27. Wu MS, Aquino LBB, Barbaza MYU, et al. Anti-Inflammatory and Anticancer Properties of Bioactive Compounds from Sesamum indicum L.-A Review. Molecules. 2019;24(24):4426. doi:10.3390/molecules24244426
A recent trend in guidelines favors topical formulations when evidence for efficacy exists. One example is the American College of Rheumatology (ACR) guidelines for hand and knee osteoarthritis which recommend the use of topical NSAIDs ahead of oral NSAIDs due to an improved side effect profile and comparable efficacy, especially in elderly populations. 1,2
8. García Rodríguez LA, Barreales Tolosa L. Risk of upper gastrointestinal complications among users of traditional NSAIDs and COXIBs in the general population. Gastroenterology. 2007;132:498–506.
Topical Phytochemicals: Arnica montana, Comfrey, Sesame
5. Derry S, Wiffen PJ, Kalso EA, et al. Topical analgesics for acute and chronic pain in adults – an overview of Cochrane Reviews. Cochrane Database Syst Rev. 2017;5(5):CD008609. Published 2017 May 12. doi:10.1002/14651858.CD008609.pub2
11. Altman RD, Dreiser RL, Fisher CL, et al. Diclofenac sodium gel in patients with primary hand osteoarthritis: a randomized, double‐blind, placebo‐controlled trial. J Rheumatol. 2009;36(9):1991‐9. [DOI: 10.3899/jrheum.081316]
The mechanism by which comfrey-containing products exert their analgesic effects is thought to be reliant on the active ingredient, rosmarinic acid. Rosmarinic acid has been studied in vitro with results that suggest this compound’s ability to inhibit the expression of cytokines may yield anti-inflammatory properties. 19 Rosmarinic acid has also been shown to inhibit prostaglandin synthesis in vivo, which further explains the anti-inflammatory properties denoted with comfrey containing products. 20
Gianetti and colleagues conducted a similar study utilizing placebo control as opposed to a reference product in a double-blind, multicenter, RCT. 25 Investigators assessed pain in motion for acute upper and lower back injuries, similar to Kucera et al’s work. The primary endpoint in this trial was also pain in motion as assessed by VAS with secondary outcomes including pain at rest and global assessment of efficacy by the patient and investigator. Results for the primary outcome of this study were highly significant with an average reduction in VAS score of approximately 95.2% in the comfrey-containing arm compared to a 37.8% reduction in the placebo arm. Results also demonstrated a rapid onset of action with a 33% reduction experienced within the first hour of application in the comfrey-containing group. Adverse events reported in this study were mild in nature and were not significantly different than that of placebo.
Others benefit from a daily preventive, such as a tricyclic antidepressant or the blood pressure drug propranolol (Inderal and generic).
While opioids may be a useful part of a postsurgical pain plan in the short term, they are not a cure-all.
“Many older adults may be taking opioids unnecessarily,” says David Ring, M.D., Ph.D., professor of surgery and psychiatry at Dell Medical School at the University of Texas at Austin and a spokesperson for the American Academy of Orthopaedic Surgeons.
But these need to be prescribed with caution for anyone who already has heart disease, high blood pressure, or other risk factors.
“The safety profile is much better, and the effectiveness is quite similar to most drug therapies,” says Roger Chou, M.D., professor of medicine at Oregon Health & Science University in Portland.
For chronic back pain that’s not responding to these measures or to prescription-strength nonsteroidal anti-inflammatory drugs (NSAIDs), the ACP recommends the prescription pain pill tramadol (Ultram and generic) or the antidepressant duloxetine (Cymbalta and generic). But both have a small effect; you’ll still need to use nondrug methods.
If these steps don’t help, consider trying a topical prescription NSAID. But think twice about using diclofenac (Voltaren and generic), which has been linked to an increased risk of heart attack and stroke.