Dr Jacob Teitelbaum MD
Many natural therapies can be very helpful for pain. My three favorite pain relieving herbals are willow bark, Boswellia, and tart cherry. All three of these can be found in combination in the End Fatigue “Pain Formula” by Integrative Therapeutics. Begin with 2-4 tabs 2-3 times a day as needed until maximum benefit is achieved (~ 4-6 weeks) and then you can use the lowest effective dose. Let’s look at these three herbals.
Willow bark is the original source of aspirin, but when used as the entire herb it has been found to be much safer and quite effective. The active ingredient is salicin, and Willow bark has been shown to be effective in both osteoarthritis and back pain. People who are severely allergic to aspirin (e.g. – aspirin induced asthma or anaphylaxes-which is very unusual) should not use Willow bark. Like aspirin and Celebrex, it acts as a COX (Cyclooxygenase enzyme) inhibitor, decreasing inflammation. There are clearly a combination of other factors in willow bark that markedly enhance its effectiveness and safety – which can be a major benefit over aspirin and NSAIDs (e.g. – Motrin) which cause an enormous amount of gastritis and ulcer bleeding, to the point of killing 15,000 – 20,000 Americans yearly! The studies on willow bark are quite consistent in their effectiveness in reducing pain. Let’s look at some of the research.
In one study, 210 patients with severe chronic low back pain were randomly assigned to receive an oral willow bark extract with either 120 mg (low dose) or 240 mg (high dose) of salicin, or placebo, in a 4-week blinded trial. In the last week of treatment, 39% in the group receiving high-dose extract were PAIN -FREE, 21% in the group receiving low-dose extract were pain-free, and only 6% in the placebo group were pain-free. The response in the high-dose group was evident after only 1 week of treatment. They then studied 451 patients who came in with low back pain in an open study, using salicin 240 mg,120 mg, or standard orthopedic/NSAID care for four weeks. 40% of the patients in the 240 mg group and 19% in the 120 mg group were pain-free after four weeks. In the standard treatment group using standard medications, only 18% were pain-free. The study showed that willow bark was not just far more effective and safer than standard prescription therapies, but also decreased the cost of care by approximately 40%!
Another review found that Willow bark extract has comparable anti-inflammatory activities as higher doses of acetylsalicylic acid/aspirin (ASS), as well as reducing pain and fever. In pharmacologically active doses, no adverse effects on the stomach lining (e.g.-indigestion, ulcers, etc) were observed, in contrast to aspirin.
A daily dose of willow bark extract standardized to 240 mg salicin per day was also significantly superior to placebo in patients with osteoarthritis of the hip and the knee. In 2 open studies against standard active treatments as controls, willow bark extract exhibited advantages compared to NSAIDs and was about as effective as Vioxx. Another placebo-controlled study found that willow bark (salicin 240 mg/day) was more effective than placebo in treating arthritis (the normal wear and tear type called osteoarthritis) after only two weeks of therapy. Other references are also available in my Pain Free 1-2-3! book for those of you who would like more information on willow bark.
All of this makes willow bark a wonderful natural pain medicine. It is safe and effective for arthritis, back pain, and likely many other types of pain! I would begin with enough to get 240 mg of Salicin a day until maximum benefit is seen (~ 6 weeks), as the benefit is dose related in severe pain. At that point, you may often be able to lower the dose to 120 mg or less a day or take it as needed.
Boswellia Serrata, also known as Frankincense, has been used in traditional Ayurvedic medicine for centuries. Boswellia has been found to be quite helpful in treating inflammation and pain and it also does this without causing ulcers like aspirin family medications. It has been shown in studies to be helpful for both rheumatoid arthritis and osteoarthritis.
In the latter study, 30 patients with osteoarthritis of the knee were given 1000 mg of an extract of Boswellia or placebo for eight weeks and then the groups were switched for the next eight weeks. All of the patients on the Boswellia showed significantly decreased pain and improved ability to walk. In fact, the improvement was quite remarkable with the pain index falling by 90% after eight weeks with a similarly dramatic increase in function. This was recently discussed at more length in the wonderful patient oriented newsletter “Nutrition and Healing” by Jonathan Wright M.D. — a physician that I have great respect for (see http://www.wrightnewsletter.com). The article was written by Kerry Bone.
