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Getting “alternative” with nerve pain: Could herbal treatments be a source of relief?

The Bottom Line

  • More than 7 million Canadians suffer from chronic pain. Nerve pain is a hard-to-treat condition that contributes to these numbers.  
  • People with nerve pain are likely to try herbal treatments with the hopes of achieving pain reduction. 
  • Research on the use of two herbal treatments—nutmeg and St John’s wort—provides insufficient evidence on their benefits and harms, calling on the need for more studies. 
  • Proceed with caution if you decide to use such treatments, and always consult your health care team before commencing.  

It is estimated that over 7 million Canadians aged 15 or older suffer from chronic pain (1). This translates into 1 in 4 people living with this invisible and often debilitating condition that reduces their quality of life (1-3). Neuropathic pain, more simply referred to as nerve pain, is one type of pain that contributes to these case numbers. Nerve pain is caused by damage to the nerves (2). Damage can stem from a variety of injuries, conditions, and diseases—such as diabetes, a bout of shingles, and brain injuries (2;4).


Unfortunately, for those experiencing the tingling, burning, and stabbing sensations that accompany a nerve pain diagnosis, relief is not easy to come by (2). Despite the availability of numerous drug-based treatment options—including medications such as opioids, anti-seizure drugs, and antidepressants—it is reported that partial pain relief is only successfully attained by 40% to 60% of people (2;6). These lackluster results, coupled with the side effects associated with medication use, help us to better understand why people living with nerve pain often look to complementary and alternative strategies (2;6-9). One such strategy is herbal treatments.


Just like any treatment option, however, it is good to do your homework first to find out if the treatment is effective and if there are any harmful side effects to be aware of. The same is true for herbal treatments. A recent systematic review set out to do just that (2).


What the research tells us

The review investigated the use of herbal treatments in adults with moderate nerve pain and ended up including only two small studies. These studies specifically looked at nutmeg applied topically (i.e., to the skin) via a spray and St John’s wort taken orally in tablet form. They both also allowed the continued use of painkillers. Very low-quality evidence demonstrates that neither herbal treatment decreases pain compared to placebo. Breaking these findings down further shows that nutmeg does not appear to provide meaningful pain relief of 30% or greater. Similarly, St John’s wort was also not shown to reduce total pain scores. In terms of safety, both people using herbal treatments and the placebo reported minor side effects; there was no significant difference in the number of side effects experienced between the two groups. Eye pain and headaches and temporary and tolerable burning or stiffness were reported by those using nutmeg. Itching, dry mouth, sweating, nausea, stomach pain, fatigue, and diarrhea were reported by those using St John’s wort. However, these findings were also based on very low-quality evidence.


People looking for relief may be wondering how they should interpret these results, given the limited number of studies and the quality of the evidence. Ultimately, when looking at the whole picture, we are left with a lot of uncertainty about both the benefits and possible harms associated with nutmeg and St John’s wort. This means that, currently, we cannot draw conclusions on their effectiveness and safety; and that their use should be approached with caution until more research is available (2). Consult your health care team about your interest in using herbal treatments before starting. This allows for an examination of potential side effects and interactions with other medications, as well as a comprehensive conversation of all the traditional and complementary or alternative treatment options available.


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References

  1. Government of Canada. Canadian Pain Task Force report: October 2020. Working together to better understand, prevent and, manage chronic pain: What we heard. [Internet] 2020. [cited August 2021]. Available from https://www.canada.ca/en/health-canada/corporate/about-health-canada/public-engagement/external-advisory-bodies/canadian-pain-task-force/report-2020.html
  2. Boyd A, Bleakley C, Hurley DA, et al. Herbal medicinal products or preparations for neuropathic pain. Cochrane Database Syst Rev. 2019; 4:CD010528. doi: 10.1002/14651858.CD010528.pub4.
  3. GustorJ B, Dorner T, Likar R, et al. Prevalence of self-reported neuropathic pain and impact on quality of life: A prospective representative survey. Acta Anaesthesiol Scand. 2008; 52:132-136. doi: 10.1111/j.1399-6576.2007.01486.x. 
  4. Dworkin R, O'Connor A, Backonja M, et al. Pharmacologic management of neuropathic pain: Evidence-based recommendations. Pain. 2007; 132: 237-251. doi: 10.1016/j.pain.2007.08.033.
  5. National Institute for Health and Clinical Excellence. Neuropathic pain: The pharmacological management of neuropathic pain in adults in non-specialist settings. [Internet] 2020. [cited August 2021]. Available from https://www.nice.org.uk/guidance/cg173 
  6. Kanodia A, Legedza A, Davis R, et al. Perceived benefit of complementary and alternative medicine (CAM) for back pain: A national survey. J Am Board Fam Med. 2010; 23(3):354-362. doi: 10.3122/jabfm.2010.03.080252. 
  7. Metcalfe A, Williams J, McChesney J, et al. Use of complementary and alternative medicine by those with a chronic disease and the general population - Results of a national population based survey. BMC Complement Altern Med. 2010; 10:58-64. doi: 10.1186/1472-6882-10-58.
  8. Thomas K, Colmen P. Use of complementary or alternative medicine in general population in Great Britain, results of the National Omnibus Survey. J Public Health. 2004; 26:152-157. doi: 10.1093/pubmed/fdh139.

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