Page 144 Acute Pain Management

4.3.10 Complementary and alternative medicines

Herbal, traditional Chinese and homeopathic medicines may be described as complementary
or alternative medicines (CAMs) because their use lies outside the dominant, ‘orthodox’ health
system of Western industrialised society (Belgrade, 2003). In other cultures these therapies may
be mainstream.
CAMs include:
• herbal medicine — substances derived from plant parts such as roots, leaves or flowers;
• traditional Chinese medicine — herbal medicines, animal and mineral substances;
• homeopathy — ultra‐diluted substances; and
• others — vitamins, minerals, animal substances, metals and chelation agents.
A drug is any substance or product that is used or intended to be used to modify or explore
physiological systems or pathological states (WHO, 1996). While the use of CAMs is
commonplace, their efficacy in many areas, including in the management of acute pain, has
not yet been subject to adequate scientific evaluation and there are limited data.
Preoperative melatonin administration led to reduced PCA morphine requirements and
anxiety after surgery (Caumo et al, 2007 Level II). Treatment with lavender aromatherapy in the
postanaesthesia care unit reduced the opioid requirements of morbidly obese patients after
CHAPTER 4 laparoscopic gastric banding (Kim et al, 2007 Level II). There is insufficient evidence that
aromatherapy is effective for labour pain (Smith et al, 2006 Level I).
A review of trials looking at the effectiveness of herbal medicines for acute low back pain
(a mix of acute, subacute and chronic pain) found that white willow bark (Salix alba),
containing salicin, which is metabolised to salicylic acid, provided better analgesia than
placebo and was similar to a coxib (rofecoxib) (Gagnier et al, 2006 Level I). Devil's claw
(Harpagophytum procumbens) was also effective and there was moderate evidence that
cayenne (Capsicum frutescens) may be better than placebo (Gagnier et al, 2006 Level I).
In dysmenorrhoea, vitamin B1 (Proctor & Murphy, 2001 Level I), vitamin E (Ziaei et al, 2005 Level II),
Chinese herbal medicine (Zhu et al, 2007 Level I), rose tea (Tseng et al, 2005 Level II), guava leaf
extract (Psidii guajavae) (Doubova et al, 2007 Level II), aromatherapy (Han et al, 2006 Level II) and
fennel (Foeniculum vulgare) (Namavar Jahromi et al, 2003 Level III‐2) provided effective analgesia.
Homeopathic arnica provided a statistically significant reduction in acute pain after
tonsillectomy (Robertson et al, 2007 Level II), however it was ineffective for pain relief after hand
surgery (Stevinson et al, 2003 Level II) and abdominal hysterectomy (Hart et al, 1997 Level II).
Peppermint oil has a NNT of 2.5 for improvement of pain or symptoms in irritable bowel
syndrome (Ford et al, 2008 Level I).
Adverse effects and interactions with medications have been described with CAMs and must
be considered before their use.

Key message
The following tick box represents conclusions based on clinical experience and expert opinion.
 There is some evidence that some complementary and alternative medicines may be
effective in some acute pain states. Adverse effects and interactions with medications have
been described with complementary and alternative medicines and must be considered
before their use (N).

96 Acute Pain Management: Scientific Evidence