betony), and Lobelia inflata (lobelia).
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References
1.
Centers for Disease Control and Prevention (CDC). CDC grand rounds: Prescription drug overdoses—A U.S. epidemic. MMWR Morb Mortal Wkly Rep, 2012; 61:10–13.
2.
CaliffRM, WoodcockJ, OstroffS. A proactive response to prescription opioid abuse. N Engl J Med, 2016; 374:1480–1485.
YarnellE.Herbs for rheumatoid arthritis. Altern Complement Ther, 2017:23:149–156.
5.
YarnellE.Herbal medicine and migraine. Altern Complement Ther, 2017; 23:192–201.
6.
FruehaufH.The flagship remedy of chinese medicine: Reflections on the toxicity and safety of aconite. Online document at: https://www.classicalpearls.org/resources/the-flagship-remedy-of-chinese-medicine-reflections-on-the-toxicity-and-safety-of-aconite/ Accessed August16, 2015.
7.
OyamaT, SmithG (eds). Pain and Kampo: The Use of Japanese Herbal Medicine in Management of Pain. New York: Springer, 2012.
8.
DengW.Clinical research on gancao guzi decoction in treating osteoarthritis of knee joint. Zhong Yao Cai, 2008; 31:1107–1110 [in Chinese].
9.
NakaeH.Efficacy of aconite tuber powder in patients with arthralgia and somatic pain. Kampo Med, 2009; 60:81–85 [in Japanese].
10.
NakanishiM, ArimitsuJ, KageyamaM, et al.Efficacy of traditional Japanese herbal medicines—keishikajutsubuto (TJ-18) and bushi-matsu (TJ-3022)—against postherpetic neuralgia aggravated by self-reported cold stimulation: A case series. J Altern Complement Med, 2012; 18:686–692.
11.
SimaL, PanL. Influence of Chinese herb on chemotherapy-induced peripheral neuropathy. Ann Oncol, 2009; 20:iii45–iii46.
12.
KakuH, KumagaiS, OnoueH, et al.Objective evaluation of the alleviating effects of goshajinkigan on peripheral neuropathy induced by paclitaxel/carboplatin therapy: A multicenter collaborative study. Exp Ther Med, 2012; 3:60–65.
13.
AbeH, KawaiY, MoriT, et al.The Kampo medicine goshajinkigan prevents neuropathy in breast cancer patients treated with docetaxel. Asian Pac J Cancer Prev, 2013; 14:6351–6356.
14.
NishiokaM, ShimadaM, KuritaN, et al.The Kampo medicine, goshajinkigan, prevents neuropathy in patients treated by FOLFOX regimen. Int J Clin Oncol, 2011; 16:322–327.
15.
KonoT, HataT, MoritaS, et al.Goshajinkigan oxaliplatin neurotoxicity evaluation (GONE): a Phase 2, multicenter, randomized, double-blind, placebo-controlled trial of goshajinkigan to prevent oxaliplatin-induced neuropathy. Cancer Chemother Pharmacol, 2013; 72:1283–1290.
16.
OkiE, EmiY, KojimaH, et al.Preventive effect of Goshajinkigan on peripheral neurotoxicity of FOLFOX therapy (GENIUS trial): A placebo-controlled, double-blind, randomized Phase III study. Int J Clin Oncol, 2015; 20:767–775.
17.
TawataM, KuriharaA, NittaK, et al.The effects of goshajinkigan, a herbal medicine, on subjective symptoms and vibratory threshold in patients with diabetic neuropathy. Diabetes Res Clin Pract, 1994; 26:121–128.
18.
WatanabeK, ShimadaA, MiyakiK, et al.Long-term effects of goshajinkigan in prevention of diabetic complications: A randomized open-labeled clinical trial. Evid Based Complement Alternat Med, 2014; 2014:12872–6.
19.
