Dr. Jacob Teitelbaum discusses some of his favorite natural therapies for pain — from willow bark to passionflower.
Pain Free 1-2-3 (McGraw-Hill, 2006) demonstrates the three critical components for healing tissue: getting optimum nutrition and sleep, correcting hormonal levels, and eliminating the factors that put stress on the body. Dr. Jacob Teitelbaum provides more than 100 treatments combining both natural and prescription approaches to guide you in aiding the body in healing, locating the source of pain and tailoring treatments for maximum effect. The excerpt below comes from chapter 11, “Natural Therapies.”
You can buy this book in the MOTHER EARTH NEWS store: Pain Free 1-2-3.
Many natural therapies can be very helpful for pain. My three favorite pain-relieving herbs are willow bark, boswellia, and cherry. Let's look more closely at these three herbs.
Willow bark is the original source of aspirin, but when used as the entire herb it has been found to be much safer than aspirin and more effective. The active ingredient is salicin, and willow bark has been shown to be effective in both osteoarthritis and back pain. People who are severely allergic to aspirin (those with aspirin-induced asthma or anaphylaxes, which are very unusual) should not use willow bark. Like aspirin and Celebrex, willow bark acts as a cyclooxygenase enzyme (COX) inhibitor, decreasing inflammation.
There is clearly a combination of other elements in willow bark that markedly enhances its effectiveness and safety — which can be a major benefit over aspirin and NSAIDs such as Motrin. Unfortunately aspirin and NSAIDs cause an enormous amount of gastritis and ulcer bleeding to the extent of killing fifteen thousand to twenty thousand Americans yearly! The studies on willow bark are quite consistent in showing its effectiveness and safety in reducing pain. Let's look at some of the research.
In one study, 210 patients with severe chronic low back pain were randomly assigned to receive an oral willow bark extract, with either 120 mg (low dose) or 240 mg (high dose) of salicin, or placebo, in a four-week blinded trial. In the last week of treatment, 39 percent of the group receiving high-dose extract were pain free; 21 percent of the group receiving low-dose extract were pain free; and only 6 percent of the placebo group were pain free. The response in the high-dose group was evident after only one week of treatment. Researchers then studied 451 patients who came in with low back pain in an open study, using salicin 240 mg, 120 mg, or standard orthopedic/NSAID care for four weeks. Forty percent of the patients in the 240 mg group and 19 percent in the 120 mg group were pain free after four weeks. In the standard treatment group, using standard medications, only 18 percent were pain free. The study showed that willow bark was not only far more effective and safer than standard prescription therapies, it also decreased the cost of care by approximately 40 percent!
Another review found that willow bark extract has anti-inflammatory activities comparable to much higher doses of acetylsalicylic acid/aspirin, and it reduces pain and fever as well. In pharmacologically active doses, no adverse effects on the stomach lining (indigestion, ulcers) were observed, in contrast to aspirin.
A daily dose of willow bark extract standardized to 240 mg salicin per day was also significantly superior to placebo in patients with osteoarthritis of the hip and the knee. In two open studies against standard active treatments as controls, willow bark extract exhibited advantages compared to NSAIDs and was about as effective as Vioxx (but much safer). Another study found that willow bark (salicin 240 mg/day) was much more effective than placebo in treating arthritis (the normal wear-and-tear type called osteoarthritis) after only two weeks of therapy.
All of this information makes willow bark a wonderful natural pain medicine. It is safe and effective for arthritis, back pain, and likely many other types of pain. I recommend beginning with enough to get 240 mg of salicin a day (six tablets of the End Pain formula) until maximum benefit is seen. At that point, you may be able to lower the dose to 120 mg or less a day, or take it as needed.
Boswellia serrata, also known as frankincense, has been used in traditional Ayurvedic medicine for centuries. Boswellia has been found to be quite helpful in treating inflammation and pain, and it does this without causing ulcers like aspirin family medications. It has been shown in studies to be helpful for both rheumatoid arthritis and osteoarthritis.
In one study, thirty patients with osteoarthritis of the knee were given 1,000 mg of either an extract of boswellia or a placebo for eight weeks; the groups were then switched for the next eight weeks. All of the patients on the boswellia showed significantly decreased pain and improved ability to walk. In fact, the improvement was quite remarkable, with the pain index falling by 90 percent after eight weeks and a similarly dramatic increase in function!