Boswellia has also been demonstrated to have significant anti-inflammatory properties, inhibiting leukotriene synthesis by inhibiting 5-lipooxygenase activity. It also decreases the activity of human leukocyte elastase (HLE). Blocking 2 inflammatory chemicals that are increased simultaneously in a variety of human diseases is unique to Boswellia. This results in its being helpful in asthma and colitis as well as pain. In one study of asthmatics, 40 patients were treated with 300 mg 3 times day for 6 weeks. 70% of the asthma patients showed improvement in symptoms and lung function and a decrease in allergic blood cells (eosinophils). Boswellia also helped in the treatment of ulcerative colitis. In one study giving Boswellia 300 mg 3 x day for 6 weeks, out of 20 patients treated with Boswellia gum resin 14 went into remission, while with sulfasalazine(the standard prescription treatment), the remission rate was 4 out of 10. Test tube studies suggest that Boswellia also markedly inhibits cancer.
It does not appear to have any major side effects that resulted in people withdrawing from the studies but rarely cause minor gastrointestinal disturbances or rash. A common dose is 150-350 mg 3 times a day.
Cherry Fruit (Prunus cerasus)– Although there are not as many human studies on the use of tart cherries, they also contain compounds which inhibit COX-1(inflammation) as effectively as ibuprofen, and tart cherries possess both antioxidant and anti-inflammatory properties. In addition, research suggests that it may also inhibit Colon and perhaps other cancers. Cherries and other colored berries are very high in many antioxidants. As with eating cherries, taking cherry fruit is quite safe. Many people are finding that simply eating 10 – 20 cherries a day has been helping their arthritis considerably. 2000 mg of cherry fruit extract (present in 6 capsules of the Pain Formula) contains the active components present in 10 cherries or 32 oz of cherry juice. Early research, as well as how many people come back for more after they have tried it (which to me is a significant indicator of effectiveness) suggests that cherry fruit holds a lot of promise!
The good news is that all of these 3 excellent and natural pain treatments in optimal dosing can now be found in the “End Pain” formula by Enzymatic Therapy.
That sounds like a great way to treat my pain! What else can I do to help healing and gets rid of pain?
The wonderful thing about Comprehensive Medicine, which combines holistic and pharmaceutical treatments, is that you have a full tool kit to deal with your problems. Otherwise, it’s like going into a shoe store and having only 1 pair of shoes to try on. Using comprehensive Medicine, almost every one can find “a shoe that fits” so you can get your life and health back!
As we discussed earlier, Pain is often simply your body’s way of telling you that it desperately needs something—and what it need as is usually natural and not a chemical. Let’s review the key things it needs and how you can give your body what it needs naturally.
Sounds good! What’s first?
First you need to give the body the nutritional building blocks it needs to heal. Otherwise, your body cannot even begin to get well. As you’ve noticed, we’ve talked about the Energy Revitalization System vitamin powder and B complex a lot. This is because it has over 50 key nutrients to serve an enormous number of needs. I could write a 500+ page book on this alone, and it would take at least 35 tablets of supplements a day for you to get what’s in the 1 berry or orange flavored drink. Instead of all that, let me keep it simple and tell you you’ll be glad your patients took it! Many people have told me that this by itself eliminated their chronic pain!
Next, although the powder has most of the nutrients that your body needs, joints require other specific nutrients for healing in addition to what’s in the vitamin powder. So if you are treating arthritis, or back pain from arthritis of the spine bones (vertebrae), give Glucosamine Sulfate (500 mg 3 x day), and consider MSM (1.5-3 grams a day for 2-5 months). MSM supplies the Sulfur amino acids needed for healing in general. Although most of the research on MSM and arthritis have not been a placebo-controlled studies, one was and showed an 80% decrease in arthritis pain after six weeks using 1500 mg in the morning and 750 mg at lunchtime
Glucosamine sulfate is a cartilage building compound that has been found to be helpful in arthritis in many studies. Although its exact mechanism of action is not yet fully understood, it is a major component of the cartilage that is damaged in arthritic joints. Glucosamine taken by mouth is incorporated in the molecules that make up this cartilage likely contributing to the healing of arthritis. I recommend the sulfate form (as opposed to Glucosamine hydrochloride), as the sulfate can also help with wound/joint healing.
