Hope On The Horizon
For pain relief without troubling side effects, try these natural remedies

By Lisa Anne Marshall
Photos by Jeff Padrick

Midol for monthly cramps, Tylenol for tension headaches, Motrin to relieve sore muscles, Advil for arthritic joints: In a busy world where slowing down isn't always an option, plenty of people become self-confessed pill-poppers when pain takes up residence in the body.

It's no surprise really; there's a great deal of pain to face. In the early '90s, researchers hypothesized that, at any given moment, one in six U.S. adults was in pain.

In seeking relief, most people turn to one of many over-the-counter analgesics, usually one of the several nonsteroidal anti-inflammatory drugs (NSAIDs). These range from mild aspirin, acetaminophen (Tylenol) and ibuprofen (Advil), to strong, non-narcotic painkiller combinations such as Pamprin, Extra Strength Excedrin and Extra Strength Tylenol. NSAIDs reduce the swelling, heat, and resulting pain caused by inflammation, a symptom of most injuries and illnesses, making them the drug of choice for Americans. In the United States, each year 13 million people use NSAIDs regularly, 30 billion over-the-counter NSAID tablets are sold annually, and 70 million NSAID prescriptions are written (New England Journal of Medicine, 1999, vol. 340, no. 24, p. 1888).

We may be gulping these pills like candy, but, in fact, cumulative and possibly severe side effects can result from the chronic use of these medications. The Physicians' Desk Reference, the principal resource on pharmaceuticals, lists more than 100 side effects for each NSAID. Chief among them is gastrointestinal (GI) toxicity, a major cause of sickness and death in the United States. According to the 1999 Journal report, amid long-term users of NSAIDs, the mortality rate from GI complications is 0.22 percent per year. As can be expected, the numbers add up. Since so many people use these drugs, NSAID-related GI complications rank 15th among the most common causes of death in the United States. NSAID-induced diseases cause more than 100,000 hospitalizations per year, at an estimated cost of $15,000 to $20,000 each. The annual expenditure for treatment of these GI complications runs around $2 billion.

This is not to say that all NSAID use is risky. Taking a couple of ibuprofen tablets for a headache every once in awhile generally doesn't cause harm, but if a person takes more than the label's recommended dose to control more severe pain or continues use over several days or weeks, side effects are probable. These include gas, heartburn and stomachache as well as constipation, diarrhea, nausea and vomiting. Severe complications include gastrointestinal hemorrhage, ulcer perforation and bowel obstruction.

Kidney failure is yet another serious side effect associated with analgesic use. People who take more than one acetaminophen pill per day, or more than 1,000 over the course of their lifetimes, appear to double the odds of end-stage renal disease (ESRD) (New England Journal of Medicine, 1994, vol. 331, no. 25, p. 1675). Researchers also found a steep increase in the odds of ESRD in people who consumed 5,000 or more pills containing various NSAIDs during their lifetimes, though the number of patients taking NSAIDs in these quantities was small.

Perhaps the most disturbing fact comes from another survey, taken in 1999, that suggests patients are uninformed about the risks of NSAID use (Journal of Rheumatology, vol. 26, suppl. 56, p. 18). Among long-term prescription NSAID users, 55 percent were unaware of complications and 15 percent were aware but unconcerned. Moreover, some 55 percent of regular NSAID users expected some warning sign before the onset of serious GI complications, but 81 percent of patients hospitalized with serious NSAID-induced complications had no previous GI symptoms.

More than 80 percent of patients hospitalized due to NSAID complications had not previous GI symptoms. So if you rely on a daily dose of pills to treat your tendinitis or navigate your migraines, you might want to reconsider. Natural alternatives can provide effective mitigation without serious side effects. The following herbs are generally considered safe for long-term use, and, with the possible exception of devil's claw, do not contribute to GI irritations or other toxicities.

Natural Alternatives For Pain Relief
Boswellia (Boswellia serrata), a gum extract from the Boswellia serrata tree native to India, comes from the Indian system of Ayurvedic medicine. Extensive human studies show the herb acts as an analgesic and contains anti-inflammatory actions similar to NSAIDs that make it particularly effective for sports injuries.

Cayenne (Capsicum annuum) contains capsaicin, a resinous and pungent substance that when applied topically will first activate pain nerves, then render them unresponsive, creating a local analgesia. Capsaicin works by depleting "substance P," the compound that transmits pain signals from the peripheral nerves to the spinal cord. Without the neurotransmitters, pain signals are no longer sent and pain isn't felt. It takes about three days and sometime longer to deplete substance P, so use capsaicin cream at least four to five times daily for a few days before judging its effectiveness.