Boswellia has also been demonstrated to have significant anti-inflammatory properties. Unique to boswellia is that it blocks two inflammatory chemicals that are increased simultaneously in a variety of human diseases. This results in its being helpful in asthma and colitis, as well as pain. In one study of asthmatics, forty patients were treated with 300 mg three times day for six weeks. Seventy percent of the asthma patients showed improvement in symptoms and lung function and a decrease in allergic blood cells (eosinophils).
Boswellia also helped in the treatment of ulcerative colitis. In one study of twenty patients in which boswellia, 300 mg three times a day, was given for six weeks, fourteen went into remission, while with sulfasalazine (the standard prescription treatment), the remission rate was four out of ten. Test tube studies suggest that Boswellia also markedly inhibits cancer.
Boswellia does not appear to have any major side effects that resulted in people withdrawing from the studies, and it rarely causes minor gastrointestinal disturbances or rash. A common dose is 150 to 350 mg three times a day.
Cherry (Prunus Cerasus)
Although there are not as many human studies on the use of cherries, they also contain compounds that inhibit COX (inflammation) as effectively as ibuprofen. Cherries also possess both antioxidant and anti-inflammatory properties. In addition, research suggests that cherries may also inhibit colon and perhaps other cancers. Cherries and other colored berries are very high in many antioxidants. As with eating cherries, taking cherry fruit extract is quite safe. Many people find that eating ten to twenty cherries a day helps their arthritis considerably. Taking 2,000 mg of cherry fruit extract (present in six tablets of the End Pain formula) contains the active components present in ten cherries or thirty-two ounces of cherry juice. Early research, as well as how many people come back for more after they have tried it, which to me is a significant indicator of effectiveness, suggests that cherry fruit extract holds a lot of promise!
As we discussed earlier, pain is often your body's way of telling you that it desperately needs something — and what it needs is usually natural and not chemical. Let's review the key things your body needs and how you can give it what it needs naturally.
First you need to give your body the nutritional building blocks it needs to heal. Otherwise, your body cannot even begin to get well. As you've noticed, I've talked about the Energy Revitalization System vitamin powder and B-complex capsule at length. This is because this formula has over fifty key nutrients that serve an enormous number of needs. Many people have told me that using the formula by itself eliminated their chronic pain!
Glucosamine Sulfate and Chondroitin
Next, although the vitamin powder has most of what your body needs, joints require other specific nutrients for healing. So if you have arthritis or back pain from arthritis of the spine, consider taking glucosamine sulfate, MSM (methylsulfonylmethane), and chondroitin.
Lipoic Acid and SAM-e
Other nutrients are also critical for nerve healing. One such element is lipoic acid, 300 to 1,000 mg per day. Alpha lipoic acid is an antioxidant that has been shown to be especially beneficial for diabetic neuropathy. The fact that lipoic acid helps in several kinds of neuropathies suggests it is worth trying in others as well, especially since it is quite benign and not very expensive.
SAM-e is a nutrient produced from trimethylglycine (betaine) in combination with multiple nutrients, including B vitamins, folate, and inositol. It was initially tested and found to be effective in treating depression. Researchers also noted, as an aside, that it improved patients' arthritis as effectively as anti-inflammatory medications (NSAIDs).
Your repair cycle occurs during sleep and your body needs eight to nine hours of sleep a night for optimal healing. Unfortunately, insomnia often accompanies pain. The good news is that many natural remedies that are very effective for sleep also directly help pain. Most of the natural sleep remedies discussed here are not sedating, yet they will help you fall asleep and stay in deep sleep. Some are available in combination formulas as well.
Wild Lettuce and Jamaican Dogwood
Traditionally, wild lettuce has been found to be wonderful for anxiety and insomnia, as well as for headaches, muscles, and joint pain. Wild lettuce also helps to calm restlessness and reduce anxiety.
In addition, the extract from Jamaican dogwood acts as a muscle relaxant and also helps people to fall asleep while calming them. According to tradition, Jamaican dogwood was used by Jamaican fishermen. Large amounts were thrown in the water. The fish would then be sedated and easy to net.
Hops and Theanine
Hops are a member of the hemp family, and the female flowers are used in beer making. Hops stimulate some hormonal activity; can suppress breast, colon, and ovarian cancer in test tube studies; and have been reported to reduce hot flashes in menopausal women. Hops are also associated with antibiotic and antifungal activity.
They have a long history of being used as a mild sedative for anxiety and insomnia. They also inhibit inflammation. A study using 120 mg of hops combined with 500 mg of valerian showed an improvement in insomnia with effectiveness similar to Valium family medications. Hops are considered to be very safe.
