Ethnopharmacological analysis of medicinal plants and animals used in the treatment and management of pain in Mauritius.

Journal of Ethnopharmacology ∎ (∎∎∎∎) ∎∎∎–∎∎∎

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Journal of Ethnopharmacology journal homepage: www.elsevier.com/locate/jep

Ethnopharmacological analysis of medicinal plants and animals used in the treatment and management of pain in Mauritius D. Priyamka Sreekeesoon, M. Fawzi Mahomoodally n Department of Health Sciences, Faculty of Science, University of Mauritius, 230 Réduit, Mauritius

art ic l e i nf o

a b s t r a c t

Article history: Received 15 June 2014 Received in revised form 17 August 2014 Accepted 17 September 2014

Ethnopharmacological relevance: Pain is a multi-faceted and multi-factorial condition which is challenging to manage and treat. Conventional therapies such as analgesics, Non-steroidal anti-inflammatory drugs (NSAIDs), and corticosteroids amongst others have been successful to some extent in its management and treatment. Nonetheless, such therapies tend to be accompanied by undesirable effects and have a limited therapeutic range. Consequently, there is a pressing need to probe for novel analgesic and anti-nociceptive drugs from traditional medicines (TM). This study was designed to record, document and analyze herbal and animal-based therapies used for the management and treatment of pain in the tropical of Mauritius. Materials and methods: Data was collected via face-to-face interviews with TM users (n ¼332) and practitioners (n ¼ 20). Seven quantitative ethnopharmacological indexes, namely family use value (FUV), use value (UV), informant agreement ratio (IAR), relative frequency of citation (RFC), fidelity level (FL), relative importance (RI) and ethnobotanicity index (EI) were calculated. Results: A total of 79 plant species distributed within 40 families and 20 polyherbal preparations was recorded. Interestingly, 6 indigenous/endemic plants have been reported for the first time to be in common use for pain management and treatment in Mauritius. The most significant biologically important plant family was Xanthorrhoeaceae with highest FUV. The species which ranked highest according to its UV was Morinda citrifolia L. Morinda citrifolia L. and Ricinus communis L. also scored the highest RFC. The IAR values for the disease categories were high (0.95–0.97). Based on EI, plants species which are known to be useful in TM accounted for 11.5% of the total flora in Mauritius. Coix lacryma-jobi L. (FL¼100%) had highest FL for lower back ache. Morinda citrifolia L. scored highest on most of the quantitative indices calculated including RI, which is endorsed by extensive documentation on its versatility and particularly its anti-nociceptive properties. Seven animal species were recorded to be in common use. Conclusion: The present ethnopharmacological study revealed a panoply of TM to be in common use for pain management and treatment in Mauritius. This study has documented for the first time medicinal plants and animal species with potential analgesic and/or anti-nociceptive properties. This study has therefore provided important baseline primary data for the discovery of new lead molecules for drug development geared towards pain management and treatment. & 2014 Published by Elsevier Ireland Ltd.

Keywords: Traditional medicines Pain Herbal remedies Zootherapy Mauritius

1. Introduction Pain relief is a matter of such uttermost significance that it has been regarded as a basic human right (Brennan et al., 2007). On

Abbreviations: EI, Ethnobotanicity Index; FL, Fidelity Level; FUV, Family Use Value; IAR, Informant Agreement Ratio; NSAIDs, Non-Steroidal Anti-Inflammatory Drugs; RFC, Relative Frequency of Citation; RI, Relative Importance; UV, Use Value; TM, Traditional Medicines; WHO, World Health Organization; MOAIFS, Ministry of Agro Industry and Food Security; MOFED, Ministry of Finance and Economic Development; VAS, Visual Analog Scale; IPNI, International Plant Name Index n Corresponding author. Tel.: þ 230 4037578; fax: þ 230 4656928. E-mail address: [email protected] (M.F. Mahomoodally).

the other hand, chronic pain remains a plaguing global phenomenon which is quite challenging to evaluate, manage and treat (Tracy and Morrison, 2013) and it accounts for more than 1.5 billion sufferers worldwide (Global Industry Analysts, 2011). On the other hand, pain can be insignificant, short-lived, and consequently the preponderance and success of conventional therapies in its treatment cannot be overlooked (Schofield, 2012). However, when pain becomes persistent and excruciating, conventional therapies including opioid and non-opioid analgesics, Non-steroidal antiinflammatory drugs (NSAIDs) and corticosteroids amongst others are scarcely effective (Turk et al., 2011; Bashir and Colvin, 2013). Common chronic pain conditions include low-back pain, headache, arthritis pain, pain from nerve damage, cancer pain, and

http://dx.doi.org/10.1016/j.jep.2014.09.030 0378-8741/& 2014 Published by Elsevier Ireland Ltd.

Please cite this article as: Sreekeesoon, D.P., Mahomoodally, M.F., Ethnopharmacological analysis of medicinal plants and animals used in the treatment and management of pain in Mauritius. Journal of Ethnopharmacology (2014), http://dx.doi.org/10.1016/j.jep.2014.09.030i

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D.P. Sreekeesoon, M.F. Mahomoodally / Journal of Ethnopharmacology ∎ (∎∎∎∎) ∎∎∎–∎∎∎

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other conditions, such as fibromyalgia, in which significant pain is experienced National Centre for Complementary and Alternative Medicine (2011). Accordingly, chronic pain has considerable repercussions on daily life including anxiety, depression, sleep disturbances, degrading interpersonal relationships, resulting in poor quality of life (Sprintz et al., 2011). The elderly constitutes a vulnerable group since a high percentage live with chronic disorders accompanied by considerable pain and symptoms burdens (Tracy and Morrison, 2013). Conventional therapies are correlated with several limitations including restricted long-term efficacy, tolerance problems and other adverse effects (Verkamp et al., 2013). These drawbacks have lead to the escalating prevalence of TM as endorsed by various studies (Berman et al., 2009; Bruckenthal, 2010; Rehberg, 2010; Fouladbakhsh et al., 2011; Peleg et al., 2011; Yoon and Kim, 2013; Zareba, 2009; Da Silva et al., 2012; Arome et al., 2014). The use of TM can be linked to a myriad of factors including psycho-social factors, ethnic and cultural characteristics, accessibility to healthcare resources and individual perception of physical and medical conditions (Yoon and Kim, 2013). One of the most common therapies used for pain management and treatment is herbal remedies (Zareba, 2009; Da Silva et al., 2012; Arome et al., 2014). Indeed, panoply of medicinal plants has been reported to be in common use for the management and treatment of various pain-related conditions. For instance, Aconiti tuber, Acorus calamus, Cannabis sativa, Nigella sativa, Ocimum sanctum and Ginkgo biloba have demonstrated pre-clinical efficacy in neuropathic pain (Gagnier, 2008). Mauritius has a rich cultural and ethnic diversity and is famous for its singular flora and fauna. Accordingly, a medley of local studies (Chintamunnee and Mahomoodally, 2012; Nunkoo and Mahomoodally, 2012; Suroowan and Mahomoodally, 2013; Mootoosamy and Mahomoodally, 2014) have attempted to document primary data in relation to traditional remedies used by the local population. Although some of them reported a few medicinal plants used in mild pain-related conditions, none has explored quantitatively the use of herbal and animal-based remedies from TM for the treatment and management of pain. Therefore, the present study has endeavored to document the panoply of TM used for pain management and treatment in Mauritius. It is anticipated that the documentation of such remedies will present new frontiers for the scientific community to instigate novel analgesic and anti-nociceptive drugs discovery.

2. Materials and methods 2.1. Study area The tropical island of Mauritius forms part of the African continent and lies in the southern hemisphere in the middle of the Indian Ocean with latitude and longitude 20.16251S, 58.29031E (Fig. 1). Mauritius enjoys a mild tropical maritime climate throughout the year, characterized by a warm humid summer extending between November and April and a relatively cool dry winter between June and September (Ministry of Finance and Economic Development, (MOFED), 2012). The main ethnic groups are the Bhojpuri speaking Hindus, constituting 40.2% of the total population. The Tamils are the second largest ethnic community (13.9%), while Telugus (5.6%) and Marathis (4%) represent smaller minorities within the overall Hindu population. The Hindus have a common language (Bhojpuri), the same regional origin (Uttar Pradesh and Bihar), religious practices, and rituals (Hollup, 1994; 2012). Since the past years, Mauritius economy has switched from sugar and textiles, into financial services and information and communication technology, as well as providing a seafood hub for

