Focus on Alternative and Complementary Therapies
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Focus Alternat Complement Ther©2005 Pharmaceutical Press
Focus Altern Complement Ther 2003; 8: 139–40
The objective of this review was to assess the effectiveness and safety of botanical medicines in the treatment of non-specific low back pain (NSLBP).
The search strategy followed the recommendations of the Cochrane Back Review Group with additional terms for botanical medicine and plant names. We searched Medline, Embase, the Cochrane Controlled Trials Register, and the Cochrane Complementary Medicine field Trials Register to June 2002. Randomised controlled trials (RCTs), with no language restrictions were included that evaluated the effectiveness of botanical medicine in adult patients suffering from non-specific low back pain. Two reviewers independently assessed trial methodology and extracted data. Methodological quality was assessed using 12 internal validity criteria. Owing to clinical heterogeneity, a qualitative review was performed according to guidelines for a ‘best evidence synthesis’ (no evidence, limited evidence, moderate evidence, or strong evidence) taking into account methodological quality and trial findings.
Nine trials were included. The trials were clinically heterogeneous with regard to study populations and botanical medicines. Three trials used Harpagophytum procumbens of which all three were of high quality. Three trials used Salix alba of which two were of high quality and one low quality. Three trials used topical applications of Capsicum frutescens of which two were high quality and one of low quality. Subgroup analyses were not possible.
For H. procumbens, doses with the equivalent of 50–100 mg harpagoside appear to reduce acute episodes NSLBP compared with placebo, though more trials are required for the higher dose. Trials on S. alba indicate that daily doses with the equivalent of 120 mg and 240 mg salicin per day, in those with acute episodes of NSLBP, provide pain relief and improve functional status compared with placebo with the 240 mg dose being superior, although more trials are required for the lower dose. Trials on Capsicum frutescens indicate a probable improvement in low back pain, yet the type of low back pain that is responsive remains to be determined. Only one comparative trial with conventional treatments for each botanical medicine has been completed to date. Hence, more comparative trials are needed. Preliminary evidence suggests equivalence between comparators.
