Submitted by: Asti Renaut, Naturopath & Herbalist
Client: Male, 27 years old
Initial presentation: Presenting with rheumatic bilateral dorsal foot pain, worst in metatarsophalangeal joints of big toe and middle 3 toes. Patient spends up to 8 hours at a stretch standing at work on concrete floors.
Patient wants to come off his daily dose of diclofenac, but cannot tolerate pain after 1-2 days without medication. Pain is “like a broken bone”, shooting pain, worse for weight bearing, worse in the morning and better for movement.
History: Pain in feet started suddenly, accompanied by shoulder pain, and diagnoses at the time of onset varied. Patient was given prednisone. Soon after onset patient developed measles, following which shoulder pain was gone but foot pain remained. Patient was taken off prednisone and put on diclofenac.
Rheumatologist diagnosed possible Rheumatoid Arthritis, but this was not conclusive. ANA is elevated, as well as CRP and ESR, but patient is not Rheumatoid Factor positive.
Patient has been on diclofenac for 5 months, initially 75mg 1-2x daily, and now once daily only. After a brief phone call patient started on Epsom salt footbaths and topical salve with Kawakawa and Rosemary applied twice daily as a massage. Also Ginger tea, dietary changes and Cod Liver Oil. At time of consultation patient had been on these supplements for 4 months. The footbaths had helped to relieve swelling, but no other changes were noted, as diclofenac was keeping pain at bay.
Patient wishes to keep treatment as simple and inexpensive as possible.
Herbal Pain Formula:
- Pukatea 70% Ginger 5% Liquorice 25% mitte 50ml, 10ml 2-3x daily, taken for first 2-3 days
- Devil's Claw 40% Kumerahou 40% Ginger 5% Liquorice 15% Peppermint 10% mitte 50ml, 10ml 2-3x daily, taken for next 2-3 days
1 week later: patient report first tonic was ineffective, but 2nd one has been good and he has not needed diclofenac since starting on it. Repeat Devil's Claw/Kumerahou tonic 210ml.
2 weeks later: patient has still not taken any diclofenac and feels no pain in feet. I am interested to see which of the two main herbs is more effective, so give the following:
- Devil's Claw 80% Liquorice 15% Ginger 5% Mitte 100ml, 5ml bd. To be taken for the first 10 days
- Kumerahou 70% Liquorice 25% Ginger 5% Mitte 100ml, 5ml bd. To be taken for the next 10 days
3 weeks later: patient is still pain-free and reports that both tonics were good, and “if anything, the 2nd one was slightly better”. His feet have been fine, he just needs to retrain his body not to limp!
Repeat Kumerahou tonic, at reduced maintenance dose of 5ml once daily.
1 month later: patient continues to do well. At our next appointment we will look at reducing dose further or coming off tonic all together.
Practitioner Comments
This was a case of trial and error, an exploratory case of finding out which herbs work best for rheumatic pain.
It was interesting to note that Pukatea, usually a very effective pain herb, was ineffective for rheumatic pain in this instance.
Kumerahou has traditionally been used for rheumatic conditions, and has alterative, anti-microbial and kidney tonic effects which may contribute.
The Ginger and Liquorice were a common denominator in all the tonics, but I doubt very much if these were the sole cause of the reduction in pain and inflammation, something indicated specifically by the fact that they were in the Pukatea tonic, but this was not effective.
I like that the Liquorice and the Kumerahou will also be helping to heal any GIT damage done due to 5-6 months of NSAID use. Obviously there are potentially other systemic immune issues that may need to be addressed, but for me as a practitioner this was an instructive case in learning the potential for herbal pain relief.