the region and becoming a destination for medical tourism and a centre for academic excellence (Overseas Development Institute, 2011). Mauritius has a rich heritage of indigenous and endemic plants and possesses 58 families of plant species consisting of both indigenous and endemic plants. A total of 711 indigenous plant species has been recorded in Mauritius, including 246 endemic plant species (Ministry of Agro Industry and Food Security (MOAIFS) (2012)). Mauritius is characterized by considerable endemism rate and species diversity. Nonetheless, the surge in population and economic growth has lead to loss, degradation and decline of ecosystems, species and genetic diversity. Economic development has stimulated forest clearance for settlement, industries and agriculture as well as intrusion on environmentally sensitive areas, including mountains and forested areas, hence resulting in biodiversity erosion. Natural disasters such as cyclones and droughts are significant threats to native biodiversity as it is highly fragmented and the populations are small, resulting in diminished adaptability to weather variations. Biodiversity consequently remains one of the top national priorities of the local authority. According to the National Biodiversity Strategy and Action Plan, it is estimated that Rs. 200 million is spent annually, in addition to external funding, on the conservation of forests and terrestrial biodiversity. A number of policies and strategies have been adopted by Government for conservation and sustainable use of biodiversity. These comprise of the National Environment Policy (2007), National Biodiversity Strategy and Action Plan (2006–2015), National Invasive Alien Species Strategy and Action Plan (2010), Non-Sugar Sector Strategic Plan (2003–2007), Strategic Options in Crop and Livestock Sector102 (2007–2015) and Study on Environmentally Sensitive Areas (Maurice Ile Durable (MID), 2013). The geographical location of Mauritius and study area (30 towns and villages spread over 9 districts) is depicted in Fig. 1. 2.2. Data collection This project was approved by the Department of Health Sciences, Faculty of Science, University of Mauritius, Mauritius. We attempted to follow the best field practice in the present ethnopharmacological survey as described by Heinrich and Verpoorte (2014) to amass primary data from local people and TM practitioners. A total of 352 key informants which included 332 TM users and 20 practitioners were interviewed during the academic year 2013–2014. Data has been collected through face-to-face interviews using a semi-structured questionnaire. Proper data was partly collected using the participatory rural appraisal method, as some of the key informants also became investigators themselves, participating in interviews, informal meetings, open and group discussions, and overt observations with semi-structured questionnaires (Nunkoo and Mahomoodally, 2012; Mootoosamy and Mahomoodally, 2014). 2.3. Questionnaire design Two questionnaires were designed for data collection. The first questionnaire for TM users comprised of 3 main parts: Part A, B and C which included structured open-ended and close-ended questions. Demographics characteristics such as age, gender, area of residence, religion, educational level, income and occupation were recorded. The second part of the questionnaire was adapted from Peleg et al., (2010) and consisted of specifications on pain sites. Indeed, pain assessment is a major challenge (Kumar and Tripathi, 2014). Pain scales have been reported to be useful for clinically assessing how intensely patients are feeling pain and for monitoring the effectiveness of treatments at different points in time. A number of questionnaires have been reported to assess


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Fig. 1. Location map of Mauritius in the Indian Ocean and study area (black dots indicate sample areas) (Adapted from Maps of World (2013) and ZenTech (2013).

chronic pains which are mainly used as research tools. In the design of the present study, much emphasis was laid on the assessment of pain based on reported pain intensity scales and questionnaires. As far as possible the respondents were asked to give explicit details about the pain types experienced and they were encouraged to indicate the precise sites of pain to the interviewer. Specifications were given in case pain occurred as a result of pain-related conditions. Voluntary assistance from a medical practitioner was sought to confirm medical conditions and to establish comparisons between the local/vernacular descriptions and standard medical terms. Informants were also requested to rate the pain intensity experienced based on a 0-10 Visual Analog Scale (VAS), (0-indication no pain; 10-worst possible pain), as well as interference with different aspects of everyday life (Peleg et al., 2010; Kumar and Tripathi, 2014). In addition, the pain intensities experienced initially before any treatment, following treatment using conventional therapies and TM were recorded. The respondents were asked to rate the influence of pain on daily life based on a scale of 0 to 10 whereby 0 represented no disturbance and 10 represented highest disturbance (Peleg et al., 2010; Kumar and Tripathi, 2014). The conventional therapies used with specifications on brand/generic names of drugs and dosage forms used were recorded. The informants were also requested to rate the effectiveness of conventional therapies and specified any side-effects experienced. The last part of the semi-structured questionnaire was based on previous studies by Kim and Song (2011) and Mootoosamy and Mahomoodally (2014) and was composed of key ethnopharmacological information; including local names of TM, plant parts used, ailments, method of preparation and administration, side effects, and dosage. Any polyherbal preparations used were also recorded. The reasons for using herbal remedies and any herb-drug interactions resulting from concomitant of herbal remedies and drugs were also documented. The sources of information regarding TM use and the reasons for using such therapies were also asked. The informants finally rated the effectiveness of TM and specified any side effects experienced. The second questionnaire for TM practitioners was adapted from previous local studies (Nunkoo and Mahomoodally, 2012; Mootoosamy and Mahomoodally, 2014). The practitioners were asked about their demographics details. They were asked about details relating to how diagnosis of patient with pain conditions occurs. Herbalists and traditional healers making use of plant remedies were asked to specify the name (vernacular or scientific

where appropriate) of plant and animals used, method of preparation, dosage and mode of administration for herbal remedies and polyherbal preparations. 2.4. Field study The interview was performed in vernacular and native languages (‘Bhojpuri’ and ‘Creole’). Some of the interviews were performed during busy hours of common areas such as the traditional ‘bazaars’. Personal visits were also made to homes, herbalists and indigenous health centers. Interviews, group discussion with knowledgeable persons and individual meetings with TM practitioners were also organized in order to collect precise data on common medicinal plants and animals in use. The questionnaire developed was strictly confidential and noncompulsory and each participant was interviewed alone where appropriate to maintain confidentiality. Participants were given information on the purpose of the survey and a prior informed consent form was dully signed by the participants before the interview was conducted. During field survey, whenever a plant species was mentioned by the participant, where possible, the participant was encouraged to show a sample of the plant species which was collected and photographed immediately. The collected sample was then identified with the help of their vernacular names and by local botanists. Data obtained during the survey was cross-checked (local/scientific names) according to locally published books (Gurib-Fakim and Gueho, 1995; Gurib-Fakim and Brendler, 2004). The Plant List (www.plantlist.org), International Plant Name index (www.ipni.org), (IPNI) and Kew Botanical Garden Plant name databases were used to validate plant scientific names as well as confirm author names (Heinrich and Verpoorte, 2014; Rivera et al., 2014). Our local database was updated whereby plant samples were assigned a collection number for future reference as suggested by Verpoorte (2008). This documentation will fully recognize the contribution of the local people who have been using the traditional knowledge, protection of community biodiversity and intellectual property rights, and benefits, if any comes out of the study and prior informed consent for publication of the work has been obtained during the survey. Seven use-categories were used to classify pain-related conditions managed and treated by TM in the present study. It was based mainly on body parts being treated and was adapted from previous studies by Waruruai et al., (2011) and Inta et al., (2013).


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Table 1 Demographic profile of TM users and practitioners. Demographic details

TM users

TM practitioners

Frequency (%)

Frequency (%) 0 1 2 10 7

Age category (years)

20–29 30–39 40–49 50–59 Z 60

23 35 58 85 131

Gender

Male Female

141 (42.5) 191 (57.5)

12 (60) 8 (40)

Place of residence

Urban Rural

155 (46.7) 177 (53.3)

10 (50) 10 (50)

Religion

Muslim Hindu Chinese Christian Tamil

71 145 3 93 20

(21.4) (43.7) (0.9) (28) (6.0)

4 6 3 5 2

(20) (30) (15) (25) (10)

Educational level

No formal education Primary Secondary Tertiary Post-tertiary

24 155 136 16 1

(7.2) (46.7) (41) (4.8) (0.3)

0 5 11 3 1

(0) (25) (55) (15) (5)

Monthly income (Mau Rs) 1 US$ Rs 30

r Rs 10,000 Rs 10,001–20,000 Rs 20,001–30,000 Rs 30,001–40,000 Rs 40,001–50,000 4 Rs 50,001 Unemployed Government officer Non-government officer Retired Traditional practitioners Traditional Chinese Medicine practitioners o5 6–10 11–15 16–20 4 20

221 (66.6) 68 (20.5) 24 (7.2) 9 (2.7) 5 (1.5) 5 (1.5) 74 (22.3) 48 (14.5) 84 (25.2) 126 (38) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0)

2 2 12 1 1 2 0 0 0 0 16 4 0 0 4 2 14

(10) (10) (60) (5) (5) (10) (0) (0) (0) (0) (80) (20) (0) (0) (20) (10) (70)

Occupation

Years of experience in TM field (years)

These included (1) earache, (2) oral, tooth ache, (3) headache, migraine, (4) gastrointestinal (GI) pain including stomach ache and abdominal pain, (5) obstetrics, gynecologic including dysmenorrhea and labor pain (6) joint pain including rheumatic pain, arthritis pain and gout pain and (7) general body ache, backache, legs ache and any other aches. 2.5. Quantitative indices The use value (UV) was used to determine the relative importance of species known locally. It was calculated as follows: UV¼ ΣUi/N; where Ui: number of uses cited by each informant for a given species, and N: total number of informants (Vitalini et al., 2013). The UV was useful in determining the plants/animals species with the highest use; that is those that were most frequently indicated in the treatment of an ailment (Hudaib et al., 2008). Relative frequency of citation (RFC) was used to demonstrate the local importance of each species. RFC was calculated as follows: RFC ¼FC/N; where, FC: number of informants mentioning the use of the species, and N: number of informants participating in the survey (Vitalini et al., 2013). Family use value (FUV) was calculated in order to identify the significance of medicinal plant families. It was calculated as FUV¼UVs/ns; where UVs: use values of the species, and ns: total number of species within each family (Cadena-González et al., 2013). The family use

(6.9) (10.5) (17.5) (25.6) (39.5)

