The Herbal Treatment of Pain

Pain is a huge topic. Pain can come from trauma, pressure on nerves, from the wear and tear of osteoarthritis, inflammation due to allergens or pollutants that can set off autoimmune reactions, low Vitamin D status, expanding cartilage under weak bones (osteomalacia), retained placentas, stress, anxiety, PTSD, even viral causes. So the first order of business is to get diagnosed, not only by a western MD but by an herbalist or doctor of Auyrveda or Chinese medicine who knows how do pattern diagnosis. Pain specialists, both eastern and western may be better able to work with chronic pain than general practitioners.

You want the solution that will give you relief without significant side effects that can damage your liver, cause significant weight gain, create internal scarring or cause tolerance or even addiction. So I urge you to look to the natural remedies first: diet, herbs, acupuncture, massage, chiropractic, physical therapy, exercise like qigong, yoga, pilates, moderate aerobics and weight training before surgery, injections and heavy drugs. For people with lower back pain there are devices like the Sacro Wedgie that help rebalance the sacrum and pelvis. And hanging, either with an inversion table or a slant board can space out your vertebrae (but you will need to do core strengthening exercises to keep it open.) Natural remedies may be slower, and you may need more than one to get synergistic relief, but they are more effective in the long run.

But don’t just tough it out. My father had serious pain in his hip, caused by a vertebra that pressed on a nerve. The pain upset his electrolyte balance to the extent that he had to be hospitalized for days to rebalance it. We found that this condition, known as SIADH, can be caused by either pain or pain-killing medications which stimulate the kidneys to inappropriately secrete ADH and this can be fatal.

First of all, make sure you have enough Vitamin D and Magnesium, both of which are chronically low, even in people who take vitamins. (Even bone vitamins only have enough D or magnesium to affect your calcium intake, not enough for their own account.) Ask your doctor for a Vitamin D blood test at your next visit. You want a 25 Hydroxy Vitamin D level of 60-100 ng/ml. If you use Quest Diagnostics, they use a different methodology which tends to overstate Vitamin D levels by a third, so divide by 1.3. Do not look at the reference ranges, look at the numbers, because the reference ranges are based on the averages of a vitamin D-deficient population. Daily doses should probably be in the range of 5000-20,000 iu of D3, with the obese, diabetics or cancer patients taking even more. People who cover for religious reasons should probably go to the higher levels too. (You would get 25,000-35,000 iu from the sun and you cannot overdose on Vitamin D from sunlight, so that is a physiological dose.) There is no longer enough magnesium in the food supply to meet the per capita population needs since much of it has blown out to sea due to poor agricultural practices. (It went down a third between the mid ’70s and mid ’90s, and who knows how much since then?) Unless you regularly eat seaweeds, you are probably deficient. People with Diabetes, IBS or Crohn’s or on blood pressure meds, heart medications, birth control pills, menopausal pills, and a host of other pharmaceuticals can also be deficient. I suggest 800mg of magnesium citrate, aspartate or orotate daily.

Keep your Omega 3s high in the form of fish oil, since they have a direct effect on inflammation and pain. Flax seed oil will probably not work- you need about 30 times the dosage and many people lack the genetic ability to convert it. So do people with impaired immune systems. Cod liver oil can also be useful, but the brand is important to get the right A/D balance. The Weston Price Foundation suggests Carlson’s, Blue Ice (online only), NOW, Twin Labs and Sonne. Avoid seed oils (Crisco, cottonseed oil, canola, peanut or linseed oils) because they will change your omega 3/6 ratio. Cook in oils that do not degrade into inflammatory compounds from heat: coconut oil, red palm oil, ghee, or rendered animal fat.

I am not otherwise going into supplements, but they include glucosamine, systemic enzymes such as serrapeptase (or silkworm in Chinese medicine), bromelain from non-irradiated pineapples, Wobenzyme and similar products, You can also try making a bone soup from cartilage-rich cracked bones, crab or shellfish shells from clean waters. The book Nourishing Traditions has good information.

Reduce sources of allergens and pollutants in your life. Allergens like gluten, soy, corn and dairy can cause painful autoimmune reactions like lupus, RA, fibromyalgia and similar conditions. So can nightshade sensitivity although only a small proportion of the population is really allergic. Heavy metal toxicity can reduce antioxidant levels in the body and can come from either a genetic predisposition to accumulate the metals or excessive exposure. Cilantro and chlorella have NOT been found to increase excreted levels in the hair, sweat, urine and stools, despite significant internet claims that they do, based on a bogus Japanese study. Garlic, malic acid from apples, EDTA and chelation will reduce levels, but go to someone who knows what they are doing so you don’t just stir up toxins to be redeposited somewhere else in your body.

When I treat pain, I look at the underlying condition. While I may use analgesic (painkilling) herbs first, the root cause must be dealt with. So core muscles may need to be adjusted and strengthened to pull a vertebra off of a nerve before St John’s wort or Jamaica dogwood will do much. You can give some palliative care with herbs and acupuncture, but they won’t last until the root condition is resolved. Similarly, an autoimmune patient may need to go off of gluten and dairy. The immune system for someone with chronic Lyme disease may need to be tonified so the virus does not flare up again. Or inflammation from excessive carbohydrates and bad fats may need to be treated with diet and turmeric before the pain really recedes. Knee and foot pain from obesity needs weight loss for long term resolution.

