468 Herbal medicines of some benefit for low back pain

September 28, 2015

written by Brian R McAvoy.

Clinical question
Compared with placebo or rofecoxib, how effective are herbal medicines for non-specific low back pain?

Bottom line
Specific herbal medicines were effective for short-term (4-6 weeks) improvement in pain and functional status for individuals with acute episodes of chronic, non-specific low back pain (LBP). There was moderate evidence for cayenne, and less for devil’s claw, white willow bark, comfrey, Brazilian arnica and lavender essential oil. Adverse effects were limited to mild, transient gastrointestinal complaints or skin irritation.

Caveat
Most trials were at low risk of bias but the quality of the evidence was mainly very low to moderate. Trials only tested the effects of short-term use (up to 6 weeks). Rofecoxib has now been withdrawn due to adverse effects. Authors of 8 of the included trials had a potential conflict of interest and 4 other authors did not disclose conflicts of interest. There was no evidence that any of these substances were safe or efficacious for long-term use.

Context
LBP is a common condition, affecting up to 35% of the population in any given month. A large proportion of people with chronic LBP use complementary and alternative medicines, including herbal medicines.

Cochrane Systematic Review
Oltean H et al. Herbal medicine for low-back pain. Cochrane Reviews, 2014, Issue 12. Art. No.: CD004504.DOI: 10.1002/14651858. CD004504.pub4. This review contains 14 studies involving 2050 participants.

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.