(0.0) (5) (10) (50) (35)

value is an index of cultural importance which can be applied in ethnobotany to calculate a value of biological plant taxon (Gakuubi and Wanzala, 2012). Relative importance value (RI) was used to demonstrate the versatility of the plant species was calculated as follows: RI ¼PPþ AC; where PP: number of pharmacological properties (reported specific ailments) attributed to a species divided by the maximum number of properties attributed to the most resourceful species (species with the highest number of properties). AC: number of ailment categories treated by a given species divided by the maximum number of ailment categories treated by the most resourceful species. The highest possible value of RI is 2.0, which indicates the highest diversity of medicinal uses of a plant (Kadir et al., 2012). Fidelity level (FL) was used to classify the recorded plant species based on their claimed relative effectiveness. It was calculated as follows: FL ¼(Ip/Iu) 100; where Ip: number of informants who mentioned the use of a particular species for a particular purpose, and Iu: total number of informants who mentioned the plant for any use (Nawash et al., 2013). Informant agreement ratio (IAR) was used to measure the agreement between informants concerning which plants are used for specific use categories. IAR was calculated as IAR ¼(Nur Nt)/ (Nur 1); where Nur: number of use records in each use category, and Nt: number of taxa used in each use category. IAR ranges from 0 to1 and a value of 1 indicates that taxa are used by many


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informants, thus inferring a high level of agreement and a distinct medicinal plant tradition (Inta et al., 2013). Ethnobotanicity index (EI) is the ratio between the number of useful medicinal species reported and the total flora in the area, expressed as a percentage. This index was used to verify the proportion of species considered useful in TM by the Mauritian population in relation to the total flora of the area in the study. It gives a very clear idea of the importance of the medicinal species in a region (Leto et al., 2013).

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3.2.3. Pain influence The majority of respondents (89.5%) stated that pain had an infuence on their daily routine life. The respondents rated to what extent pain distubed their daily routine on a rating scale (0- no disturbance, 10- highest disturbance) including disturbance on daily activity, mood, ability to walk, routine work, relationship with other people, sleep and enjoyment from life. Sixteen, 13.6%, 13.6% and 15.4% of respondents rated an average of 5 the disturbance of pain on daily activity, mood, ability to walk and routine work respectively.

2.6. Statistical analysis 3.3. Conventional therapies Data obtained was tabulated and analyzed using statistical package SPSS 16.0 and Microsoft Office Excel 2007. Relevant literature was collected by probing scientific databases (Pubmed, Scopus, EBSCO, and Google Scholar), local university dissertations/books and other web sources such as records from PROTA and PROSEA.

3. Results 3.1. Demographic profile The demographic characteristics of the TM users (n ¼332) and TM practitioners (n ¼20) are summarized in Table 1. As depicted in Table 1, the mean age for TM users and practitioners were 53.7 714.6 and 57.6 711.4 respectively. A preponderance of female TM users (57.5%) was noted with the majority being rural residents. The greater proportion of TM users (46.7%) had completed primary level of schooling whilst the majority of TM practitioners (55%) had attained secondary level of schooling. The average monthly income of the majority of households (66.6%) was estimated to be less than Rs 10,000 (1 US$ Rs 30). The TM users encompassed mostly retired people (38.0%). The TM practitioners were practising on a full-time basis with the majority (70%) having more than 20 years of experience. 3.2. Pain 3.2.1. Types of pain The various types of pain experienced by the informants were catergorised into 11 groups. The respondents accounted for all pain types they have ever experienced irrespective of whether they have used conventional or TM for pain management. Back pain (upper, middle or lower), hip and waist pains (77.1%) were found be most common among respondents. Limbs pain (including forearms, arms, hands, thighs and legs pains) (64.8%), stomach pain (49.7%), head pain (45.2%), shoulder pain (36.4%) and knee pain (33.7%) were also frequent. Other pain types included dysmenorrhea and labor pain. 3.2.2. Pain conditions and assessment Thirty percent of the respondents had experienced pain as a result of an illness or a disorder. The common disorders included sciatica (36.1%), rheumatoid arthritis (21.3%), osteoarthritis (11.2%), gout (6.5%), migraine (5%), peroneal tendonitis (5%), cancer pain (2%), ostheoporosis (2%) endometriosis (1%) and fibromyalgia (1%). Other disorders (8.9%) which resulted in pain included tarsal coalition, tennis elbow, frozen shoulder, varicose, diabetic neuropathy, cramps, swelling and other conditions where inflammation of bones, cartilages and joints were common. In relation to pain assessment before any therapy, 21.2% and 20.5% of respondents rated the pain intensity experienced as 5 and 4 respectively based on Visual Analog Scale (VAS) of 0–10. Less than 10% reported pain intensity to be severe that is 8 based on the afore-mentioned scale.

3.3.1. Conventional therapies for pain management and treatment A high proportion of respondents (97.0%) had used conventional therapies for pain management and treatment. The participants had accounted for all the conventional medications used for pain management. One participant may have used more than 1 allopathic medicine at a given time. The most prevalent drugs were paracetamol (91.8%) and NSAIDs (55.6%). Frequently used NSAIDs included Diclofenac (70.5%), Aspirin (32.8%), Ibuprofen (25.6%) and Celecoxib (15.2%). Other drugs included corticosteroids, anti-depressants, anxiolytics and sedatives. Sedatives and anxiolytics were used in certain cases where patients experienced extreme, excruciating pain, to produce relaxing effects and consequently provide minimal relief. The most common dosage forms were analgesic and antiinflammatory tablets and capsules (84.1%), followed by antiinflammatory suppositories (51.6%), anti-inflammatory sprays (45.8%) and ointments (21.6%). Balms including Mentholatums, Tiger Balms, Sloan's analgesics and ThermoGreens were frequently applied topically for pain relief. 3.3.2. Effectiveness and side effects associated of conventional therapies The majority of respondents (27.4%) rated 4 the pain intensity based on the VAS following conventional medicine use showing a slight amelioration in pain intensity compared to initial pain assessment. The greater proportion of participants seemed dissatisfied with conventional therapy, rating its effectiveness 4 based on a Likert scale. Less than 5% of the sample reported conventional therapies to be very effective. More than 50% of respondents observed no side effects with conventional therapy. However 24% experienced mild side effects and 15% rated side effects to be severe. The most frequent side effects as reported by respondents are gastric ulceration (40.5%), abdominal discomfort (25.1%), constipation (4.4%), diarrhea (10%) and nausea with ibuprofen (20%). Forty percent of the TM users reportedly experienced gastric ulceration from Diclofenac. 3.4. Herbal remedies A total of 79 plant species distributed within 40 families and 76 genera have been described by respondents to be used for pain management and treatment (Table 2). Families with the largest number of entities are Lamiaceae (6) followed by Apiaceae (5), Asteraceae (5), Euphorbiaceae (5) and Poaceae (5). In addition, 20 polyherbal preparations were used by informants for several painrelated conditions (Table 3). One plant with the local name ‘Chenoire’ was unable to be identified by the local botanist. It was recorded under its local name and was not included in any quantitative analyzes. Species that ranked highest according to their UV were Morinda citrifolia (1.11), Ricinus communis (1.07), Aloe vera (0.52), and


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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 6

Scientific name of Family plant (collection number)

VN/CEN

Acalypha wilkesiana Mull. Arg. (PS17)

Feuille rouge/ L Copper leaf

Method of preparation, dose and mode of administration

RFC

UV

Common recorded literature uses

Heated oil is applied evenly on leaf which is carefully tied to pain site. 2 leaves 0.25 are tied to forehead for headache.

Body ache, legs pain, Joint pain (rheumatism)

Bath with decoction of leaves for legs pain, joint pain and body ache. Or legs are soaked in decoction of leaves when painful.

BU

Ear ache Legs pain

Bulb is heated to extract oil. 2 drops of oil extracted is inserted in ear. Bulbs are crushed and mixed with Mustard oil (Brassica juncea oil) and concocted paste is applied on aching body parts.

0.07

0.08 Anticarcinogenic, antiatherosclerotic, antithrombotic, antimicrobial, antiinflammatory and antioxidantc

Aloe vera (L.) Burm. Xanthorrhoeaceae Aloe vera/ f. (PS34) Aloe vera

G

Legs pain, Body ache

Gel is applied locally on pain site. Gel is consumed orally. 2 tablespoons daily.

0.40

0.52 Anti-inflammatory, analgesicd

Ananas bracteatus Baker (PS12)

Ananas marron/Wild pineapple

L

Body ache

Leaves are crushed and poultice made from leaves is applied on pain site.

0.03

0.03 –

Annona muricata L. Annonaceae (PS43)

Corossol/ Soursop

L

Headache

Leaves are crushed and poultice made from leaves is applied on forehead.

0.04

0.04 Antitumoral, antimicrobial, cytotoxicity, antiparasitic and pesticidale

*

Euphorbiaceae

Bois L bigaignon/NA

Legs pain Body ache, joint pain (rheumatism)

Decoction of leaves is taken orally. 3 cups per week for rheumatism pain. Bath with decoction of leaves for legs pain or body ache.

0.06

0.07 Antioxidant and antiglycationf

*

Aphloiaceae

Fandamane/ Albino-berry

L

Stomach ache

Decoction of leaves is taken orally. 3 cups per week.

