Can Herbs Help Osteoarthritis Symptoms? A Conclusive 'Maybe'
Evidence is lacking, and cautions abound -- but that doesn't mean herbal supplements are never helpful.
After about a year of intermittent shoulder pain that interfered with my ability to weight train and dance, I finally got an MRI. Looking at the scan, my orthopedic surgeon said, “I can’t do anything.” I didn’t have a torn rotator cuff, which is one of the most prevalent shoulder problems affecting older adults. “You have arthritis in that shoulder, and you’ll have to just do the best you can.”
Doing the best I can has meant very occasionally taking an ibuprofen, since I don’t like to take pills, using topical ointments such as Tiger’s Balm, and icing my shoulder after dancing and doing an upper-body workout. But the pain persists, and the other day my trainer said she thought her herbalist might be able to help. An herbalist? Complementary medicine has never been my thing. I’m aware that herbs, like drugs, can cause unwanted side effects; interact with drugs or with each other; and are potentially toxic, as a Consumer Reports article documented a couple of years ago. That article noted that of the more than 56,000 dietary supplement products (including herbal supplements) in the Natural Medicines Comprehensive Database, only about a third have some scientific support regarding safety and effectiveness.
What’s more, a recent comprehensive review of herbal products used to treat osteoarthritis found “little conclusive evidence” to justify their use. The authors of the review, which was published in the January 2012 issue of the British Medical Association’s Drug and Therapeutics Bulletin, cautioned that there have been few studies on the use of herbal medicines for osteoarthritis, and those that have been done contain design flaws that compromise the findings—e.g., variations in the chemical makeup of the supplements tested, small numbers or patients, short study duration (a particular issue for a chronic condition that persists over years).
“The clinical trial evidence, such as it is, indicates that ASUs [vegetable extracts of avocado or soybean oils], Indian frankincense, and rosehip, may work, and seem to produce few unwanted side effects,” according to the review. But the authors underscore that “More robust data are needed.” They also warn about “potentially dangerous interactions with other medicines”—for example, extensive use of nettle can interfere with drugs used to treat diabetes and high blood pressure, and willow bark can cause digestive symptoms and renal problems."
So what about that herbalist? Well, I don’t take any medications or other herbs that could interact with whatever she might suggest. And it would be nice to find something that quells the pain besides ice and rest. But how do I know whether an herb might cause some other kind of side effect-- nausea, dizziness, hives, whatever--if I’ve never taken one? Wouldn’t I have to be as careful as I would if I were taking a prescribed drug? And how would I know if it’s working? Could I distinguish between symptom relief due to rest or therapeutic exercises (to extend my range of motion and improve “tracking” of my shoulder) from whatever an herb might be doing?
Will I talk to the herbalist on the phone to explain my condition/symptoms? Probably. Will I make an appointment to see her and embark on herbal therapy? Possibly. But only if I’m convinced my other conservative treatments aren’t working.
But that’s me. People handle chronic conditions—and concomitant pain—differently. And when there’s no cure, it’s probably not harmful to try interventions for which there is no solid scientific evidence--as long as you’re careful about potential interactions and side effects, and don't spend too much money before you see any results.