Muscular skeletal inflammation
Inflammation can be generalized and due to an autoimmune process as in rheumatoid arthritis… or it can occur locally as a result of bruising, infection, burns, headaches, and sprains and strains. Caution should be exercised when treating inflammation without understanding its cause—this may delay diagnosis of conditions that could continue to worsen without medical attention.
Over the counter nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin , ibuprofen , and naproxen , are commonly used for mild inflammation. Prescription strength NSAIDs, including ibuprofen, naproxen , etodolac , and indomethacin , are prescribed when over the counter products are ineffective. Oral corticosteroids such as prednisone and methylprednisolone are often prescribed to reduce severe inflammation.
More recently, biologic agents such as etanercept (Enbrel), adalimumab (Humira), and infliximab (Remicade) have been developed to treat more serious inflammatory conditions. Since pain and inflammation go together, there has been much interest in the use of herbal remedies for inflammation. Capsaicin is an extract of cayenne pepper that may ease many types of chronic pain when applied regularly to the skin. In animal studies, capsaicin was consistently effective at reducing pain when given by mouth, by injection, or when applied topically. A controlled trial in humans found that application of a solution of capsaicin (0.075%) decreased sensitivity of skin to all noxious stimuli. In several uncontrolled and at least five controlled clinical trials, capsaicin has been consistently shown to decrease the pain of many disorders, including trigeminal neuralgia, shingles, diabetic neuropathy, osteoarthritis, and cluster headaches. For treatment of chronic pain, capsaicin ointment or cream (standardized to 0.025 to 0.075% capsaicin) is typically applied to the painful area four times per day. It is common to experience stinging and burning at the site of application, especially for the first week of treatment; avoid getting it in the eyes, mouth, or open sores. Preliminary reports from Chinese researchers also note that 75 mg per day of THP (an alkaloid from the plant corydalis) was effective in reducing nerve pain in 78% of those tested. As early as 1763, use of willow bark to decrease pain and inflammation was reported. Its constituents are chemically related to aspirin. These constituents may decrease pain by two methods: by interfering with the process of inflammation, and by interfering with pain-producing nerves in the spinal cord. No human studies have investigated the pain-relieving potential of willow bark, and questions have been raised as to the actual absorption of willow bark’s pain-relieving constituents. The potential pain-reducing action of willow is typically slower than that of aspirin. In animal research, alcohol/water extracts of plants from the genus phyllanthus (25 to 200 mg per 2.2 pounds body weight) have shown a marked ability to decrease pain. This family includes the plants Phyllanthus urinaria, P. caroliniensis, P. amarus, and P. niruri. Like aspirin, phyllanthus extracts appear to reduce pain by decreasing inflammation. Other herbs that have been historically used to relieve pain (although there are no modern scientific studies yet available) include valerian, passion flower, American scullcap, Piscidia erythrina, and crampbark (Viburnum opulus).
Transcutaneous electrical nerve stimulation (TENS) is a form of electrical physical therapy that has been used in the treatment of pain since the early 1970s. Pads are placed on the skin and a mild electrical current is sent through to block pain sensations. Many TENS units are small, portable, and may be hidden under clothing. A review of the first ten years of research on TENS described success rates in treating chronic pain varying from 12.5% to 92% after one year of treatment. Variations in success rates were attributed to differences in the type of pain the TENS was treating. More current research identifies specific conditions that consistently respond well to TENS therapy: rheumatoid arthritis, osteoarthritis, low back pain, phantom limb pain, and post-herpetic nerve pain (shingles). Pain caused by pinched nerves in the spine responds poorly to TENS therapy. While a small number of controlled trials have reported no benefit, most evidence suggests TENS is an effective form of therapy for many types of pain. Acupuncture has been shown to decrease pain by acting on the enkephalin-based, pain-killing pathways. In 1997, the National Institutes of Health (NIH) stated that acupuncture is useful for muscular, skeletal, and generalized pain, as well as for anesthesia and post-operative pain. The NIH statement was based on a critical review of over 67 controlled trials of acupuncture for pain control. Practitioners of manipulation report that it often produces immediate pain relief either in the area manipulated or elsewhere. Controlled trials have found that people given spinal manipulation may experience reduction in pain sensitivity of the skin in related areas, a reduction in joint and muscle tenderness in the area manipulated, and a decrease in elbow tenderness when the neck was manipulated. One study showed no effect of lower spine manipulation on sensitivity to deep pressure over low back muscles and ligaments. Some researchers have speculated that joint manipulation affects pain by enhancing the effects of endorphins. However, only one of three controlled studies has shown an effect of manipulation on endorphin levels.
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