0.04

0.04 Anti-inflammatoryg

Apium graveolens L. Apiaceae (PS01)

Celerie/ Celery

L, ST

Lower back ache, body Infusion of leaves is taken orally. 1 cup daily for 1 week. Or Decoction of seeds is 0.10 ache taken orally. 1 cup daily for 1 week.

0.13 Analgesic, antinociceptiveh Anti-inflammatory, antioxidanti

Artemisia absinthium L. (PS49)

Asteraceae

Armoise, Herb de Feu/ Wormwood

L

Dysmenorrhea

Decoction of leaves is taken orally. 1 cup daily during menstruation.

0.12

0.12 Anthelmintic, antifungal, antimicrobial activity, diuretic, emmenagoguej

Artocarpus heterophyllus Lam. (PS77)

Moraceae

Jacques/ Jackfruit

L

Stomach ache

Infusion of leaves is taken orally. 1 cup daily for 3 days

0.06

0.06 Anti-inflammatory, antibacterial, antioxidant and antidiabetick

Atropa belladonna L. (PS02)

Solanaceae

Belladone/ Deadly nightshade

L

Chronic body ache

Tincture of leaves is prepared using ethanol 90% which is heated in a water bath 0.12 then poured over leaves. Resulting tincture is applied as compress on pain site. Instead of ethanol 90%, rum can be added, preparation is same as aforementioned. And 1 table spoon of resulting mixture is mixed with 1 cup of water and taken orally for chronic pain.

0.12 Joint pain (rheu matism), leg pain (sciatica), and nerve pain (neuralgia)l

Ayapana triplinervis Asteraceae (Vahl) R.M.King & H.Rob. (PS22)

Ayapana/ Water Hemp

L, WP

Stomach ache, Headache

Leaves infusion is taken orally. 1 cup daily for 3 days.

0.14

0.17 Antimicrobial, anti-inflammatorym

Azadirachta indica A.Juss. (PS33)

Lila de perse/ L Neem

Headache, migraine

Leaves are crushed and paste is applied to forehead.

0.19

0.21 Abortifacient, analgesic, hypoglycaemic, immunomodulatoryn

Body ache, Joint pain (rheumatism)

Decoction of leaves is prepared and when concoction turns yellow in color, table salt is added. Preparation is then allowed to cool and used to bath. Or decoction of leaves is applied as compress on painful body sites.

Abdominal pain

Decoction of leaves is taken orally. 1 cup daily for 3 days.

0.11

0.14 Antitumour, anti-inflammatory, antidiabetic, antihyperglycemic, antioxidanto

Antidesma madagascariense Lam. (PS70) Aphloia theiformis (Vahl) Benn. (PS63)

Bidens pilosa L. (PS62)

Amaryllidaceae

Bromeliaceae

Meliaceae

Asteraceae

L'ail/Garlic

Lavillebague/ L, cobbler's pegs WP

0.53 Antibacterial and antifungal Hypoglycemic b

a

Headache

Allium sativum L. (PS25)

Euphorbiaceae

Part Pain condition plant



Table 2 List of medicinal plants used for pain management and treatment.

67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 Crassulaceae

Capsicum frutescens L. (PS21)

Sulfat/ Cathedral Bells

L

Solanaceae

Piment sec/ Chili

FR, S

Cardiospermum halicacabum L. (PS58)

Sapindaceae

Liane Pok Pok/Balloon Vine

Cassia fistula L. (PS35)

Fabaceae

Catharanthus Apocynaceae roseus (L.) G.Don (PS13)

Legs pain

Decoction of whole plant is prepared and when mixture turns black in color, it is allowed to cool and then used for legs bath. Heated oil is applied evenly on leaf which is carefully tied to pain site. Bath with 0.29 decoction of leaves for legs pain and body ache. Decoction of leaves is prepared and applied as compress on painful body sites.

0.34 Antimicrobial, anti-ulcer, antinociceptive, anti-inflammatory, antidiabetic, neurosedative and muscle relaxant, hepatoprotectivep

Ear ache

Seeds of dried chilies are removed and a concoction is prepared using oil. 1-2 drops of mixture is inserted in ear.

0.05 Carminative, antispasmodic and antiseptic. Arthritis, rheumatismq

WP

Legs pain

Decoction of leaves is prepared and applied as compress on painful body sites. 0.08

0.08 Diaphoretic, diuretic, emetic, laxative, antibacterial, anti-diarrheal, antioxidantr

Sene/Golden shower

L

Stomach ache

Infusion of leaves is taken orally. 1 cup daily for 3 days.

0.07

0.07 Laxative, antiperiodic, depurative, antiinflammatory, Gout arthritis, and rheumatalgias

Saponaire/ Madagascar rosy periwinkle

L

Stomach ache


0.11

0.13 Anthelminthic, antineoplastic, antidiabetic, antidiarrhealt

L

Legs pain

Decoction of leaves is used for foot bath. Feet are immersed in the preparation for at least 30 minutes. Bath with infusion of leaves for rheumatism pain and body ache. Leaves are 0.15 crushed together with that of ‘Chenoire’ leaves and applied as a poultice on pain site. A cluster of leaves mixed with table salt is used to rub painful body sites. This is usually followed by bath with infusion of leaves as aforementioned.

0.16 Insecticidal, antimicrobial, antiviral, anticoccidial, anti-nociceptive, anticancer and antitussiveu

Body ache, Legs pain

0.05

Cinnamomum camphora (L.) J. Presl. (PS71)

Lauraceae

Cinnamomum zeylanicum Blume (PS32)

Lauraceae

Canelle/ Cinnamon

B

Stomach ache

Bark is added to decoction of Camellia sinensis and a cup of concoction is taken 0.03 orally for 3 days.

0.03 Analgesic, antipyretic, antioxidant. antiinflammatory, antidiabetic, antimicrobialv

Coffea arabica L. (PS42)

Rubiaceae

Café/Coffee

S

Abdominal pain

Decoction of seeds is taken orally. 1 cup daily for 3 days.

0.03 Antiproliferative, antioxidant, and antimicrobialw

Coix lacryma-jobi L. Poaceae (PS76)

Collier cipaye/ Job's Tears

RT

Lower back ache

Decoction is prepared using root following thorough washing and 1 cup is taken 0.15 orally per 2 weeks.

0.15 Antiproliferative,anti-inflammatory, anticancer and antiallergicx

Colocasia esculenta Araceae (L.) Schott (PS11)

Songe/Wild Taro

L

Headache

Heated oil is applied evenly on leaf which is tied carefully to pain site. 1 leaf can 0.16 be tied to forehead for headache.

0.16 Antibacterialy

Corymbia citriodora Myrtaceae (Hook.) K.D. Hill & L.A.S.Johnson (PS57)

Eucalyptus citronelle/ Lemon eucalyptus

L

Joint pain (rheumatism)

Bath with decoction of leaves for rheumatism pain.

0.03 Antifungalz

Curcuma longa L. (PS04)

Zingiberaceae

Safran vert/ Tumeric

RZ, RP

Legs pain, body ache

Turmeric powder is heated in oil and paste is applied on pain site. Or rhizome is 0.22 crushed and paste is applied to pain site.

0.32 Anti-inflammatory, antioxidant, antithrombotic, wound healingaa

Cymbopogon citratus Stapf (PS50)

Poaceae

Citronelle/ Lemongrass

ST

Joint pain (rheumatism) Stomach ache

Rhizome is crushed and added to milk and taken orally. 1 cup of milk is used and honey is added to enhance preparation. Infusion of leaves together with Curcuma longa, Zingiber officinale and Vepris 0.06 lanceolata leaves is taken orally.

0.06 Antinociceptive, antifungal, antiinflammatory, antimalarial, antimutagenicitybb

Cynara scolymus L. (PS44)

Asteraceae

Artichaut/ Artichoke

L


Infusion of leaves is prepared and applied as compress on painful body sites.

0.07 Hepatoprotective, anticarcinogenic, antioxidative, anti-inflammatory, antibacterialcc

Cynodon dactylon (L.) Pers. (PS20)

Poaceae

Chiendent/ Bermuda grass

WP

Body ache

A concoction is prepared using Curcuma longa rhizome, Cynodon dactylon weed 0.04 and Trachyspermum ammi seed whereby each plant is crushed and mixed together with Mustard oil (Brassica juncea oil). The paste obtained is applied on pain site.

0.04 Antidiabetic, antioxidant and hypolipidemic, immunomodulatory, hepatic antioxidantdd

Daucus carota L. (PS56)

Apiaceae

Carrote/Wild carrot

RT

Joint pain (gout)

Decoction of root is used for gout pain. 3 cups per week.

0.04 Antimicrobialee

Body ache, joint pain (rheumatism)

0.03

0.03

0.07

0.04



Bryophyllum pinnatum (Lam.) Oken (PS69)

7

67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 8

Table 2 (continued ) VN/CEN



RFC

UV

*

Asparagaceae

Bois chandelle/NA

L

Stomach ache


0.03

0.03 –

*

Erythroxylaceae

Bois de ronde/ Bolivian coca

ST

Lower back ache as a Infusion of stem bark is taken orally. 3 cups per week. result of kidney stones or urinary infections

0.05

0.05 Antimicrobialff

Eucalyptus globulus Myrtaceae Labill. (PS64)

Eucalyptus/ Tasmanian Blue Gum

L

Legs pain

Decoction of leaves is used for foot bath. Salt is added to the mixture. Feet are 0.16 immersed in the preparation for at least 30 minutes. Leaves of Tamarindus indica L. can also be added to the preparation.

