Are Herbal Products Effective for Treating Neuropathic Pain?

New Delhi: According to the results of a recent review, there is “insufficient” evidence to conclude that either nutmeg or St John’s wort are effective in helping treat pain in neuropathic conditions.

To determine both the analgesic efficacy as well as adverse events associated with herbal products when used in the management of neuropathic pain. Various search engines (CENTRAL and the Cochrane Database of Systematic Reviews, MEDLINE, Embase, CINAHL, AMED) were utilized to obtain randomized and double-blinded controlled trials analyzing the efficacy of herbal therapy in neuropathic pain conditions compared to placebo, no intervention, or another active comparator. Additionally, trial registries were searched to obtain information on any ongoing studies analyzing these objectives.

Studies were required to include patients ≥18 years old with ≥1 neuropathic pain condition for ≥3 months. “The primary outcomes were participant‐reported pain relief of 30%, or 50%, or greater, and participant‐reported global impression of clinical change (PGIC).”

Two studies with a total of 128 patients assessing both diabetic- and non-diabetic neuropathic pain conditions were included in the review. The studies compared the efficacy of nutmeg (applied topically) and St John’s wort (capsule form) to placebo and allowed concomitant use of analgesic medications.

When looking at participant‐reported pain relief of 30% or greater over baseline, we observed no evidence of a difference (P=.64) in response to nutmeg versus placebo (RR 1.12, 95% confidence interval (CI) 0.69 to 1.85; 48.6% vs 43.2%),” wrote the authors. It is important to note that the evidence for this outcome was rated as very low quality.  In addition, neither nutmeg nor St John’s wort were associated with a meaningful reduction in total pain score when compared with placebo.

The similar adverse events were observed for the treatment groups compared to the placebo groups; 5% of patients (5/91) withdrew from the treatment groups compared to 6.5% of patients (6/91) in the placebo groups.

Based on these results, there is a lack of evidence to determine whether nutmeg or St John’s wort provide significant analgesic efficacy in neuropathic pain conditions. “The results from this review should be treated with skepticism as we have very little confidence in the effect estimate.”

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