And then there are the herbs:

California poppy (Eschscholzia californica) is a mild analgesic, good for stress headaches and is not to be confused with its opiate-containing cousins.

Opium poppy (Papaver somniferum) is a strong analgesic, not legal in the US but used elsewhere. Lettuce (Lactuca virosa) contains small amounts of the opiates but as a tincture is quite weak. An extracted concretion cooked down from the latex called Lactucarium is stronger but does not approach illegal opiods- if you need that, get a prescription.

Frankincense (Olibanum or Boswellia carterii) and myrrh ( Commiphora Myrrha) are famously good for pain and gum guggul ( Commiphora Mommol) should work the same way. They increase the circulation and are antiseptic and antimicrobial as well. Especially good for trauma with congealed blood, bruises, cardiac pain due to angina and arthralgias that are worse with wind or dampness and as an emmenagogue good for painful menstruation.

Corydalis yanhusuo is used like the opiates in Chinese medicine. A decoction of simmered yanhusuo reduces pain and increases circulation. Good for stabbing pain, trauma, fibroid pain and spasmodic gallbladder pain (but get the gallbladder checked so your ducts don’t get blocked).

Kava kava (Piper methysticum) is used for genitourinary pain, fibromyalgia, and pain accompanied by anxiety. It is used in conditions classified by Chinese medicine as “Liver wind” arthralgias. You should use a water extraction or fluid extract as solvent extraction may release undesirable compounds. Not legal in Canada, but a very effective herb which is safe in water or moderate alcohol extractions. Peppery flavor which can cause numbness.

St. John’s wort is traditionally used for nerve pain, despite its modern reputation for depression. It is antispasmodic and antiviral as well. However St. John’s wort can reduce the effectiveness of pharmaceutical painkillers or other meds if you are taking both at the same time. The herb speeds the phase 1 detoxification process of the liver (CYP3A4, CYP206, CYP2E1 and P. glycoprotein pump) which reduces the concentration of certain drugs in your bloodstream by metabolizing them faster. According to David Winston, St. John’s wort can increase metabolism of protease inhibitors (Indinivir), Cyclosporin, Digoxin, Irinotecan, Warfarin, R&S Verapamil, Voriconazale, Vabradine, Atorvastatin, Talinolol, Omeprazole, Imatinab Mesylate, Simvastatin, Methadone, and Amitriptyline (tricyclic antidepressant), thus reducing blood levels. It may also affect oral contraceptive pills and Quazepam. In human studies it did not affect Prednisone, Ibuprofen, Theophylline, Pravastatin, or Carbamazepine. (Materia Medica, unpublished draft) Check with your pharmacist or Registered Herbalist or look up the detoxification pathways for all your medications on the web.

Jamaica dogwood (Piscidia Erythrina) is excellent for nerve pain, facial nerve pain (especially from Bell’s Palsy) and is also antispasmodic which makes it good for menstrual pain. Be careful of the source as the tree is uncommon and there are alternate species on the market.

Indian pipe (Monotropa uniflora) is a saprophyte which is too rare for large commercial use but may be harvested and tinctured where it is locally abundant. Make sure you have an ethical source. It was used by the Cherokee and the Eclectics for pain for those with a very low pain threshold. Antispasmodic, tonic, sedative, nervine and anticonvulsive, it was also used for the pain of gonorrhea before the advent of antibiotics.

A number of other herbs may be combined for pain if you have a formula derived by an herbalist. For instance blood movers like turmeric, cyperus or cayenne may reduce inflammation and reduce blockages. Avena sativa, milky stage oats, can nourish the nerves and build bones. Herbs may direct where other pain-killing herbs go- achyranthes for instance is a “medicine horse” that directs herbs down to the knees. And inflammation may be accompanied by low level infection, which is why berberine-containing herbs like coptis, Oregon grape, Baikal skullcap and goldenseal may be used in pain formulas. You may also have herbs that generate fluids like rhemannia or asparagus root or oiophogon tubers in arthritis formulas where joint fluids are scarce.

Herbs work best when you can taste them. Your taste is not merely aesthetic: it prepares your body to use the herbs, stimulating the secretion of bile and other digestive juices. So teas, infusions (sitting on the herbs for 15 minutes to 24 hours), decoctions (simmered for 20 or so minutes), tinctures (in alcohol) and fluid extracts (combined cooking and alcohol extraction) are better than capsules, allow a sufficient dose and can reduce side effects because less can be ingested. While the alcohol in tinctures enhances absorption by 10% and moves blood which is generally useful for pain, glycerin usually slows absorption by 30% according to David Winston. The one exception to this I have found is Cedar Bear’s Tinct Tract extracts which uses a proprietary method to enhance absorption. My favorite tincture brands are Herbalist & Alchemist and Herb Pharm, both of which have exceptional sourcing and extraction methods. I may use others including my own for less tricky extractions or herbs which are broadly available in the quality I prefer, but those would be best for the Jamaica Dogwood or Indian Pipe.

The three health conditions that take the most lasting toll on happiness are depression, chronic pain and insomnia. (One can get over losing a leg or an arm more readily.) If we can help these three alone we can make a significant impact on the happiness of a population. Pain itself can cause depression and insomnia. While giving analgesics alone -pharmaceutical or herbal- is not a cure, it can often help sleep which in turn will lessen pain and depression. But it is important to look at lifestyle, physical conditions, allergens and pollutants and to treat those for lasting effect.