0.16 Antioxidantgg

Euphorbia hirta L. (PS14)

Jean Robert/ WP Asthma weed

Abdominal pain

Infusion of whole plant is taken orally. 1 cup for 1 week.

0.04 Antirumour, ant ispasmodic, antidiarrhoeal, anti-inflammatory, antibacterialhh

Furcraea foetida (L.) Asparagaceae Haw. (PS41)

Aloès, la loie/ L Mauritiushemp

Ear ache

Leaf is heated and crushed to extract juice and 2 drops are inserted in ear. Young 0.11 leaves are preferred.

0.11

Gomphocarpus physocarpus E. Mey. (PS78)

Fanore/ Balloon plant

Stomach ache

Decoction of leaves is taken orally. 1 cup daily for 1 week.

0.05

0.05 Sedative, strengthen bodyjj

Dracaena reflexa Lam. (PS68) Erythroxylum laurifolium Lam. (PS31)

Euphorbiaceae

Apocynaceae

L

0.04


Anti-oxidantii

Hedychium Zingiberaceae flavescens Carey ex Roscoe (PS29)

Zinzam RZ marron/ Yellow ginger

Joint pain (rheumatism), body ache

Rhizome is crushed and cooked in Mustard oil (Brassica juncea oil) and concoction is applied on pain sites.

0.11

0.14 Antibacterial, antifungal, and insecticidalkk

Heimia myrtifolia Cham. & Schltdl. (PS09)

Ambaville/ Sun opener

L


Decoction of leaves is taken orally. 3 cups per week for rheumatism pain.

0.07

0.07 Diuretic, anti-inflammatory, cytotoxicll.

Heliotropium Boraginaceae indicum L. (PS59)

Herb papillon/ Indian heliotrope

WP, L Lower back ache as a Decoction of whole plant is taken orally. 3 cups per week. result of kidney stones or urinary infections

0.03

0.03 Anti-inflammatory, diuretic, abortifacient, wound healing and antitumormm

Hypericum spp. L. (PS36)

Hypericaceae

Millepertuis/ St. John's wort

L

Stomach ache


0.01

0.01 Antidepressant, antiviral, antimicrobial, anti-inflammatory, antibacterialnn

Illicium verum Hook.f. (PS72)

Schisandraceae

Anie etoilee/ Star anis

F

Stomach ache

Decoction of flowers is taken orally. 1 cup daily for 3 days.

0.07

0.07 Insecticidal, antifungal, antimicrobial and antioxidativeoo

Lantana camara L. (PS28)

Verbenaceae

Vieille fille/ common lantana

L

Body ache

Leaves are pounded and poultice made from leaves is applied on pain site.

0.06

0.06 Antifungal,anti proliferative, antimicrobialpp

Linum usitatissimum L. (PS54)

Linaceae

Graine de lin/ S Flaxseed

Lower back ache

Decoction of seeds (following soaking of seeds for at least 8 hours) is consumed 0.05 per litre on a daily basis.

0.05 Anti-inflammatory, analgesic and antipyreticqq

Litsea glutinosa (Lour.) C.B.Rob (PS06)

Lauraceae

Bois zozo/ Indian laurel

L, ST


Infusion of leaves is taken orally. 1 cup daily for rheumatism pain.

0.02 Anti-nociceptiverr

Manihot esculenta Crantz (PS19) Matricaria chamomilla L. (PS48)

Euphorbiaceae

Manioc/ Cassava Chamomile/ Chamomile

L

Legs pain

F

Stomach ache, spasms in pregnant women

Heated oil is applied evenly on leaf which is tied carefully to pain site. 2 leaves 0.08 are tied to legs. Infusion of flowers is taken orally. 1 cup daily for 1 week. 0.07

Mentha piperita L. (PS61)

Lamiaceae

La menthe/ Peppermint

L

Stomach ache

Lythraceae

Asteraceae


0.02

0.20

0.08 Antioxidant and antiradicalss 0.09 Anti-inflammatory and antiseptic, also antispasmodic and sudorifictt 0.20 Antiviral, antibacterial, antifungal, radioprotective, antioedema, analgesic, and antioxidant uu



Scientific name of Family plant (collection number)

67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 Cucurbitaceae

Margoz/Bitter FR gourd

Body ache

Fruit is crushed to extract juice which is taken orally. 1 tablespoon daily for 1 week.

Morinda citrifolia L. Rubiaceae (PS10)

Feuille Tortue/Noni

L

Legs pain, headache, body ache

Heated oil is applied evenly on leaf which is tied carefully to pain site. 2 leaves 0.45 are tied to forehead for headache.

1.11

Musa acuminata Colla (PS23)

Banane/Wild banana

L

Lower back ache, joint pain (rheumatism) Headache, migraine

Decoction of leaves is prepared and applied as compress on painful body sites.

0.08 Antibacterial and antioxidantxx

Musaceae

0.03

0.03 Analgesic, anti-inflammatory,antipyretic, antispasmodic, hypotensivevv Antithrombotic, antioxidant, analgesic and anti-inflammatory, xanthine oxidase inhibitory, antispasmodicww

Young leaf is heated and carefully tied to head for head ache. Infusion of leaves is 0.07 taken orally. 1 cup daily for 1 week.

Nigella sativa L. (PS45)

Ranunculaceae

Nigelle/Black cumin

S

Stomach ache

Seeds are ingested with 1 cup of water daily for 1 week.

0.03

0.03 Anticancer, antidiabetic, antiradical, immunomodulatory, analgesic, antimicrobial, anti-inflammatoryyy

Ocimum basilicum L. (PS75)

Lamiaceae

Tukmaria/ Sweet basil

S

Stomach ache

Seeds are soaked overnight and drank with lukewarm water in the morning. 1 cup daily for 1week.

0.04

0.04 Antimicrobialzz

Ocimum tenuiflorum L. (PS05)

Lamiaceae

Tulsi/Holy basil

L

Stomach ache

Infusion of leaves is taken orally. 1 cup daily for 3 days. Or 3 raw leaves are chewed and juice is ingested.

0.14

0.16 Anticancer, antidiabetic, antifungal, antimicrobial, analgesic, antispasmodicaaa

Orthosiphon Lamiaceae aristatus (Blume) Miq. (PS27)

Autochiffon/ Cat's whiskers

L

Ear ache Lower back ache as a result of renal inflammation

Leaves are crushed to extract the juice and 2 drops are inserted in ear. Infusion of leaves is taken orally. 3 cups per week.

Oryza sativa L. (PS15)

Poaceae

Du riz/Rice

S

Back ache, shoulder ache

Heat uncooked rice and put in a cotton cloth and used as a poultice to apply on 0.05 pain site.

0.05 Anti-leukemicccc

Paederia foetida L. (PS67)

Rubiaceae

Liane caca/ Skunkvine

L

Stomach ache/ epigastric pain

Decoction of leaves is taken orally. 1 cup daily for 1 week.

0.07

0.07 Anti-inflammatory, antioxidant, antithrombolytic, anticytotoxic, antidiabeticddd

Petroselinum crispum (Mill.) Nyman (PS40)

Apiaceae

Persie friser/ Parsley

L

Joint pain (gout)

Infusion of leaves is taken orally. 2-3 cups is consumed daily for gout pain.

0.12

0.12 Antimicrobial, menorrhagic, anticoagulant, antihypertensive, antioxidanteee

Phyllanthus emblica Phyllanthaceae L. (PS65)

Amla/ Indian gooseberry

L, FR

Body ache, legs pain

Bath with decoction of leaves for body ache, limbs pain. Or Juice extracted from 0.13 fruits is taken daily.

0.14 Analgesic, anti-inflammatory, antioxidant, chemoprotective, hypolipidaemicfff

Pimpinella anisum L. (PS08)

Gros l'ani/ Aniseed

FR

Stomach ache

Infusion of aniseed is taken orally. 1 cup daily for 1 week.

0.12 Antimicrobial, antifungal, antiviral, antioxidant, muscle relaxant, analgesic and anticonvulsantggg

Piper betle L. (PS37) Piperaceae

Betel/Betel

L

Headache, body ache

Leaf is tied carefully to pain site. 2 leaves tied to forehead for headache. Leaves 0.04 are crushed and Curcuma longa paste is added. Concoction is dissolved in water and 1 cup of preparation is taken orally for 1 week.

0.05 Antimicrobial, Gastroprotective, Antioxidant, anti-arthritis, anti-strokehhh

Plantago lanceolata Plantaginaceae L. (PS24)

Plantain/ ribwort plantain Peche/Peach

L


Bath with decoction of leaves for rheumatism pain. Young leaves are preferred. 0.11

0.11

L

Stomach ache


0.08

0.08 Antibacterial, antifungal, phytotoxic and insecticidaljjj

L

Stomach ache


0.08

0.08 Anticestodal, analgesic, anti-inflammatory, antimicrobial, hepatoprotective and antioxidantkkk

0.38

1.07 Anti-inflammatory and antioxidantlll

Apiaceae

Prunus persica Stokes (PS18)

Rosaceae

Psidium guajava L. (PS52)

Myrtaceae

Goyave/ Guava

Ricinus communis L. (PS30)

Euphorbiaceae

Palma L Christi/Castor oil plant

Headache, body ache

Heated oil is applied evenly on leaf which is carefully tied to pain site.

