Solving the pain puzzle
Whether it’s a headache, sore muscles or arthritis, when pain strikes, life suddenly seems to stop. So you reach for the aspirin, or maybe the ibuprofen or naproxen. If you suffer from chronic pain, you may look to even stronger drugs to ease your suffering. But, while over-the-counter and prescription pain relievers can temporarily interrupt pain, most come with undesirable, even dangerous, side effects — and some may actually worsen the problem by inhibiting the healing process.
We all know what pain feels like, but few of us know the biology behind the “ouch” factor. Pain is a result of inflammation. When you are injured, the body responds with cyclooxygenase-2 or COX-2, a recently discovered enzyme related to COX-1. While COX-1 enzymes are responsible for maintaining balance in the stomach and kidneys, COX-2 involves turning a stored fat called arachidonic acid into prostaglandins, which inflame injured areas and lead to pain.
Enter nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen or naproxen, over-the-counter remedies that work by inhibiting COX-1 and COX-2 enzymes. Although NSAIDs are the most popular pain-relief medications, long-term use can result in gastrointestinal upset, peptic ulcers and intestinal bleeding, and may even contribute to colon, kidney or liver damage. In fact, a report in The American Journal of Medicine revealed that more than 107,000 people are hospitalized each year due to complications from NSAID use.
In an effort to soothe pain without leaving users vulnerable to these side effects, researchers have created a new generation of COX-2 inhibitors. Sold under the names Celebrex and Vioxx, these drugs also relieve pain and inflammation, but because they only target the COX-2 enzyme, they carry fewer gastrointestinal risks than traditional NSAIDs. Better yet, studies have found that Celebrex was just as effective at stopping pain as narcotics without the risk of addiction, and Vioxx could conquer the toughest menstrual cramps. While these drugs were being hailed as the new “safe” aspirin, disturbing reports began to surface. Users reported several side effects, including diarrhea, headaches, respiratory infections, dizziness and skin rashes. Researchers from the University of California at Irvine found that these new pain relievers could worsen colitis and interfere with the healing of gastric ulcers. Of greater concern, the U.S. Food and Drug Administration received reports of 10 deaths within months of the release of Celebrex and both drugs were found to increase heart-attack risk. In fact, a recent meta-analysis of 23,407 patients found that these new drugs significantly increase the risk of heart attack.
Fortunately, a number of natural methods can defeat pain without relying on risky over-the-counter and prescription drugs. The following herbs offer relief through their anti-inflammatory and analgesic properties. But, instead of dealing a deathblow to COX-2, these herbs modulate the production of prostaglandins, thereby keeping inflammation in check.
Boswellia (Boswellia serrata): Long used by Ayurvedic practitioners to treat inflammatory diseases, boswellia binds to the enzymes that cause inflammation. German researchers recently found that the herb is an effective remedy for the chronic pain associated with rheumatoid arthritis. To ease arthritic pain, take 150 mg three times daily.
Devil’s claw (Harpagophytum procumbens): Because it is rich in potent anti-inflammatory and analgesic compounds, most researchers credit the iridoid glycosides in devil’s claw for this herb’s pain-relieving potential. During one double-blind, placebo-controlled trial, 63 participants with lower-back pain took devil’s claw or a placebo for four weeks. At the end of the study, those taking the herb reported a significant improvement in muscular pain and stiffness compared to the placebo group. While the recommended dosage to alleviate pain is 100 to 250 mg three times a day, don’t take this herb if you suffer from ulcers or gallstones or if you’re taking warfarin.
Ginger (Zingiber officinale): This tasty herb, traditionally used to soothe digestive woes, is also a potent COX-2 inhibitor. The keys, say researchers, are gingerols — compounds that hamper the release of arachidonic acid. In a study conducted at the University of Sydney, Australia, researchers found that ginger was just as effective as aspirin at inhibiting COX-2. For best results, take 2,000 to 4,000 mg a day or drink 3 to 4 cups of ginger tea. Although ginger is a safe herb, it may interact with some cancer drugs and certain blood-thinning medications.
Turmeric (Curcuma longa): In a double-blind clinical trial conducted by New York’s Presbyterian Hospital and Cornell University, arthritis patients given turmeric reported a significant decrease in inflammation. The reason behind the herb’s effectiveness is curcumin, the compound that gives turmeric its deep-yellow color. Curcumin directly inhibits the COX-2 enzyme and the formation of prostaglandins. For chronic pain, take 400 to 600 mg of a standardized curcumin supplement three times daily.
Willow bark (Salix spp.): Often called “herbal aspirin,” willow bark is a natural source of salicylic acid — the active compound in aspirin. When they compared it to Vioxx, Australian researchers found willow bark just as effective as the pharmaceutical drug for pain and inflammation, but without its negative side effects. The recommended dosage is 1,000 to 3,000 mg of the powdered herb daily as needed. Although willow bark has been safely used for 3,500 years, do not use the herb if you are allergic to aspirin. Rarely, willow can cause stomach upset in aspirin-sensitive individuals; reduce the dose or discontinue the herb if this occurs. People taking anticoagulant or antiplatelet medications should also avoid using willow bark.
Sometimes popping a pill isn’t the most effective way to deal with pain. Muscle aches, sprains and arthritis can all benefit from the following topical remedies.
Arnica (Arnica spp.): Athletes have relied on arnica for years to reduce the swelling and bruising that accompanies sprains. But this homeopathic remedy is just as effective for arthritis or everyday muscle aches. A group of researchers from the Queen Victoria Hospital in Sussex, England, also found that arnica is a first-line defense against the pain of carpal tunnel syndrome. Arnica is available as a ready-to-use ointment or cream — follow package directions for application guidelines.
Cayenne pepper (Capsicum annuum): Cayenne’s primary anti-inflammatory component, capsaicin, works by interrupting the formation of COX-2. Research shows that capsaicin not only reduces pain and inflammation, it significantly improves range of motion. In one study at Craigavon Hospital in Ireland, researchers found that creams containing capsaicin can even reduce shooting pain. For the most effective pain relief, use a cayenne cream containing 0.025 to 0.075 percent capsaicin one to four times a day. But, since this remedy can be fiery, test it on a small area first and never apply it near the eyes or on broken skin.
Kim Erickson is a frequent contributor and author of Drop Dead Gorgeous: Protecting Yourself from the Hidden Dangers of Cosmetics (Contemporary, 2002).
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