Natural Antiinflammatory Agents for Pain Relief in Athletes

Joseph C. Maroon, M.D.; Jeffrey W. Bost, P.A.-C.; Meghan K. Borden; Keith M. Lorenz; Nathan A. Ross

Disclosures

Neurosurg Focus. 2006;21(4) 

In This Article

Rediscovery of Alternative Antiinflammatory Agents

Pain reduction through the use of pharmacologically derived antiinflammatory agents has been one of the greatest contributions of modern medicine. Despite the sophistication of drug design, however, major complications are still associated with virtually all medications used for pain reduction. On the other hand, plant-derived nutraceutical preparations have been used for hundreds and even thousands of years to obtain effective pain relief, and herbal medications are becoming increasingly popular because of their relatively few side effects. Nevertheless, there are problems associated with these dietary supplements, and their use requires knowledge of their biological action, clinical studies (both affirmative and negative), and potential interactions with other nutraceutical products and prescription medications. Their evaluation with appropriately designed controlled studies has exploded in recent years, and the findings must be viewed with a greater degree of confidence due to the study designs and quality of the investigators. The distribution of information on dietary supplements is often limited to media reports, and despite the quality of the studies, there is often limited information transferred to the medical community compared with studies of pharmacological discoveries, which are heavily reported by the pharmaceutical industry. It is important for healthcare practitioners to learn in a scientific and critical way about the various dietary supplements their patients are taking.

The processes used to prepare herb-derived compounds pose complications when it comes to determining the quantity and concentration of the products.[46,96,149] The preparation processes are not standardized, and therefore the extraction process and the type of plant used may affect the true concentration of the product. In addition, there is a lack of uniformity within and between manufacturers. It can be difficult to determine which product and manufacturer offers the best consistency. Although standardization is unlikely, most products from major US manufacturers will be of a higher quality. Although in the US dietary supplements are not held to the same rigorous testing and standards as pharmaceutically derived medications, there are many regulations that still control their manufacture, because these are food products. The US government, through the FDA and other agencies, routinely inspects the manufacture of vitamins or supplements made in this country, as it would for any food product. [46,96,109,149] Contaminants, such as the recently discovered high lead content found in various Ayurvedic preparations that were made by an Indian manufacturer and imported into the US,[46,93,96,149] are generally thought to be uncommon, but can be a concern when purchasing imported supplements.

Because the FDA will not allow claims that vitamins or supplements can treat or cure a medical condition to be placed on the packages of dietary supplements, any claims must be vague and nonclinical, unless an FDA-approved trial has been completed. Due to the multibillion-dollar sales of nutraceutical products, and the desire of some manufacturers to inflate claims and perhaps not cite possible side effects, one must be cautious about various drug interactions, particularly bleeding complications associated with white willow bark, ginger, garlic, and others. Therefore, such medicinal preparations are not without risk. Many supplements, however, including those just listed, have been the subject of hundreds if not thousands of scientific reports and trials indicating both safety and efficacy. Supplements that can affect the inflammatory pathways are some of the most studied, and there are many reports substantiating their effectiveness. Because these are natural products, we believe they should be clear candidates as alternatives to pharmaceutical antiinflammatory agents in all patients, not just athletes. We have recently published a study in which omega-3 EFAs were used as an alternative and/or complementary agent to NSAIDs to treat spine-related pain successfully in our patient series, which also included both amateur and professional athletes.[108] Capsaicin, oil of camphor, and other natural topical preparations are commonly used for muscle soreness and local application for painful traumatic injuries.[21,29,30,116] Additional scientific studies are needed to elucidate further the potential applications of natural agents in the treatment of traumatically induced pain syndromes. Nevertheless, with hundreds of studies now completed and very positive personal testimonials, there are now early indications that many natural supplements have a place in treating pain and its root cause, inflammation.

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