Saccharum officinarum L. (PS46)

Poaceae

Cane/Sugar cane

Legs pain, body ache, stomach ache Ear ache

Bath with decoction of leaves for limbs pain or body ache. Or A poultice of crushed leaves is applied on pain site. Young leaf is crushed to extract the juice and 1-2 drops are inserted in ear.

L

0.05 Antioxidant and anti-inflammatorybbb 0.05

0.12

Anti-inflammatory and antioxidantiii



Momordica charantia L. (PS51)

0.04 Antioxidantmmm 0.04

9

67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 Scientific name of Family plant (collection number)

VN/CEN



RFC

UV

Salvia hispanica L. (PS03)

Lamiaceae

Chia/Chia

S

Stomach ache

Seeds are ingested with 1 cup of water daily for 1 week.

0.01

0.01 Improves adiposity and normalize hypertriacylglycerolaemia and insulin resistancennn

Senna occidentalis (L.) Link (PS66)

Fabaceae

Casse puante/ RT Coffee Senna

Stomach ache

Infusion is prepared using root following thorough washing. 1 cup is consumed 0.05 daily and treatment is continued for maximum 10 days.

0.05 Antibacterial, antimalarial, antitrypanosomalooo

Swertia chirata C. B. Gentianaceae Clarke (PS38)

Chirayata/ Chiretta

L

Body aches resulting from fever

Infusion of leaves is taken orally. 1 cup daily for 1 week.

0.04

0.04 Antioxidative, anti-inflammatory and anticarcinogenicppp

Symphytum officinale L. (PS60)

Boraginaceae

Consoudre/ Comfrey

L

Pain resulting from bone fractures, open cuts and dislocated joints

Leaves are crushed and paste is applied on pain site. Leaf is warmed and tied carefully to pain site.

0.08

0.08 Anti-inflammatory, analgesic, antiedematous, adstringentqqq

Syzygium aromaticum (L.) Merr. & L.M. Perry (PS73)

Myrtaceae

Ziroffe/Clove

F

Stomach ache

Infusion of flower is taken orally. 1 cup daily for 3 days.

0.15

0.18 Antiseptic, analgesic, anaestheticrrr

Tamarindus indica L. (PS74)

Fabaceae

L

Toothache Legs pain

Clove is inserted between gum and aching tooth. Decoction of leaves is used for foot bath. Salt is added to the mixture and 0.08 sometimes ethanol is added. Feet are immersed in the preparation for at least 30 minutes.

0.08 Antifungal, anti-inflammatory, and antidiabeticsss

Thymus vulgaris L. (PS39)

Lamiaceae

Dithint/ Thyme

L

Abdominal pain

Infusion of leaves is consumed orally. 1 cup daily for 3 days.

0.07 Antispasmolytic, antibacterial, antifungal, antiseptic, antlelmintic, antitusivettt

Trachyspermum ammi Sprague (PS53)

Apiaceae

Jawain/ Bishop's weed

S

Labor pain Stomach ache

Infusion of thyme together with Zingiber officinale is taken orally for labor pain. Decoction of seeds is consumed per litre on a daily basis for 1 week. 0.07

0.07 Antiviral, anti-inflammatory, antifungal, antipyretic, analgesic, antinociceptive, antioxidantuuu

*

Toddalia asiatica Lam. (PS26)

Rutaceae

Patte poule/ orange climber

WP

Legs pain

Whole plant is crushed together with Curcuma longa rhizome and resulting paste is applied on pain site.

0.08

0.08 Anti-microbialvvv

*

Vepris lanceolata (Lam.) G.Don (PS47)

Rutaceae

Patte poule piquant/ white ironwood

L


Decoction of leaves is taken orally for rheumatic pains. 3 cups per week for rheumatism pain.

0.09

0.09 Antibacterialwww

Verbena officinalis L.(PS16)

Verbenaceae

Verveine/ Common vervain

L/WP Stomach ache

Infusion of leaves is taken orally. 1 cup daily for 1 week.

0.03

0.03 Anti-inflammatory, analgesicxxx

Zingiber officinale Roscoe (PS79)

Zingiberaceae

Zinzam/ Ginger

RZ

Labor pain, abdominal pain

Decoction of crushed ginger is taken orally. 1cup daily for 3 days for abdominal 0.14 pain.

Masson/ Indian plum –

L

Headache

Heated oil is applied evenly on leaf which is carefully tied to pain site.

0.04

L

Body ache, legs pain Body ache

Bath with decoction of leaves for legs pain or body ache. Bath with infusion of leaves for body ache.

–

Ziziphus mauritiana Rhamnaceae Lam. (PS07) Unidentified – ‘Chenoire’(PS55)

0.06


0.20 Analgesic, sedative, antipyretic and antibacterial, antioxidant, antiinflammatory, antimicrobialyyy 0.08 Antibacterialzzz –

–

n Indigenous/Endemic plants; RFC ¼ relative frequency of citation; UV ¼ use value; C ¼ cultivated; G ¼ Gel; L¼ Leaves; WP ¼ Whole plant; F¼ Flowers; S¼Seeds; RP ¼Root powder; RZ¼ Rhizome; RT ¼Root; FR¼ Fruit; F¼ Flower; BU¼ Bulbs; Stem¼ ST; VN¼ Vernacular Name; CEN¼ Common English Name; SN ¼Scientific Name; NA ¼Not applicable. a Jekayinfa et al. (1997); b Ikewuchi et al. (2011); c Capasso (2013); d Devaraj and Karpagam (2011); e Gajalakshmi et al. (2012);



10

Table 2 (continued )

67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 f

D.P. Sreekeesoon, M.F. Mahomoodally / Journal of Ethnopharmacology ∎ (∎∎∎∎) ∎∎∎–∎∎∎ 11


Mahomoodally et al. (2012); Jonville et al. (2011); h Jawad et al. (2006); i Mencherini et al. (2007); j Mahmoudi et al. (2009); k Manuel et al. (2012); l Rita and Animesh (2011); m Gauvin-Bialecki and Marodon (2008); n Hashmat et al. (2012); o Bartolome et al. (2013); p Tatsimo et al. (2012); q Vinayaka et al., (2010); r Raza et al. (2013); s Bhalodia, Shukla (2011); t Gajalakshmi et al. (2013); u Chen et al. (2013); v Manosi et al. (2013); w Nuhu (2014); x Bhandari et al. (2012); y Nakade et al. (2013); z Aguiar et al. (2014); aa Çikrikçi et al. (2008); bb Shah et al. (2011); cc Alghazeer et al. (2012); dd Ashokkumar et al. (2013); ee Maxia et al. (2009); ff Gurib-Fakim et al. (2005); gg Mota et al. (2012); hh Patil and Magdum (2011); ii Mathew et al. (2012); jj Stafford et al. (2005); kk Sakhanokho et al. (2013); ll Ayoub et al. (2010); mm Dash and Murthy (2011); nn Stojanovic et al. (2013); oo Huang et al. (2010); pp Ganjewala et al. (2009); qq Kaithwas et al. (2011); rr Pradeepa et al. (2013); ss Tsumbu et al. (2011); tt Singh et al. (2011); uu Saharkhiz et al. (2012); vv Ullah et al., (2012); ww Gilani et al. (2010); xx Karuppiah and Mustaffa (2013); yy Ramadan (2007); zz Adigüzel et al. (2005); aaa Pattanayak et al. (2010); bbb Hsu et al. (2010); ccc Liao et al. (2006); ddd Ahmed et al. (2014); eee Mahmood et al. (2014); fff Dhale and Mogle (2011); ggg Shojaii and Abdollahi Fard (2012); hhh Pradhan et al. (2013); iii Al-mamun et al. (2007); jjj Aziz (2013); kkk Metwally et al. (2010)‘; lll Zarai et al. (2012); mmm Duarte-Almeida et al. (2011); g

67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132


12

Bryophyllum pinnatum (0.34). Interestingly the plant parts with highest prevalence used for remedy preparation were leaves (58.1%) whilst other plant parts (whole plant, stem, seeds, bark, root, flowers, fruits, bulbs, and gels) recorded less than 10% of use. The most frequent preparation method was decoction (34%) both for internal and external administrations (oral use, compress, bath and washing) followed by infusion (25.8%), poultice (20.6%) and others preparations (tinctures, intact plants, juices). The frequency of plant species uses documented were highest for stomach ache (22.7%), followed by body ache (20.2%), joint pain (13.4%) and legs pain (12.6%). Other conditions such as headache, migraine, ear ache, lower back ache, dysmenorrhea, abdominal pain, labor pain and tooth ache recorded less than 10% of uses. The biological plant taxons with highest FUV were Xanthorrhoeaceae (FUV¼0.52) with 1 plant species, Rubiaceae (FUV¼0.40) with 3 plant species and Euphorbiaceae (FUV¼0.36) with 5 plant species (Table 4). The highest IAR (1.00) was observed for use categories related to toothache but it had only one reported plant species therefore was not considered. Obstetrics, gynecologic and general body aches categories had second highest IAR showing a high agreement among informants. Most of the other use-categories including earache, headache/migraine and GI pain had IARs of 0.96. Artemisia absinthium (FL ¼100%) scored maximum for dysmenorrhea. Atropa belladonna (FL ¼100%) chronic pain, and Coix lacryma-jobi (FL ¼100%) for lower back ache. Both Mentha piperita (FL ¼100%) and Pimpinella anisum (FL ¼100%) had highest FL for stomach ache. Plantago lanceolata (FL ¼100%) and Vepris lanceolata (FL ¼100%) had highest FL for joint pain (rheumatism). Symphytum officinale (FL ¼ 100%) had highest FL for pain resulting from bone fractures, open cuts and dislocated joints. Based on RI values, Morinda citrifolia was found to possess highest diversity as a medicinal plant since it had maximum pharmacological properties and was exploited for highest number of use categories. Acalypha wilkesiana, Azadirachta indica and Ricinus communis also had high RI values of 1.80. The EI was used to verify the proportion of species considered useful in traditional medicine used by the Mauritian population in relation to the total flora (Leto et al., 2013). The total flora of the study was calculated using data from Republic of Mauritius, (ROM) (2011) which is estimated to be 685 plant species and 79 plant species have been found to be used for pain management and/or treatment in this study. Therefore, it was calculated as EI ¼79/ 685 100 ¼11.5%. 3.5. Zootherapy

