Page 75 Guide to Pain Management in Low-Resource Settings

Complementary Th erapies for Pain Management 63

Herbs and other dietary Poison hemlock (Conium maculatum) appar-
supplements: what to use? ently is used in parts of Africa for neuralgia and cancer
pain, but it has not been shown to be useful for this pur-
White willow (Salix alba), also known as willow bark, pose. Instead, its historic role in producing death is cor-
bay willow, black willow, and white willow bark, is in roborated in literature reports.
common use in Africa. Th e active preparation is derived Prunus africana (Pygeum africanum, Rosaceae)
from the bark of the tree. Willow bark contains salicin, is a plum tree found in tropical Africa and widely used in
the phytotherapeutic precursor of aspirin (acetylsali- Europe and the United States to treat benign prostate hy-
cylic acid). Products should be standardized to the con- pertrophy (BPH). Mice fed Pygeum africanum showed a
tent of salicin with daily doses ranging from 60–120 mg signifi cant reduction of prostate cancer incidence, but no
per day. Caution should be exercised in patients with prostate cancer human studies have been conducted.
known allergy or intolerance to aspirin or nonsteroidal Valerian (Valeriana offi cinalis), although a pop-
anti-infl ammatory drugs (NSAIDs). Willow bark should ular remedy in Africa, was found no better than placebo
not be administered to children with a fever, because when studied.
of the risk of Reye’s syndrome. Adverse reactions are Verbena (Verbena offi cinalis) has been studied
analogous to those seen with aspirin, including gastro- only for the treatment of topical infl ammation. Its topi-
intestinal bleeding, nausea, and vomiting. Willow bark cal analgesic activity was less than the analgesic activity
may have additive eff ect with aspirin and NSAIDs and of methyl salicylate ointment.
should therefore not be administered concurrently.
Clinical studies demonstrate effi cacy of willow bark in Pearls of wisdom
the management of back pain and osteoarthritis. A sys-
• Complementary therapies serve as adjuncts to
tematic review of clinical trials suggests that it may also
mainstream cancer care and can relieve physical
be eff ective in treating low back pain.
and mental symptoms for people with pain and
Boswellia preparations, used to treat infl amma-
other symptoms.
tion, come from the gum of the Boswellia serrata tree.
• Th ey address body, mind, and spirit and enhance
Randomized controlled trials show that they reduce
patients’ quality of life.
pain and swelling in osteoarthritic knee joints. Animal
• Th ey are low-cost, minimally or non-invasive,
studies suggest these eff ects may result from the agent’s
and comforting, and they allow patients a choice
suppression of pro-infl ammatory cytokines.
of treatment.
Corydalis rhizome was studied in only one trial.
• Th eir largely favorable risk-benefi t ratio suggests
Conducted in human patients, the results showed that
that complementary therapies can play an impor-
after a single, oral administration of C. yanhusuo or A.
tant role in physical and emotional rehabilitation
dahuricae extracts, pain scores signifi cantly decreased.
and can be especially useful in pain management.
Devil’s claw (Arpagophytum procumbens). Anal-
• Oral agents should fi rst be determined to be safe.
ysis of commercial products reveals wide variation in
Some plants used for medicinal purposes have no
chemical components. Limited side eff ects are reported.
benefi ts and are dangerous; physicians and pa-
A clinical study suggests that devil’s claw may benefi t
tients should be alerted to the serious negative ef-
patients with osteoarthritis of the hip or knee.
fects, including death, that these agents may pro-
Henbane (Hyoscyamus niger) can be toxic and
duce. Herbs may be contraindicated for patients
even fatal, even at low doses. Common eff ects of hen-
on prescription medication.
bane ingestion in humans include hallucinations, dilated
pupils, and restlessness. Less common problems (tachy-
cardia, convulsions, vomiting, hypertension, hyperpy- References
rexia, and ataxia) are reported. Henbane is a toxic plant [1] Alfano CM, Smith AW, Irwin ML, Bowen DJ, Sorensen B, Reeve BB,
and should not be ingested! Meeske KA, Bernstein L, Baumgartner KB, Ballard-Barbash R, Malone
KE, McTiernan A. Physical activity, long-term symptoms, and physical
Passion fl ower (Passifl ora incarnate) is used pri- health-related quality of life among breast cancer survivors: a prospec-
tive analysis. J Cancer Surv 2007;1:116–28.
marily to treat insomnia, anxiety, epilepsy, neuralgia, and [2] Alimi D, Rubino C, Pichard-Léandri E, Fermand-Brulé S, Dubreuil-
withdrawal syndromes from opiates or benzodiazepines. Lemaire ML, Hill C. Analgesic eff ect of auricular acupuncture for
cancer pain: a randomized, blinded, controlled trial. J Clin Oncol
It has not been studied in humans for pain control. 2003;21:4120–6.