Numerous double-blind studies have proved that topical capsaicin creams are helpful for various conditions, including fibromyalgia muscle pain, shingles-derived nerve pain, diabetic neuropathy, post-surgical pain and psoriasis.

Corydalis (Corydalis ambigua), called yan hu suo in Traditional Chinese Medicine, is the strongest pain-killer in the Chinese Materia Medica, according to Ellen Kamhi, PhD, RN, coauthor of The Natural Medicine Chest (M. Evans and Co., 1999). Traditionally it's been used to alleviate all types of discomfort, including abdominal, hernial, and menstrual pain, and is often sold in a complex formula rather than as a single herb.

In recent times, Australian researchers have reported that some corydalis alkaloids are 40 percent as effective as morphine in treating pain. Preliminary reports from Chinese researchers noted that 75 mg per day of one such compound (tetrahydropalmatine, or THP) was effective in reducing nerve pain in 78 percent of 64 patients tested. Headaches, painful menstruation, and abdominal pain after childbirth are among the conditions that responded to THP administration.

Devil's Claw (Harpagophytum procumbens), a plant native to the Kalahari Desert of southwestern Africa, is commonly used in Europe for pain relief. The herb acts as an analgesic and anti-inflammatory.

In a four-week 1996 study in Germany, of 118 patients with lower back pain, devil's claw extract relieved pain to a point just short of statistical significance. The same researcher conducted another experiment in 1999 and found an extract offered better pain relief than placebo for 197 subjects with lower back pain. However, subjects in the devil's claw group experienced more frequent GI upset.

Feverfew (Tanacetum parthenium) contains an active component called parthenolide that can inhibit the production and secretion of prostaglandins (natural substances that create inflammation), resulting in reduced inflammation, decreased secretion of histamine, and reduced fevers—hence its name. Feverfew is also used to relax smooth muscles in the uterus, helping to alleviate menstrual pain, and to prevent and treat migraines by inhibiting the release of substances that dilate blood vessels.

Ginger (Zingiber officinale) has a wealth of beneficial effects. It is analgesic, anti-inflammatory, and antimicrobial, and it reduces fever. It relieves pain by inhibiting the body's synthesis of inflammatory chemicals. In addition, research shows that a constituent of dried ginger called 6-shogaol can mildly reduce pain, probably by blocking substance P (Neuropharmacology, 1992, vol. 31, no.11, p. 1165).

A phyllanthus extract proved to be six to seven times more potent than aspirin. Phyllanthus (Phyllanthus spp.) includes several species such as P. niruri and P. sellowianus. Phyllanthus extracts, in preliminary animal research, show a marked ability to decrease pain, most likely by decreasing inflammation. P. sellowianus proved to be six to seven times more potent than aspirin or acetaminophen in test-tube studies, and the extracts also demonstrated liver-protective properties.

Turmeric (Curcuma longa), the popular yellow cooking spice, has a long tradition of use for aches and pains. The herb's active constituent, curcumin, can be taken internally or used topically. In lab experiments, curcumin proved as effective as the anti-inflammatory agents hydrocortisone and phenylbutazone in reducing inflammation, but without toxicity. Topical curcumin is thought to deplete substance P.

Willow Bark (Salix alba) has one of the longest historical uses in Western medicine for pain relief. Its active constituent, salicin, was modified by chemists to create aspirin (acetylsalicylic acid). Aside from a few studies, however, willow bark's therapeutic properties are inferred from studies on individual salicylates, which have shown analgesic, anti-inflammatory, and fever-reducing activity. One, sodium salicylate, has been shown to inhibit the functioning of neutrophils, the most abundant cells associated with acute inflammation (Scientific American, 1991, vol. 264, no. 1, p. 84).

In a recent study in Israel, researchers found that a willow bark extract standardized to 120 mg and 240 mg salicin and given once or twice a day was effective in treating lower back pain. Researchers concluded that willow bark extract, especially at higher dosages, was an effective alternative to treatment with NSAIDs (American Journal of Medicine, 2000, vol. 109, no. 1, p. 9). While the pain-reducing action of willow bark is typically slower than that of aspirin, the relief lasts longer.

Pamper The Pain
Beyond these solutions, simply being kind to yourself can help lessen the hurt. One of the nicest ways to treat yourself herbally is with a mineral bath, which can ease a variety of pains. Mineral baths often include salt, bromide, sulfate, potassium, magnesium, calcium and lithium—elements that aid nerve impulses and moderate mood. The minerals spread oils and herbal extracts through the bath to the skin, and the salts and warm water condition the skin so the oils and extracts can be absorbed, while the sodium extracts toxins. And, besides all the science, taking the time to slow down and soak beats popping a pill any day.

Lisa Anne Marshall is a freelance writer and editor who has reported on the natural products industry for more than a decade.