ooo

Chicco et al. (2009); Ibrahim et al. (2010); ppp Saha and Das (2010); qqq Araújo et al. (2012); rrr Pinto et al. (2009); sss Ali and Shah (2010); ttt Zeghad and Merghem (2013); uuu Hassanshahian et al. (2014); vvv Karunai et al. (2012); www Gurib-Fakim et al. (2005); xxx Liu et al. (2012); yyy Yeh et al. (2014); zzz Najafi (2013).

Seven animal-derived products have been documented belonging to 7 families and 4 classes of species (Mammalia, Actinopterygii, Gastropoda, Chilopoda) were documented (Table 5). Mammals with 4 reported species were most common. The UV of zootherapeutic resources ranged from 0.01 to 0.04. The species with highest UV were Helix aspersa (0.04), Anguilla japonica (0.03) and Ovis aries (0.02). All the animal species recorded one use thus all of them had a FL of 100%.

nnn

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66

3.6. Reasons for using TM Reasons for using TM are summarized in Table 6. It was found 63.2% of the informants used a combination of TM with conventional therapy. 3.7. Pain intensity assessment following TM use The majority of respondents (59%) rated 2 as the pain intensity based on the VAS following TM (fig. 1). This tend to show a


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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66

13

Table 3 List of polyherbal preparations and related information used for pain management and treatment. FOC

Scientific name of plant

Pain condition


No. of plants used

Bidens pilosa L., Ocimum tenuiflorum L.

Abdominal pain

Decoction of Bidens pilosa L. whole plant, 3 leaves of Ocimum tenuiflorum L. 1 cup taken orally daily.

2

8

Bryophyllum pinnatum (Lam.) Oken, Cinnamomum camphora (L.) J.Presl.,‘Chenoire'

3 Joint pain (rheumatism) Bath with decoction of Bryophyllum pinnatum (Lam.) Oken leaves, Cinnamomum camphora (L.) J.Presl. leaves and ‘Chenoire' leaves.

15

Cassia fistula L., Paederia foetida L., Cinnamomum zeylanicum Blume, Artemisia absinthium L., Hypericum spp. L.

Dysmenorrhea

5 Decoction of Cassia fistula L. leaves, Paederia foetida L. leaves, Cinnamomum zeylanicum Blume leaves, Artemisia absinthium L. leaves, Hypericum spp. L. leaves is taken orally (Already available in mixture from herbalist). 2 cups taken orally per day for 3 days just before menstruation is due to start.

10

Cinnamomum camphora (L.) J.Presl., ‘Chenoire’

Body ache, joint pain (rheumatism)

Bath with decoction of 10 Cinnamomum camphora (L.) J.Presl., leaves and 10 ‘Chenoire’ leaves.

2

15

Cinnamomum zeylanicum Blume, Cymbopogon citratus Stapf.

Stomach ache

Decoction of 1bark of Cinnamomum zeylanicum Blume and 2 3 leaves of Cymbopogon citratus Stapf. 1 cup taken orally daily.

5

Curcuma longa L., Zingiber officinale Roscoe, Cymbopogon citratus Stapf.

Abdominal pain

Decoction of less than 5 g of Curcuma longa L. rhizome and Zingiber officinale Roscoe rhizome and stem of Cymbopogon citratus Stapf. 1 cup taken orally daily.

3

5

Cynara scolymus L., Cassia fistula L.

Migraine

Infusion of Cynara scolymus L. leaves and Cassia fistula L. leaves 2 (Already available in mixture from herbalist) is taken orally.1 cup taken orally in the morning and at noon before meal.

10

Cynodon dactylon (L.) Pers., Curcuma longa L., Trachyspermum Body ache ammi Sprague

A concoction is prepared using Curcuma longa L. rhizome, Cynodon dactylon (L.) Pers. weed and Trachyspermum ammi Sprague seeds whereby each plant is crushed and mixed together with Mustard oil (Brassica juncea oil). The paste obtained is applied on pain site.

3

7

*

Lower back ache as a result of kidney stones or urinary infections

Decoction of Erythroxylum laurifolium Lam. stem bark, Aphloia 5 theiformis (Vahl) Benn. leaves, Cassia fistula L. leaves, Antidesma madagascariense Lam. leaves, Heimia myrtifolia Cham. & Schltdl leaves (Already available in mixture from herbalist). 3 cups taken orally per day in the morning, at noon and at night.

6

Headache

Decoction of Eucalyptus globulus Labill.leaves, Vepris lanceolata (Lam.) G.Don leaves, Cymbopogon citratus Stapf. stem, Citrus aurantium L. leaves (Already available in mixture from herbalist). 1 cup taken orally in the morning and at night.

4

5

Stomach ache Gomphocarpus physocarpus E.Mey., Verbena officinalis L., Orthosiphon aristatus (Blume) Miq., Paederia foetida L., Ayapana triplinervis (Vahl) R.M.King & H.Rob., Cassia fistula L., Mentha piperita L., Matricaria chamomilla L.

Decoction of Gomphocarpus physocarpus E.Mey. leaves, Verbena 8 officinalis L. leaves, Orthosiphon aristatus (Blume) Miq. leaves, Paederia foetida L. leaves, Ayapana triplinervis (Vahl) R.M.King & H.Rob. leaves, Cassia fistula L. leaves, Mentha piperita L. leaves, Matricaria chamomilla L. flowers (Already available in mixture from herbalist). 3 cups taken orally per week.

6

Heliotropium indicum L., Aphloia theiformis (Vahl) Benn., Dracaena reflexa Lam., Erythroxylum laurifolium Lam.

Back ache

Decoction of Heliotropium indicum L. whole plant, Aphloia theiformis (Vahl) Benn. leaves, Dracaena reflexa Lam. leaves, Erythroxylum laurifolium Lam. leaves (Already available in mixture from herbalist). 1 l daily.

4

6

Lantana camara L., Citrus limon (L.) Burm.f.

Body ache

Decoction of Lantana camara roots and Citrus limon (L.) Burm.f. roots. 3 cups taken orally per week.

2

4

Matricaria chamomilla L., Verbena officinalis L.

Stomach ache

Infusion of 3 Matricaria chamomilla L. flowers and 3 Verbena officinalis L. leaves. 1 cup taken orally daily.

2

8

Mentha piperita L., Ayapana triplinervis (Vahl) R.M.King & H. Rob., Pimpinella anisum L.

Stomach ache

Infusion of 3 Mentha piperita L. leaves, 3 Ayapana triplinervis (Vahl) R.M.King & H.Rob. leaves and a pinch of Pimpinella anisum L. 1 cup taken orally daily.

3

22

Prunus persica Stokes, Mentha piperita L., Pimpinella anisum L. Stomach ache

3 Infusion of 3 Prunus persica Stokes leaves, 3 Mentha piperita L. leaves and a pinch of Pimpinella anisum L. 1 cup taken orally daily.

10

Psidium guajava L., Mentha piperita L., Pimpinella anisum L.

Stomach ache

3 Infusion of 3 Psidium guajava L. leaves, 3 Mentha piperita L. leaves and a pinch of Pimpinella anisum L. 1 cup taken orally daily.

8

Thymus vulgaris L., Zingiber officinale Roscoe

Labor pain

Infusion of 2 Thymus vulgaris L. stems and less than 5 g of Zingiber officinale Roscoe rhizome. 2 cups taken orally.

6

Erythroxylum laurifolium Lam., Aphloia theiformis (Vahl) Benn., Cassia fistula L., Antidesma madagascariense Lam., Heimia myrtifolia Cham. & Schltdl.

Eucalyptus globulus Labill., Vepris lanceolata (Lam.) G.Don, Cymbopogon citratus Stapf., Citrus aurantium L.

2


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14

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66

Table 3 (continued ) Scientific name of plant

Pain condition


*

Joint pain(rheumatism)

Decoction of 3 Vepris lanceolata (Lam.) G.Don leaves, 3 leaves of 3 Litsea glutinosa (Lour.) C.B.Rob, less than 5 g of Zingiber officinale Roscoe rhizome. 3 cups taken orally per week. Decoction of Verbena officinalis L. leaves, Matricaria chamomilla 5 L. leaves, Mimosa pudica L. leaves, Hypericum spp.L. leaves, Citrus aurantium L. leaves (Already available in mixture from herbalist). 1 cup taken orally in the morning and at night.