ChanTYK, CritchleyJAJH. Usage and adverse effects of Chinese herbal medicines. Hum Exp Toxicol, 1996; 15:5–12.
20.
WangY, ShiL, SongFR, et al.Exploring the ester-exchange reactions of diester-diterpenoid alkaloids in the aconite decoction process by electrospray ionization tandem mass spectrometry. Rapid Commun Mass Spectrom, 2003; 17:279–284.
21.
Pharmacopoeia Commission of People's Republic of China. Pharmacopoeia of the People's Republic of China 2005. Beijing: People's Medical Publishing House, 2005.
22.
PeterK, SchinnerlJ, Susanne FelsingerS, et al.A novel concept for detoxification: Complexation between aconitine and liquiritin in a Chinese herbal formula (“Sini Tang”). J Ethnopharmacol, 2013; 149:562–569.
23.
FanYF, XieY, LiuL, et al.Paeoniflorin reduced acute toxicity of aconitine in rats is associated with the pharmacokinetic alteration of aconitine. J Ethnopharmacol, 2012; 141:701–708.
LiY, TuD, XiaoH, et al.Aconitine blocks HERG and Kv1.5 potassium channels. J Ethnopharmacol, 2010; 131:187–195.
26.
GottigniesP, El HorT, TamezeJK, et al.Successful treatment of monkshood (aconite napel) poisoning with magnesium sulfate. Am J Emerg Med, 2009; 27:75–5.e1–755.e4
27.
MoffatAC, OsseltonMD, WiddepB, eds. Clarke's Analysis of Drugs and Poisons, Vol 2, 3rd ed. London: Pharmaceutical Press, 2004.
ShuH, AritaH, HayashidaM, et al.Inhibition of morphine tolerance by processed Aconiti tuber is mediated by kappa-opioid receptors. J Ethnopharmacol, 2006; 106:263–271.
30.
ShuH, HayashidaM, AritaH, et al.High doses of processed Aconiti tuber inhibit the acute but potentiate the chronic antinociception of morphine. J Ethnopharmacol, 2008; 119:276–283.
31.
GutserUT, FrieseJ, HeubachJF, et al.Mode of antinociceptive and toxic action of alkaloids of Aconitum spec. Naunyn Schmiedebergs Arch Pharmacol, 1998; 357:39–48.
32.
TakizawaY, IsonoT, SuzukiY, et al.Analgesic effects of Tsumura-shuuji-bushi-matsu and mesaconitine. Nihon Yakurigaku Zasshi, 1992; 100:307–316 [in Japanese].
33.
ChanTY.Aconite poisoning following the percutaneous absorption of Aconitum alkaloids. Forensic Sci Int, 2012; 223:25–27.
34.
MartinML, Ortiz de UrbinaAV, MonteroMJ, et al.Pharmacologic effects of lactones isolated from Pulsatilla alpina subsp apiifolia. J Ethnopharmacol, 1988; 24:185–191.
35.
MooreM.Medicinal Plants of the Mountain West, rev ed. Santa Fe, NM: Museum of New Mexico Press, 2003.
36.
KernJR, CardellinaJHII. Native American medicinal plants. Anemonin from the horse stimulant Clematis hirsutissima. J Ethnopharmacol, 1983; 8:121–123.
37.
ChawlaR, KumarS, SharmaA. The genus Clematis (Ranunculaceae): Chemical and pharmacological perspectives. J Ethnopharmacol, 2012; 143:115–150.
38.
JungYB, RohKJ, JungJA, et al.Effect of SKI 306X, a new herbal anti-arthritic agent, in patients with osteoarthritis of the knee: a double-blind placebo controlled study. Am J Chin Med, 2001; 29:485–491.
39.
JungYB, SeongSC, LeeMC, et al.A four-week, randomized, double-blind trial of the efficacy and safety of SKI306X: A herbal anti-arthritic agent versus diclofenac in osteoarthritis of the knee. Am J Chin Med, 2004; 32:291–301.
