Harpagophytum for musculoskeletal pain: a systematic review

Gagnier JJ^1,2, Chrubasik S^3,4, Manheimer E⁵

¹Faculty of Medicine, Department of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada

²Research Department, Canadian College of Naturopathic Medicine, Toronto, Ontario, Canada

³Department of Forensic Medicine, University of Freiburg, Freiburg, Germany

⁴Department of Pharmacy, University of Sydney, Herbal Medicines Research and Education Center, Sydney, Australia

⁵Faculty of Medicine, Department of Complementary Medicine, University of Maryland, USA

Introduction

Historically, Harpagophytum procumbens has been used for many conditions. Pharmacologic, in vitro and animal studies suggest the efficacy of this plant for rheumatic conditions.

Methods

We included only RCTs, quasi-randomised controlled trials and CCTs, with no language restrictions, using adults suffering from pain in the musculoskeletal system due to osteoarthritis, rheumatoid arthritis, or low back pain. We searched Embase, Medline, CINAHL, Cochrane controlled trials registry, Cochrane Musculoskeletal specialised register, dissertation abstracts, BIDS ISI and the Cochrane Complementary Medicine Fields Specialized Register up to September 2002. Methodological quality was assessed using the internal validity criteria from the Cochrane Back Review group.

Results

We isolated 13 trials meeting the criteria above. Because of clinical heterogeneity of the trials we conducted a qualitative review considering methodological quality and treatment effects. Methodological quality was poor in most trials. There were six trials on various forms of osteoarthritis, four trials on non-specific low back pain, and three including samples with mixed conditions.

Discussion

There is conflicting evidence for the use of a powdered extract of H. procumbens, at a daily dose equivalent of 57–60 mg harpagoside, in the treatment of mixed sites of osteoarthritis. There is limited evidence for the use of an ethanol extract of H. procumbens, at a daily dose equivalent of < 30 mg harpagoside, in the treatment of osteoarthritis of the knee or hip osteoarthritis.

Moderate evidence exists for the use of an aqueous extract of H. procumbens, at a daily dose equivalent to 100 mg and 60 mg (when compared with 12.5 mg rofecoxib) harpagoside, in the treatment of acute exacerbations of chronic non-specific low back pain. Strong evidence exists for the use of an aqueous extract of H. procumbens, at a daily dose equivalent of 50 mg harpagoside, in the treatment of acute exacerbations of chronic non-specific low back pain.

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