Unlike aspirin/NSAIDS that do not slow down destruction of joints in arthritis, Glucosamine has been shown to actually help stabilize and often heal the joints on x-ray! Doses of less than 1000 mg a day do not affect symptoms, and the standard dose is 500 mg 3 times a day. It can also be taken as 1500 mg once a day. It can be taken with or without food, and had no more side effects than placebo. Chondroitin sulfate is sometimes added to Glucosamine or taken by itself. Its benefits are modest as less than 10% of is absorbed as opposed to 90% for Glucosamine sulfate. Because of this, I rarely use Chondroitin. On the other hand, 1200 milligrams a day can be helpful in slowing down arthritis and is worth trying if you do not get adequate relief with the other treatments. It can be taken all at once or 400 mg 3 times a day with equal effectiveness.
Other nutrients are also critical for nerve healing and most of these are in the powder. One that is not that I would add if you have nerve pain is Lipoic acid 300-1000 mg/day. Alpha lipoic acid is an antioxidant which has been shown to be beneficial for diabetic neuropathy. Another study showed that it was also helpful in “burning mouth syndrome”. This syndrome is characterized by chronic pain on the tongue and sometimes the anterior palate and lips without any visible lesions. It is most often seen in postmenopausal women and has characteristics of being neuropathic pain. In a study of 60 patients, half received 200 mg of lipoic acid 3 times a day or placebo for 2-5 months. 97% of the patients improved versus 40% of those in the placebo group. 13% had complete resolution of their pain and another 74% had “decided improvement” where none of the placebo patients had this level of improvement. Almost all the patients showed some improvement by two months with 73% still showing benefit at the end of 12 months despite having stopped the treatment. That lipoic acid helps in several kinds of neuropathies suggest that it is worth trying in others as well, as it is quite benign and not very expensive.
SAM-e is a nutrient produced from trimethylglycine (betaine) in combination with multiple nutrients including B vitamins, folate, and inositol. It was initially tested and found to be effective in treating depression. Researchers also noted as an aside that it improved patients’ arthritis as effectively as anti-inflammatory medications (NSAIDS). A number of studies were done including one which gave 600 mg a day for 2 weeks followed by 400 mg daily for 2 years. Pain and stiffness decreased within one week and the improvement continued throughout the two-year trial. A study which reviewed seven other studies was inconclusive. A major problem with SAM-e is that it is not stable and breaks down easily, with many products not really delivering what they claim. In addition, it is quite expensive. An alternative that I prefer is to use the nutrients needed to make SAM-e in your body. Doing this in several patients (using the nutrients found in the Energy Revitalization System vitamin powder) resulted in increased blood levels of SAM-e similar to those found by taking 400-800 milligrams daily.
What else should I keep in mind for pain?
As noted above, pain is the body’s way of trying to get your attention. In addition to asking for nutritional support, pain also can be a sign that the patient needs 8+ hours of deep sleep a night, hormonal support, and to treat any underlying infections (especially yeast, parasites, and sinusitis). These and a host of other natural remedies (and how to tailor them to specific situations) are discussed at length in my new book “Pain Free 1-2-3!” and previous articles. For more information on over 150 available treatments (by category), including dosing and other patient instructions, click on the “treatment protocol” link on my website (bottom left at http://www.vitality101.com). This will give you detailed information on the different therapies available for each problem and how to use them.
With so many safe and effective natural remedies available for pain, it is no longer necessary for over 50 million Americans to be in chronic pain, and tens of thousands to die each year from NSAIDs and other pain medications! Isn’t it time for you to be Pain Free?
Maryon Stewart
Dr. Judith Orloff MD