The Treatment and Management of Inflammatory Conditions
In this article I discuss the side effects of some anti-inflammatory drugs and the potential of many herbal medicines to effectively and safely treat inflammatory conditions.
I have used herbal medicines over many years to treat patients suffering from the pain of inflammation. In most cases patients are able to reduce the dose of their anti-inflammatory drugs, thus minimising side effects. Some patients have been able to stop their drugs altogether.
It should be remembered that the cardiovascular complications now associated with the use of some anti-inflammatory drugs occurred after the long-term use and are unlikely to occur with short-term use. However, these drugs are often used over extended periods of time simply because many inflammatory conditions are chronic, often causing increased pain as they progress.
Anti-inflammatory Drugs - New Safety Concerns
There is a very wide variety of inflammatory conditions covering almost every body system. They include all forms of arthritis; gastrointestinal disorders such as Crohn’s disease and colitis; reproductive disorders including endometriosis in women and prostatitis in men; the majority of autoimmune diseases; and many skin conditions have a component of inflammation.
Largely the medical treatment of inflammation centres on the use of non-steroidal anti-inflammatory drugs (NSAIDs) and steroidal anti-inflammatories. There is no doubt that these drugs offer pain relief for many patients but they are not without their problems. It is probably best not to use these drugs over the long-term but to limit them to short-term use. A full list of the potential adverse reactions that can occur with extended use of steroidal anti-inflammatories such as prednisone and prednisolone is too extensive to list in this article but include gastrointestinal symptoms, osteoporosis, reproductive changes in men and women, weight gain, fluid retention and poor wound healing.
The most notorious side effect of the non-selective NSAIDs is damage to the stomach often resulting in ulcers and bleeding. They can also cause liver and kidney impairment. The newer class of NSAIDs are known as COX-2 selective inhibitors because they target specifically one enzyme (known as cyclooxygenase-2). They were considered an important addition to the list of anti-inflammatory drugs because they may be less likely to cause damage to the intestinal lining. However, the safety of this class of drugs is now being called into question.
On September 30, 2004 Vioxx, a COX-2 inhibitor, was voluntarily withdrawn from the market due to an increased risk of cardiovascular problems, mostly heart attacks and strokes. In a long-term clinical study it was found that the risk of heart attack was doubled in patients taking Vioxx compared with those taking the placebo.
This decision to withdraw Vioxx from the market place would not have been taken lightly by the manufacturers, Merck & Co. Since its release in 1999 it has been a big seller and in 2003 annual sales totalled $US5.6 billion. Another company, Pfizer, has refused to voluntarily withdraw Celebrex, also a COX-2 inhibitor, from the market after a clinical trial was terminated early due to increased cardiac risk. Pfizer claim these results are in conflict with those from other trials.
There are now concerns about the safety of all COX-2 inhibitors and they are being closely monitored by both the FDA in America and the TGA in Australia. There is also serious concern about the apparent over prescribing and overuse of these drugs.
There is no doubt that these recent findings about COX-2 inhibitors are a blow not only to the manufacturers but more importantly to the patients who rely on them for pain relief. However, it gets worse. The increased risk of cardiac problems may not be limited to COX-2 inhibitors. Naproxen, one of the older non-selective NSAIDs (available since 1976), has also been implicated. In December 2004 preliminary results from a long-term clinical trial using Naproxen (most commonly sold as Naprosyn in Australia) suggest that long-term use may be associated with an increased cardiovascular risk compared with placebo.
Since the debate about the safety of NSAIDs it has been suggested that paracetamol is just as effective as NSAIDs in relieving pain from inflammation. In some patients this may be the case but for many paracetamol is simply not strong enough. It is also important to remember that paracetamol is not without side effects, the main one being liver damage.
Herbal Medicine – Effective Anti-inflammatory Treatment
There are many herbal medicines that are effective when used to relieve inflammation and bring about pain relief. The majority of these have a very long history of use in the cultures to which they indigenous. Nowadays we also have scientific research and clinical studies to support the traditional use of some of these herbs.
So, which are the best anti-inflammatory herbs to use? There is no quick answer to this question. Remember that the aim of the Naturopath, when treating inflammation, is not only to relieve discomfort but also to correct underlying deficiencies and imbalances. We can easily read a list of anti-inflammatory herbs and try one or two but this will not usually give the best results. Herbal medicine works much better if it is prescribed to suit the individual rather than just the condition being treated.
In some cases a particular herb is best suited to a particular complaint. This is because there are many different imbalances and many different chemicals in the body that can cause or contribute to inflammation and these vary in different inflammatory conditions. Therefore, the way each herb works to reduce inflammation can be matched to the particular condition.
However, the matching of herb and condition is only part of the story. Another very important consideration is the quality and strength of the herbal product being used. For example, the herb Willow Bark has anti-inflammatory activity but when used as a tea or as a normal herbal extract it is often not strong enough.
For the last few years we have been fortunate enough to have available to us a tablet containing a high potency Willow Bark extract. It is exactly the same as the one used in a number of clinical trials which showed improvement in patients with osteoarthritis or lower back pain. It has an analgesic effect as well as being anti-inflammatory.
There are a number of other anti-inflammatory herbs that have been proven in clinical trials. Some reduce inflammation associated with inflammatory substances such as prostaglandins, others work on inflammation associated with the immune system, while some reduce swelling associated with inflammation. As already mentioned for Willow Bark some herbs will also have an analgesic effect.
An understanding of how each herb works to reduce inflammation enables us to be much more specific with the herbal medicines prescribed to treat each inflammatory condition. To achieve the best results care must be taken in prescribing herbal medicines, not only in giving the correct herb/herbs for the condition being treated, but also to avoid adverse reactions or interactions with drugs.
Inflammation causes tissue damage and the production of free radicals, which further damage surrounding tissues. Therefore it is important to use herbal medicines and nutrients that mop up the free radicals and promote healing. Gotu Kola is an important and well researched herb that promotes healing and helps to prevent the formation of excessive scar tissue. However, in order to achieve these benefits the herb must be of very good quality and strength and prescribed at the correct dosage.
Herbs that promote circulation to the affected area are also important. These include Ginkgo, Ginger, Cayenne and Prickly Ash.
Other ‘Natural’ Anti-inflammatory Agents
The effectiveness of Glucosamine and Chondroitin supplementation in the treatment of arthritis is well known. Their main role is to promote regeneration and healing of cartilage in the joints. It is cartilage damage that causes the majority of pain in arthritic conditions. These are sometimes combined with anti-inflammatory herbs. Vitamin C combined with bioflavanoids can also help to reduce inflammation and improve cartilage healing.
Anti-oxidants help to reduce the damage caused by inflammation and include many herbs and nutrients. Fresh fruit and vegetables are pack with anti-oxidants as is green tea and red wine (moderate amounts).
Good nutrition is essential to provide, not only antioxidants, but also a large number of trace elements that contribute to a reduction in inflammation and are essential for tissue repair. General good health is also dependent on good nutrition and the healthier you are the more likely your body is able to heal itself and recover from illness.
Article by Berris Burgoyne ©
I am passionate about helping people improve their health and well-being.
I believe that the human spirit has the potent ability to bring about healing when it is given the necessary support to do so.
This support can be achieved in a number of ways including dietary and lifestyle adjustments and natural medicines.
These address any imbalances, and by adopting healthy habits and attitudes that nourish your spiritual, emotional and physical well-being you can achieve optimal health.