Theanine comes from green tea and has been shown to improve deep sleep and to help people maintain calm alertness during the day. Green tea also is helpful as an immune stimulant and has many other benefits.
Passionflower is an excellent herb used throughout South America as a calming agent and is even present in sodas. In fact, it is not uncommon for friends to tell an anxious person, "Why don't you go get a passionflower drink." The active component is in the leaves. Herbalists use passionflower to treat muscle spasms, colic, dysentery, diarrhea, anxiety, and menstrual pain. A number of studies support its having a calming effect. Early data also suggest that it may increase men's libido. Passionflower has other pain management benefits as well. In one animal study, it was shown to decrease morphine tolerance and withdrawal, thereby improving morphine's effectiveness and safety.
Valerian is commonly used as a remedy for insomnia. One placebo-controlled study showed that people taking valerian (400 mg of extract each night for two weeks) fell asleep more quickly and had better sleep quality without next-day sedation. Another placebo-controlled study using 450 and 900 mg doses for just one night also showed improved sleep, but there was some hangover with the higher dose. A number of other studies also show benefit, including an improvement in deep sleep. The benefits were most pronounced when people used valerian for extended periods as opposed to simply taking it for one night. Another study showed it to be as effective as a Valium family medication (oxazepam). A review of multiple studies concluded, "Valerian is a safe herbal choice for the treatment of mild insomnia and has good tolerance." Most studies suggest that it is more effective when used continuously rather than as an acute sleep aid.
Combining Remedies for Fuller Effect
Because I have found all six of these herbals to be dramatically helpful in patients with disordered sleep, anxiety, and/or chronic pain, I had them all combined in the Revitalizing Sleep Formula (found in Appendix B of the book). One to four capsules can be taken at bedtime to help sleep, or an hour before bedtime if the main problem is falling asleep. You'll see the effect of a given dose on sleep the first night you take it, although the effectiveness increases with continued use. It can also be used during the day for anxiety and muscle pain. Although the bottle says to take up to four capsules a day, one could take up to three or four capsules two or three times each day, as it is very safe. If you're still not getting eight to nine hours of sleep a night, magnesium (75 to 250 mg) and calcium (600 mg) at bedtime also help sleep. It can also be used together with the End Pain formula for more powerful pain relief.
Besides these herbs, I recommend the natural sleep aids in the following sections.
Hydroxy L-Tryptophan (5-HTP)
Take 200 to 400 mg at night. When used for six weeks, a 300 to 400 mg dose has been shown to decrease fibromyalgia pain and often helps people to lose weight. Your body uses 5-HTP to make serotonin, a neurotransmitter that helps improve the quality of sleep while also decreasing levels of substance P, your body's pain messenger. The one caution I give is that if you are taking other treatments that increase serotonin (these include antidepressants such as Prozac, Saint-John's-wort, Ultram, Desyrel, and others), limit the 5-HTP to 200 mg at night. It takes six to twelve weeks to see the full effect of 5-HTP, and it is more expensive than the other remedies. Nonetheless, it may be worthwhile in treating chronic pain.
This is a hormone produced by the pineal gland. Although melatonin is natural and available over the counter, this does not mean that it is without risk. My concern with any hormone is that although it might be quite safe when used within the body's normal range, I worry about toxicity when people take more than the body would normally make. For most people, all it takes to restore melatonin to normal levels is 0.5 mg. The usual dose you find in stores, however, is 3 mg, which is six to ten times the dose that most people need. Except for a small subset of people, who likely have trouble absorbing it properly, the 0.5 mg dose is every bit as effective for sleep as higher doses. I would use a dose higher than 0.5 mg only if it clearly helps you sleep better than the lower dose.
Many other natural therapies can be powerfully effective in the treatment of pain while also being safe and relatively inexpensive. Although we do not have space to review all of them, let's look at a few that are worth being aware of.
Topical Gels for Muscle and Arthritis Pain
I am a big fan of using topical therapies. By applying these gels directly to a targeted area of pain, you get a high dose to where it's needed without saturating your whole body as you do with tablets.
A promising product for the relief of muscle and arthritis pain does just that. Joint Gel by NF Formulas is an over-the-counter natural pain reliever that is applied directly on the skin. It contains menthol, MSM (methylsulfonylmethane), white willow, pine bark, and botanical oils that provide relief of aches and pains. Joint Gel also can relieve the pain of backaches, muscle sprains, and strains. Its roll-on design delivers the gel directly onto the skin and does not leave an oily or sticky feeling. As you massage the Joint Gel over the painful joint or muscle until absorbed, you'll initially feel the menthol. The active ingredient in peppermint is menthol, which serves as a counterirritant, stimulating the nerves that perceive cold while simultaneously depressing those for pain. Joint Gel's aloe leaf, white willow bark, and MSM are also well known for their natural pain-relieving properties. Pine bark also provides unique antioxidants known to play a role in the stabilization of joints and muscles. Because it contains eucalyptus, rosemary, and ginger botanical oils, Joint Gel smells good. You can use Joint Gel three to four times daily.