40.
SongYW, LeeEY, KohEM, et al.Assessment of comparative pain relief and tolerability of SKI306X compared with celecoxib in patients with rheumatoid arthritis: A 6-week, multicenter, randomized, double-blind, double-dummy, Phase III, noninferiority clinical trial. Clin Ther, 2007; 29:862–873.
41.
MillsS, BoneK. Principles and Practice of Phytotherapy: Modern Herbal Medicine. Edinburgh, United Kingdom: Churchill Livingstone, 2000.
42.
SaifyZS, NoorF, MushtaqN, DarA. Assessment of Anemone pulsatilla for some biological activities. Pakistan J Pharm Sci, 1998; 11:47–53.
43.
WeissRF.Herbal Medicine. Beaconsfield, United Kingdom: Beaconsfield Publishers, 1985.
44.
YuanCS, MehendaleSR, WangCZ, et al.Effects of Corydalis yanhusuo and Angelicae dahuricae on cold pressor-induced pain in humans: A controlled trial. J Clin Pharmacol, 2004; 44:1323–1327.
45.
LiaoZG, LiangXL, ZhuJY, et al.Correlation between synergistic action of Radix Angelica dahurica extracts on analgesic effects of Corydalis alkaloid and plasma concentration of dl-THP. J Ethnopharmacol, 2010; 129:115–120.
46.
ZuoC, ChenYT, WangZM. Clinical efficacy of Corydalis composite combined with methotrexate in treating rheumatoid arthritis. Zhongguo Zhong Xi Yi Jie He Za Zhi, 2009; 29:1023–1025 [in Chinese].
47.
XuRS, ZongXH, LiXG. Controlled clinical trials of therapeutic effects of Chinese herbs promoting blood circulation and removing blood stasis on the treatment of reflex sympathetic dystrophy with type of stagnation of vital energy and blood stasis. Zhongguo Gu Shang, 2009; 22:920–922 [in Chinese].
48.
ZuoC, YinG, CenXM, XieQB. Controlled clinical study on compound Decumbent Corydalis Rhizome and diclofenac in treatment of knee osteoarthritis. Zhongguo Zhong Yao Za Zhi, 2015; 40:149–153 [in Chinese].
49.
TanHY, ZhuSJ, TongL, et al.Safety and efficacy of tongkuaixiao ointment in reliving cancer-induced pain: A multicenter double-blind placebo-controlled randomized trial. J Tradit Chin Med, 2016; 36:695–700.
50.
WeiXD, ShenHL, WangLJ, et al.Analyses of total alkaloid extract of Corydalis yanhusuo by comprehensive RP × RP liquid chromatography with pH difference. J Anal Methods Chem, 2016; 2016:9752735.
51.
ChangHM, ButPPH, eds. Pharmacology and Applications of Chinese Materia Medica, vol. 1. Hackensack, NJ: World Scientific, 1986.
52.
WangL, ZhangY, WangZ, et al.The antinociceptive properties of the Corydalis yanhusuo extract. PLoS One, 2016; 11:e016287–5.
53.
ZhangY, WangC, WangL, et al.A novel analgesic isolated from a traditional Chinese medicine. Curr Biol, 2014; 24:117–123.
54.
ZhangY, WangC, GuoZ, et al.Discovery of N-methyltetrahydroprotoberberines with κ-opioid receptor agonists-opioid receptor agonist activities from Corydalis yanhusuo W.T. Wang by using two-dimensional liquid chromatography. J Ethnopharmacol, 2014; 155:1597–1602.
55.
YangZ, ShaoYC, LiSJ, et al.Jin, Medication of l-tetrahydropalmatine significantly ameliorates opiate craving and increases the abstinence rate in heroin users: A pilot study. Acta Pharmacol Sin, 2008; 29:781–788.
56.
