Presented by: Phil Rasmussen
Date: 26 July 2022
Pain is a symptom of almost all human diseases, and pain management is an important and challenging issue for natural health clinicians. Available analgesic drugs often have limitations, while plant-derived preparations have long been used to help humans manage pain associated with an array of conditions. These and less drug-dependant approaches to pain management, have gained much interest in recent years.
Watch the webinar here.
Key learnings:
- A clinically focused webinar on the traditional and research-based evidence of plant medicines for pain management and conditions where pain is a prominent feature.
- A discussion on the different types of pain and identifying factors.
- Looking at specific medicinal plants and formulations aimed at addressing both aetiological factors as well as reducing symptoms.
- How to make informed decisions on introducing particular herbal medicines into the treatment regime to support patients in pain.
Questions & Answers:
Q. What would be your recommendation for a client that has vulvodynia pain and is taking oxycodone every 3-4 hours due to severe pain for alternative and/or complementary pain management?
A. This is a challenging one, as vulvodynia can be caused by several different factors and presents differently in different patients. If she is needing to take oxycodone every 3-4 hours, it is quite serious, as this is a strong opiate analgesic and wouldn’t normally be prescribed as a first-line treatment.
Trying to identify and address any underlying or contributory factors is recommended. It would be helpful to know what, if any, progress or insights have been made here. Also, the duration of the vulvodynia pain (by definition likely to be > 3 months) and what, if any, triggering or initiating factors have been identified. While often difficult to identify, hormonal factors, nerve injury from surgery or childbirth, or a history of post-traumatic stress or abuse may be contributory, and if so, an attempt should be made to treat, including with herbal medicines.
Aside from taking herbal analgesics and anti-inflammatories orally, local treatments/poultices/douches with gentle anti-inflammatory and soothing herbs such as marshmallow, hoheria, and ribwort may be helpful.
From a herbal analgesic perspective, trailing 1-2 herbs as alternatives to at least some of the oxycodone may be necessary, and reasonable doses would be required. Many herbs discussed during the 'Pain Management' webinar and some example formulas could be useful, including paeony, dong quai, turmeric, ginger, coptis, corydalis, horopito, and, if available, pukatea.
Q. If you are providing high doses of herbs for pain management (analgesic – as needed), would you still need to pay attention to staying below the maximum therapeutic dosage range per week?
A. No. There is a lot we don’t know about maximum therapeutic dosage ranges per week for each herbal extract. Doses recommended by most companies tend to be on the conservative side and are not suitable for all adult patients. Even with psychoactive or analgesic drugs such as antipsychotics or opiates, dosages can sometimes exceed manufacturer recommendations, as occasionally higher dosages are needed to invoke the therapeutic response required for a particular patient. Refer to the Phytomed Dosage Chart on the website for more information.
Q. Is Pukatea suitable for long-term use?
A. Yes. As with all drugs and herbal medicines, even if there could be issues with dependency or tolerance through long-term use, there are always situations and patients for whom such long-term use is appropriate. There is no evidence that long-term use of Pukatea leads to dependency or significant adverse events, but as with all analgesics, it should only be used long-term if the indications (such as intractable pain or pain poorly controlled by other more readily available herbs) warrant this. Each patient’s individual situation should be considered before making a clinical decision.
Q. Will Pukatea be available again in the future at Phytomed?
A. That is a tricky one. I’d like to say yes, but given how difficult it has been to source a sustainable supply of the bark from mature or flood-prone trees that have passed away, I can’t really say. In many parts of Aotearoa, there are a lot of Pukatea trees growing, and with climate change and increased flooding, some of these are likely to fall (which is the only time they are harvested) and should be made available to herbalists. However, we are still waiting for new suppliers to approach us.
Q. What would be your choice for the management of chronic MS?
A. This is challenging, and the herbal treatment should relate to the individual picture, symptomatology, history, concomitant illness, and stage of what is invariably a progressive condition. As with all neurological conditions, I focus on neuroprotective and neuro-restorative phytomedicines that can reduce neuron inflammation, such as ginkgo, bacopa, American ginseng, nigella, withania, and codonopsis. Medicinal fungi such as lion's mane and reishi may also be helpful, as can baical skullcap and, in some patients, certain forms of Cannabis sativa.
Q. What are your thoughts on using PEA and cannabis together on the endocannabinoid system for neuropathic pain?
A. I don’t see why this combination can't be used, given their mechanisms of action are likely somewhat different (PEA doesn’t just work on the endocannabinoid system). I would recommend introducing one at a time, and if the response is insufficient, then adding the other. Corydalis or nigella can also be good for neuropathic pain, with the latter protecting against cannabis-induced memory loss in rats.
Q. Can you share some more herbal information on vestibular conditions that involve headache/migraine pain with dizziness?
A. A differential diagnosis is important, and thorough investigations and consultation with a neurologist, if necessary, are crucial. Headaches and dizziness can indicate a range of conditions from minor (stress headaches) to serious (brain tumor). Understanding as much as possible about the history, manifestation, and causes is pivotal.
Vestibular migraine is a relatively new term given to many forms of headache with concomitant dizziness. As with other types of headaches, management should be individualized. Herbal treatments may include feverfew, larger-than-usual doses of ginger, lion's mane, baical skullcap, ginkgo, hawthorn, and analgesic herbs such as pukatea, corydalis, paeony, and cannabis.
Q. What is your recommendation for pain management for osteoporosis?
A. Black cohosh (Actaea racemosa) and paeony (Paeonia lactiflora) can be helpful, particularly where osteoporosis appears as a result of menopause or peri-menopause. Baical skullcap has useful anti-inflammatory effects and can protect against bone deterioration. Chinese privet (Ligustrum lucidum) fruits are also an underrated and often very helpful treatment and prophylactic for osteoporosis, supported by numerous animal studies and research. While not an analgesic per se, addressing the underlying condition causing the pain is key to ameliorating discomfort and making it more manageable.