Botanicals for Musculoskeletal Pain

Overview
Musculoskeletal pain is one of the primary reasons people seek out botanical medicine as an alternative
to pharmaceutical treatments. There are a variety of botanicals that can be used in the treatment of low
back pain (LBP) and osteoarthritis (OA), two very common musculoskeletal complaints that affect many
people all over the world.
LBP is the fifth most common reason that people seek out the care of a medical professional, and
billions are spent annually on this painful medical condition. It’s estimated that up to 80% of adults
experience LBP at some point in their lives. LBP is also a common cause of job-related disability and of
missed days at work. It can arise from heavy lifting or other physical activity, and or develop insidiously
over a period of time. There is no “magic bullet” treatment for LBP, and most cases resolve within
several weeks.
OA occurs due to the imbalance of cartilage synthesis and degradation, leading to the formation of bone
spurs and osteophytes. Most people over the age of 65 have radiographic evidence of OA on x-rays.
Knee OA is particularly debilitating, and one of the leading causes of impaired mobility in elderly
patients.

Devil’s claw (Harpagophytum procumbens)

Devil’s claw gets its name from the miniature, claw-like hooks
that cover the fruit of this plant. It is native to southern Africa
and grows well in the desert. It contains anti-inflammatory
properties that are useful in treating musculoskeletal symptoms
such as back or joint pain. A research study1 found devil’s claw
to be not only better than placebo in the treatment of low back
pain but as effective as nonsteroidal anti-inflammatory drugs
(NSAIDs). It may also be useful in treating knee pain from OA.
This botanical should be avoided in patients with stomach ulcers
and those who take blood thinners. Devil’s claw can potentially
interact with diabetes medications and should be used with
caution in these patients.

 2018 Regents of the University of Minnesota. All rights reserved.

Botanicals for Musculoskeletal Pain

Willow bark (Salix alba)

Dating to the time of Hippocrates, there is folk knowledge that

using the bark of the white willow tree helps ease pain and treat
fevers. It wasn’t until centuries later that researchers discovered
that the bark of this tree contains salicylic acid, which was then
synthetically modified to acetyl-salicylic acid, better known as
aspirin! I like to think of willow bark as “nature’s aspirin,” and
it’s useful in treating minor musculoskeletal pain. ‘
It is milder and gentler on the stomach than aspirin, but the
same safety rules apply: willow bark should be not be used in
children due to the risk of Reye’s syndrome or in any person
with an allergy to aspirin. Willow bark should be avoided in
people who have kidney disease or asthma. It may increase risk
of bleeding for people taking blood thinners.

Ginger (Zingiber officinale)

Although probably best known for its culinary delights, ginger
may also be an effective treatment for knee OA. Gingerol is one
of the active constituents in ginger, and gives ginger its anti-
inflammatory properties. A research trial2 looking at the effects
of a ginger extract in the treatment of knee OA found the ginger
extract to be superior to placebo. These results are promising
but more research is needed.
Mild gastrointestinal upset may occur with ginger consumption,
and this botanical should be avoided in people who are taking
blood thinners.

 2018 Regents of the University of Minnesota. All rights reserved.

Botanicals for Musculoskeletal Pain

Capsaicin
Capsacin may be a reasonable option for those interested in a
topical treatment for knee OA. It is an alkaloid derived from the
common pepper plant, including hot peppers, and is probably
best known as a spicy addition to culinary dishes. When applied
topically over a period of time, capsaicin depletes local sensory
nerve endings of something called substance P, a
neurotransmitter involved in sending pain signals to the brain.
The result is diminished pain wherever the cream was applied.
Capsaicin comes in multiple strengths and needs to be applied
four times daily over a period of several weeks to be effective.
Although more research is needed, a few research trials3,4 have
shown benefit of topical capsaicin in treatment of knee OA.
A localized burning sensation is a common side effect, but is
tolerable. Care should be taken to avoid contact of the cream
with the mouth or eyes, as it may cause irritation.

References
1. Chrubasik, S., et al. (1999). Effectiveness of Harpagophytum extract WS 1531 in the treatment of
exacerbation of low back pain: a randomized, placebo-controlled, double-blind study. Eur J
Anaesthesiol 16:118-129.
2. Altman, D., et al. (2001) Effects of a ginger extract on knee pain in patients with
osteoarthritis. Arthritis Rheum 44:2531-2538.
3. Zhang, W.Y. & Li Wan Po, A. (1994). The effectiveness of topically applied capsaicin. A meta-
analysis. Eur J Clin Pharmacol 46(6):517-22.
4. McCarthy, G.M. & McCarty, D.J. (1992). Effect of topical capsaicin in the therapy of painful
osteoarthritis of the hands. J Rheumatol 19:604-607.

 2018 Regents of the University of Minnesota. All rights reserved.