ChoiMG, RheePL, ParkH, et al.Randomized, controlled, multi-center trial: comparing the safety and efficacy of DA-9701 and itopride hydrochloride in patients with functional dyspepsia. J Neurogastroenterol Motil, 2015; 21:414–422.
57.
YarnellE.Herbs for atrial fibrillation. Altern Complement Ther, 2017; 23:102–111.
58.
Centers for Disease Control and Prevention. Jin bu huan toxicity in adults—Los Angeles, 1993. MMWR Morb Mortal Wkly Rep, 1993; 42:920–922.
59.
LaiCK, ChanAY. Tetrahydropalmatine poisoning: Diagnoses of nine adult overdoses based on toxicology screens by HPLC with diode-array detection and gas chromatography-mass spectrometry. Clin Chem, 1999; 45:229–236.
60.
MaZJ, LiXD, GuXZ, et al.Effects of different types and standard of processing vinegaron inherent constituents in rhizoma of Corydalis yanhusuo. Zhongguo Zhong Yao Za Zhi, 2006; 31:465–467 [in Chinese].
61.
WuH, WaldbauerK, TangL, et al.Influence of vinegar and wine processing on the alkaloid content and composition of the traditional Chinese medicine Corydalis rhizoma (yanhusuo). Molecules, 2014; 19:11487–11504.
62.
FelterHW.Eclectic Materia Medica, Pharmacology and Therapeutics. Sandy, OR: Eclectic Medical Publications, 1922, reprinted 1998.
63.
UkiyaM, AkihisaT, YasukawaK, et al.Anti-inflammatory and anti-tumor-promoting effects of cucurbitane glycosides from the roots of Bryonia dioica. J Nat Prod, 2002; 65:179–183.
64.
SivakumarT, PerumalP, KumarRS, et al.Evaluation of analgesic, antipyretic activity and toxicity study of Bryonia laciniosa in mice and rats. Am J Chin Med, 2004; 32:531–539.
65.
CaterinaMJ, SchumacherMA, TominagaM, et al.The capsaicin receptor: A heat-activated ion channel in the pain pathway. Nature, 1997; 389:816–824.
66.
TurnbullA.Tincture of Capsaicin as a Remedy for Chilblains and Toothache, vol. 1. Dublin: Free Press, 1850:95–96.
67.
KeitelW, FrerickH, KuhnU, et al.Capsicum pain plaster in chronic non-specific low back pain. Arzneim Forsch, 2001; 51:896–903.
68.
MathiasBJ, DillinghamTR, ZeiglerDN, et al.Topical capsaicin for chronic neck pain. A pilot study. Am J Phys Med Rehabil, 1995; 74:39–44.
69.
GuedesV, CastroJP, BritoI.Topical capsaicin for pain in osteoarthritis: A literature review. Reumatol Clin, 2016Aug26 [Epub ahead of print]; DOI: 10.1016/j.reuma.2016.07.008.
70.
MorgenlanderJC, HurwitzBJ, MasseyEW. Capsaicin for the treatment of pain in Guillain–Barré syndrome. Ann Neurol, 1990; 28:19–9.
71.
WeintraubM, GolikA, RubioA. Capsaicin for treatment of post-traumatic amputation stump pain. Lancet, 1990; 336:1003–1004.
72.
WatsonCPN, EvansRJ. The postmastectomy pain syndrome and topical capsaicin: A randomized trial. Pain, 1992; 51:375–369.
73.
YongYL, TanLT, MingLC, et al.The Effectiveness and safety of topical capsaicin in postherpetic neuralgia: A systematic review and meta-analysis. Front Pharmacol, 2017; 7:53–8.
74.
WistE, RisbergT. Topical capsaicin in treatment of hyperalgesia, allodynia and dysesthetic pain caused by malignant tumor infiltration of the skin. Acta Oncol, 1993; 32:34–3.
75.
Capsaicin Study Group. Effect of treatment with capsaicin on daily activities of patients with painful diabetic neuropathy. Diabetes Care, 1992; 15:159–165.
