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Herbal Medicine for Low Back Pain

A Cochrane Review

Gagnier, Joel J., ND, MSc, PhD*,†; Oltean, Hanna, MPH*; van Tulder, Maurits W., PhD; Berman, Brian M., MD§; Bombardier, Claire, MD; Robbins, Christopher B., PhD*

doi: 10.1097/BRS.0000000000001310

Study Design. Systematic review of randomized controlled trials (RCTs).

Objectives. To determine the effectiveness of herbal medicine for nonspecific low back pain (LBP).

Summary of Background Data. Many people with chronic LBP use complementary and alternative medicine (CAM), visit CAM practitioners, or both. Several herbal medicines have been purported for use in treating people with LBP. This is an update of a Cochrane Review first published in 2006.

Methods. We searched numerous electronic databases up to September 2014; checked reference lists in review articles, guidelines and retrieved trials; and personally contacted individuals with expertise in this area. We included RCTs examining adults (over 18 years of age) suffering from acute, sub-acute, or chronic nonspecific LBP. The interventions were herbal medicines that we defined as plants used for medicinal purposes in any form. Primary outcome measures were pain and function. Two review authors assessed risk of bias, GRADE criteria (GRADE 2004), and CONSORT compliance and a random subset were compared with assessments by a third individual. Two review authors assessed clinical relevance and resolved any disagreements by consensus.

Results. Fourteen RCTs (2050 participants) were included. Capsicum frutescens (cayenne) reduces pain more than placebo. Although Harpagophytum procumbens (devil's claw), Salix alba (white willow bark), Symphytum officinale L. (comfrey), Solidago chilensis (Brazilian arnica), and lavender essential oil also seem to reduce pain more than placebo, evidence for these substances was of moderate quality at best. No significant adverse events were noted within the included trials.

Conclusions. Additional well-designed large trials are needed to test these herbal medicines against standard treatments. In general, the completeness of reporting in these trials was poor. Trialists should refer to the CONSORT statement extension for reporting trials of herbal medicine interventions.

Level of Evidence: N/A

*Departments of Orthopaedic Surgery, Ann Arbor, MI

Epidemiology, University of Michigan, Ann Arbor, MI

Department of Health Sciences, Faculty of Earth and Life Sciences, VU University, Amsterdam, Netherlands

§Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD

Institute for Work & Health, Toronto, ON, Canada.

Address correspondence and reprint requests to Dr. Joel J. Gagnier, ND, MSc, PhD, MedSport, University of Michigan, Domino's Farms, Lobby A, 24 Frank Lloyd Wright Drive, Ann Arbor, MI; E-mail:

Received 5 October, 2015

Accepted 6 October, 2015

This review is adapted from the Cochrane Review ‘Oltean H, Robbins C, van Tulder MW, Berman BM, Bombardier C, Gagnier JJ. Herbal medicine for low back pain. The Cochrane Database of Systematic Reviews 2014, Issue 12. Art. No.: CD004504. DOI: 10.1002/14651858.CD004504.pub4’. Copyright Cochrane Library, reproduced with permission.

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

No funds were received in support of this work.

Relevant financial activities outside the submitted work: consultancy, grants, payment for lectures, travel/accommodations/meeting expenses.

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