Oral Enzymes That Treat Inflammation
Another wonderful treatment for inflammation is the use of oral enzymes. For those looking for a gentle, natural, and fairly side effect free method of reducing inflammation, digestive enzymes can be very helpful. When taken with food, enzymes help digest fats, proteins, and carbohydrates. When taken in between meals, digestive enzymes are absorbed into the bloodstream and are active throughout the body, not just in the digestive tract. This allows them to perform other functions such as combating inflammation. My favorite enzyme supplements for pain and inflammation are MegaZyme and Ultrazyme. They contain pancreatic enzymes (protease, amylase, and lipase), trypsin, papain, bromelain, lysozyme, and chymotrypsin.
Enzymes in high doses may "digest" inflammation by removing fibrin from inflamed areas, thereby restoring drainage and reducing swelling. This speeds wound healing. For example, one study used bromelain, an enzyme derived from the stem of the pineapple plant, in 146 boxers with multiple face bruises and black and blue marks after a boxing match. Half the boxers received the real thing and half received placebo. All signs of bruising disappeared within four days in 78 percent of the boxers receiving bromelain as compared to only 14 percent of those on a placebo. By working with your body, bromelain is able to reduce pain and inflammation caused by numerous health problems. It can also improve circulation. Bromelain helps the body make its own enzymes to dissolve and clean up dead tissue and debris from the site of inflammation.
Some physicians are under the misconception that enzymes taken by mouth would simply be digested and not absorbed into the body. This is not the case when they are taken on an empty stomach. In this situation enzymes are well absorbed, raising their levels in the blood.
In addition to decreasing inflammation, taking enzymes may help improve function in other ways. Enzymes are necessary for many reactions to take place within your body's cells, such as assisting with rejuvenation and healing. For example, studies showed that taking large doses of pancreatic enzymes could help people with pancreatic cancer to live longer. Research by Dr. Gonzalez has shown this to be the case, and a larger scale study using this enzyme treatment in pancreatic cancer is now being funded by the National Cancer Institute. Many people have found that taking enzymes can markedly help decrease inflammatory pain. For example, in one study of muscle soreness after downhill running, subjects were given either enzymes or a placebo. In the enzyme group, muscle soreness was much less than in the placebo group.
Although I strongly recommend that people use plant-based enzymes for digestion, pancreatic enzymes are better for inflammation. The pancreatic enzymes in Ultrazyme and MegaZyme are very high potency. The other enzymes present are also powerfully effective. Papain is often used to relieve the inflammation and pain in sports injuries because athletes have discovered that it speeds up the healing process. Papain has also been used to reduce inflammation from wisdom tooth extractions, root canals, and other oral surgeries. Unlike prescription anti-inflammatories such as Prednisone (a powerful, prescription-only corticosteroid medication with a long list of health risks), enzymes treat inflammation safely.
To summarize, although enzymes such as Ultrazyme and MegaZyme may be helpful in aiding digestion of your food when taken with meals, I recommend that you take them on an empty stomach because enzymes are most effective at reducing pain and inflammation when you take them between meals. For acute pain, enzymes can simply be taken for a few days as needed. For chronic pain, begin by taking either of them regularly (two to three tablets three times a day) between meals for six to twelve weeks to see how much it helps or until the pain and inflammation are gone. Then you can take the enzymes as needed.
Intravenous "Myers Cocktails" Nutritional Therapies
A major problem in chronic pain is that the areas that hurt often have decreased blood flow. That means that even when you feed your body, the areas in pain may still be starved. This is one reason why using the intravenous "Myers cocktails" nutritional therapies can be so effective. The magnesium in the IV causes the closed-down blood vessels in your muscles and brain to open, flooding the starved areas with nutrients and washing away toxins. Unfortunately, although very worthwhile, these IV treatments require repeat visits by a nurse and cost approximately eighty to one hundred dollars per dose.