76.
McCleaneG.Topical application of doxepin hydrochloride, capsaicin and a combination of both produces analgesia in chronic human neuropathic pain: A randomized, double-blind, placebo-controlled study. Br J Clin Pharmacol, 2000; 49:574–579.
77.
YarnellE.Herbal medicine and migraine. Altern Complement Ther, 2017; 23:149–156.
78.
PaiceJA, FerransCE, LashleyFR, et al.Topical capsaicin in the management of HIV-associated peripheral neuropathy. J Pain Symptom Manage, 2000; 19:45–52.
79.
DerryS, RiceAS, ColeP, et al.Topical capsaicin (high concentration) for chronic neuropathic pain in adults. Cochrane Database Syst Rev, 2017; 1:CD00739–3.
80.
SharmaSK, SinghA, SharmaM. Mechanisms and clinical uses of capsaicin. Eur J Pharmacol, 2013; 720:55–62.
81.
WalshD, NelsonKA, MahmoudFA. Established and potential therapeutic applications of cannabinoids in oncology. Supportive Care Cancer, 2003; 11:137–143.
82.
ManzanaresJ, JulianMD, CarrascosaA. Role of the cannabinoid system in pain control and therapeutic implications for the management of acute and chronic pain episodes. Curr Neuropharmacol, 2006; 4:239–257.
83.
Martín-SánchezE, FurukawaTA, TaylorJ, MarinJLR. Systematic review and meta-analysis of cannabis treatment for chronic pain. Pain Med, 2009; 10:1353–1368.
84.
RhyneDN, AndersonSL, GeddeM, BorgeltLM. Effects of medical marijuana on migraine headache frequency in an adult population. Pharmacotherapy, 2016; 36:505–510.
85.
BuggyDJ, ToogoodL, MaricS, et al.Lack of analgesic efficacy of oral delta-9-tetrahydrocannabinol in postoperative pain. Pain, 2003; 106:169–172.
86.
HoldcroftA, MazeM, DoréC, et al.A multicenter dose-escalation study of the analgesic and adverse effects of an oral cannabis extract (Cannador) for postoperative pain management. Anesthesiology, 2006; 104:1040–1046.
87.
DragtS, NiemanDH, BeckerHE, et al.Age of onset of cannabis use is associated with age of onset of high-risk symptoms for psychosis. Can J Psychiatry, 2010; 55:165–171.
88.
WallaceM, SchulteisG, Hampton AtkinsonJ, et al.Dose-dependent effects of smoked cannabis on capsaicin-induced pain and hyperalgesia in healthy volunteers. Anesthesiology, 2007; 107:785–796.
89.
JussofieA, SchmizA, HiemkeC. Kavapyrone enriched extract from Piper methysticum as modulator of the GABA binding site in different regions of rat brain. Psychopharmacology, 1994; 116:469–474.
90.
FrieseJ, GleitzJ. Kavain, dihydrokavain, and dihydromethysticin non-competitively inhibit the specific binding of [3H]-batrachotoxinin-A 20-alpha-benzoate to receptor site 2 of voltage-gated Na+ channels. Planta Med, 1998; 64:458–459.
91.
JamiesonDD, DuffieldPH. The antinociceptive action of kava components in mice. Clin Exp Pharmacol Physiol, 1990; 17:495–508.
92.
EmserW, BartyllaK. Improvement in quality of sleep: Effect of kava extract WS 1490 on the sleep patterns in healthy people. TW Neurologie Psychiatrie, 1991; 5:633–642 [in German].
93.
LehrlS.Clinical efficacy of kava extract WS 1490 in sleep disturbances associated with anxiety disorders. Results of a multicenter, randomized, placebo-controlled, double-blind clinical trial. J Affect Disord, 2004; 78:101–110.
94.
YarnellE.Herbal medicine for insomnia. Altern Complement Ther, 2015; 21:173–179.