Another way to get the blood vessels to open wide is to take a B vitamin called niacin (not niacinamide, which does not cause flushing). This trick was taught to me by a brilliant chiropractor and pain specialist, Ron Huse, D.C. in Houston, Texas. Take 100 to 500 mg of niacin three to four times a day, as needed, to cause a "flushing" feeling, which occurs within approximately ten to twenty minutes. This can significantly help pain and is inexpensive. Try to keep the dose at 1,000 mg a day or less, if this is enough to cause flushing, because higher doses can sometimes (but rarely) cause liver inflammation or unmask diabetes. This treatment also helps to lower cholesterol and is often used for this purpose. The flushing will make you feel like you are in the Florida sun for about fifteen to forty-five minutes and will often be intense. Do not worry; it is not dangerous and can help your muscles to heal while decreasing pain.
Arnica: A Powerful Homeopathic
The classic homeopathic for acute tissue injuries is arnica. This can be highly effective and is available as a cream (Traumeel by the Heel Company). This is a product that should be in everybody's medicine cabinet.
Turmeric (Curcumin Longa)
Turmeric is an ingredient in curry powder and a relative of ginger. Turmeric contains curcumin, which has been shown to be an effective antioxidant. A study of forty-five days of supplementation with curcumin showed marked decreases (60 percent) in the level of serum lipid peroxide. It is suspected that the curcumin might therefore reduce the risk of heart disease, cancer, and inflammatory conditions, and it may also help asthma. A review of several studies suggests that curcumin has anti-inflammatory, antioxidant, anticarcinogenic, antiviral, and anti-infectious activities. A common dose would be 500 to 1000 mg three times a day.
Unfortunately, curcumin is poorly absorbed in the absence of piperine — a compound that comes from black pepper. Piperine can increase the absorption of many different substances and medications, potentially leading to toxic blood levels, however, and should therefore be used with caution — preferably with their use being guided by a health practitioner. When used in combination with boswellia, turmeric has been shown to improve both osteoarthritis and rheumatoid arthritis.
In traditional Indian medicine, curcumin has been used to treat arthritis, inflammation, skin disease, and infections for many centuries. It contains at least 133 active compounds, and approximately four hundred studies have been published on curcumin in the last several years. It has also been found to be effective in treating gastric ulcers and indigestion as well as lowering serum cholesterol.
Ginger and Butterbur
Ginger acts to decrease inflammation by inhibiting two key enzymes (cyclooxygenase and lipooxygenase, with secondary leukotriene inhibition). Although studies suggest some benefit with arthritis, I consider the effect to be modest compared to the End Pain formula. Butterbur has been found effective in the prevention and treatment of migraine headaches.
Saint-John's-wort has been found to be helpful in treating neuropathic pain for some people. This treatment is safe and inexpensive and helps depression, so it is worth a try — especially if other treatments have failed.
Although it may seem odd to include marijuana as an herbal, it is an herb, and it is my job to give you medical information regardless of the politics involved. Studies suggest that the receptors that marijuana binds to can also decrease pain. In addition, it can decrease the suffering associated with pain, improve appetite in situations where weight loss is associated with pain (as in cancer), and is likely much safer than many other medications. The active ingredient in marijuana, THC, is available by prescription in a medication called Marinol. It is, of course, much more expensive in this form and probably not as effective, but it can be helpful.
Capsaicin is another cream that comes from hot chili peppers. It works by depleting the substance P pain transmitter in nerve endings, interfering with the ability to send pain signals to the brain.
It can be very helpful in some situations, but I tend to avoid using it. I am uncomfortable with irritating the body so much that it depletes the pain-sending chemicals. In addition, capsaicin can make the problem worse by stimulating pain when it is first used, and it has to be taken regularly or the pain-sending chemicals have a chance to recover.
An Easy-to-Make Home Remedy
The following home remedy, Purple Pectin for Pain, is inexpensive and easy to try. It is especially geared to work for arthritis.
Purchase Certo, the thickening agent used to make jams and jellies, in the canning section of your local grocery. Certo contains pectin, a natural ingredient found in the cell walls of plants. Take one to three tablespoons of Certo in eight ounces of grape juice one to two times daily (you can try more if you wish). If it's going to help, you'll likely know in seven to fourteen days. You can lower the dose as you feel better.
As you can hopefully tell by this chapter, there are many natural and prescription treatments available that can be helpful. You do not have to be in pain. There are other excellent natural therapies to consider, and these are simply a sampling of my favorite natural remedies.
Reprinted with permission from Pain Free 1-2-3: A Proven Program for Eliminating Chronic Pain Now by Dr. Jacob Teitelbaum and published by McGraw-Hill, 2006. Buy this book from our store: Pain Free 1-2-3.