Vepris lanceolata (Lam.) G.Don, Litsea glutinosa (Lour.) C.B. Rob, Zingiber officinale Roscoe

Verbena officinalis L., Matricaria chamomilla L., Mimosa pudica Migraine L., Hypericum spp. L., Citrus aurantium L.

No. of plants used

FOC

5

5

L¼ Leaves; WP¼ Whole plant; F ¼ Flowers; S¼ Seeds; B ¼Bark; RZ ¼ Rhizome; RT¼ Root; FR ¼Fruit; F¼ Flower; BU ¼Bulbs; FB¼ Flower bud; Stem Bark¼SB; ST¼ Stem; VN¼ Vernacular Name; CEN ¼Common English Name; SN ¼Scientific Name n

Indigenous/Endemic species; FOC ¼ Frequency of citations (One respondents may have cited more than 1 polyherbal preparations)

considerable reduction in pain intensity level [mean¼ 2.3071.094] compared to initial pain intensity assessment [mean¼ 4.9871.865] and compared to pain intensity level following conventional medicine use [mean¼3.5371.551]. Paired sample t-tests performed showed that mean pain intensity level initially before TM use is significantly different from the mean pain intensity level following TM use (t¼26.307, po0.01). More than 50% of informants rated TM to be effective based on a Likert scale. Less than 2% found TM not effective at all. 3.8. Side-effects experienced with TM Ninety percent of TM users experienced no side effects. However, 2 respondents reported resulting burns on pain areas following application of Morinda citrifolia leaf on pain site. One respondent reported that oral consumption of Atropa belladonna caused palpitations. No herb-drug interactions were reported by informants using herbal remedies concurrently with conventional therapies.

4. Discussion Pain is a highly multi-faceted and multi-factorial condition (Gordon et al., 2014), which is challenging to treat and assess (Tracy and Morrison, 2013; Kumar and Tripathi, 2014). The present study has endeavored for the first time to document quantitatively TM commonly used for pain management and treatment in Mauritius. This condition was found to be an inseparable part of informants' life affecting all age groups, predominantly the elderly. This particular age group experienced mostly chronic pain as a result of disorders such as sciatica, rheumatoid arthritis, osteoarthritis and gout which were disrupting and difficult to disengage from. Indeed, a negative correlation was found between age group and pain disorders experienced showing that the elderly are more prone to experience pain as a result of disorders. In addition, this greatly impacted on their quality of life as they experienced sleep difficulties, depression and related complications. This finding can be corroborated to a study in which Atkinson et al. (2013) reported that the elderly experience panoply of painful conditions accompanied by considerable pain and symptom burdens. Consequently, this greatly affects quality of life of these individuals (Yoon and Kim, 2013). Informants suffering from chronic pain reported that it had negative effects on their well-being and quality of life with highest disturbance on daily activity, mood, interpersonal relationships, sleep and enjoyment from life. Accordingly, in a study, Sprintz et al. (2011) reported that chronic pain has considerable repercussions on daily life resulting in poor quality of life. Among the different pain types reported by informants, back pain was found to be most common. Interestingly, in a study

conducted in 5 European countries, Langley (2011) reported that back pain had been commonly cited by that more than 65% of respondents. In addition, in a recent study by Aickin et al. (2013) it was found that back pain was one of the conditions commonly necessitating primary care providers' intervention leading to extensive health care utilization. During interviews, it was found that conventional therapies including opioid and non-opioid analgesics, NSAIDs and antidepressants were extensively utilized for managing and treating different pain conditions in Mauritius. These were mostly successful in treating mild, short-lived pain conditions whereas chronic pain conditions being recurrent and intermittent in nature were poorly managed requiring not only opioid drugs but sedatives to produce relaxing effect. Interestingly, Martin and Eisenach (2001) reported similar observation stating that pain is inherent in daily life and most of the time when it is minor, it can effectively be managed with simple analgesics. However, they reported that neuropathic pain or persistent pain is insensitive to treatment with simple drugs but may respond to antidepressants despite the fact that antidepressants are not involved in the pain pathway. In the present study significant associations were found between TM use and demographic characteristics such as age, gender, place of residence, religion and occupation. Interestingly, in a study, Yoon and Kim (2013) reported that TM use can be related to a number of factors including psycho-social factors, ethnic and cultural characteristics, accessibility to healthcare resources and individual perception of physical and medical conditions. The most common reason cited for using TM was based on the preference for a combination of allopathic medicines and alternative therapies. Interestingly, Peleg et al. (2011) reported that most patients used alternative medicines to complement conventional therapies for management and treatment of pain. Herbal remedies were the most commonly used TM and we reported 79 medicinal plants distributed within 40 families and 76 genera to be used exclusively for pain-related conditions. A total of 6 plants species indigenous/endemic to Mauritius namely Antidesma madagascariense, Aphloia theiformis, Erythroxylum laurifolium, Dracaena reflexa, Toddalia asiatica and Vepris lanceolata have been documented for the first time to be used for pain management and treatment. Families with the largest number of entities were Lamiaceae with 6 species followed by Apiaceae, Asteraceae, Euphorbiaceae and Poacea with 5 species each. This may be supported by the fact that Lamiaceae is considered to be one of the largest plant families in the world and is characterized by nearly 250 genera, most of which are of aromatic and of therapeutic significance (Orhan et al., 2012). The frequency of plant species uses documented were highest for stomach ache, followed by body ache, joint pain and legs pain. In addition, 15 plant species were used to treat more than 1 pain


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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66

Table 4 Family use values (FUV) of the documented medicinal plants.

Table 4 (continued ) Family

Family

Species (UV)

Amaryllidaceae Annonaceae Aphloiaceae Apiaceae

Allium sativum Annona muricata Aphloia theiformis Pimpinella anisum Apium graveolens Petroselinum crispum Daucus carota Trachyspermum ammi Catharanthus roseus Gomphocarpus physocarpus Colocasia esculenta Furcraea foetida Dracaena reflexa Matricaria chamomilla Ayapana triplinervis Cynara scolymus Bidens pilosa Artemisia absinthium Symphytum officinale Heliotropium indicum Ananas bracteatus Bryophyllum pinnatum Momordica charantia Erythroxylum laurifolium Ricinus communis Acalypha wilkesiana Manihot esculenta Euphorbia hirta Antidesma madagascariense Tamarindus indica Senna occidentalis Cassia fistula Swertia chirata Hypericum spp. Mentha piperita Ocimum tenuiflorum Thymus vulgaris Ocimum basilicum Salvia hispanica Orthosiphon aristatus Cinnamomum camphora Litsea glutinosa Cinnamomum verum Linum usitatissimum Heimia myrtifolia Azadirachta indica Artocarpus heterophyllus Musa acuminata Eucalyptus globulus Syzygium aromaticum Corymbia citriodora Psidium guajava Phyllanthus emblica Piper betle Plantago lanceolata Coix lacryma-jobi Saccharum officinarum Cynodon dactylon Cymbopogon citratus Oryza sativa Nigella sativa Ziziphus mauritiana Prunus persica Morinda citrifolia Paederia foetida Coffea arabica Toddalia asiatica Vepris lanceolata Cardiospermum halicacabum Illicium verum Capsicum frutescens Atropa belladonna Verbena officinalis Lantana camara Aloe vera

ns

FUV

1 1 1 5

0.08 0.04 0.04 0.1

2

0.09

1 2

0.16 0.07

5

0.12

2

0.06

1 1 1 1 5

0.03 0.34 0.03

3

0.07

1 1 6

0.04 0.01 0.09

3

0.07

1 1 1 1 1 4

0.05 0.07 0.21 0.06 0.08 0.11

1 1 1 5

0.14 0.05 0.11 0.07

1 1 1 3

0.03 0.08 0.08 0.40

2

0.09

1 1 2

0.08 0.07 0.09

2

0.05

1

0.52

Zingiberaceae

Apocynaceae Araceae Asparagaceae Asteraceae

Boraginaceae Bromeliaceae Crassulaceae Cucurbitaceae Erythroxylaceae Euphorbiaceae

Fabaceae

Gentianaceae Hypericaceae Lamiaceae

Lauraceae

Linaceae Lynthraceae Meliaceae Moraceae Musaceae Myrtaceae

Phyllanthaceae Piperaceae Plantaginaceae Poaceae

Ranunculaceae Rhamnaceae Rosaceae Rubiaceae

Rutaceae Sapindaceae Schisandraceae Solanaceae Verbenaceae Xanthorrhoeaceae

(0.08) (0.04) (0.04) (0.12) (0.13) (0.12) (0.04) (0.07) (0.13) (0.05) (0.16) (0.11) (0.03) (0.09) (0.17) (0.07) (0.14) (0.12) (0.08) ((0.03) (0.03) (0.34) (0.03) (0.05) (1.07) (0.53) (0.08) (0.04) (0.07) (0.08) (0.05) (0.07) (0.04) (0.01) (0.20) (0.16) (0.07) (0.04) (0.01) (0.05) (0.16) (0.02) (0.03) (0.05) (0.07) (0.21) (0.06) (0.08) (0.16) (0.18) (0.03) (0.08) (0.14) (0.05) (0.11) (0.15) (0.04) (0.04) (0.06) (0.05) (0.03) (0.08) (0.08) (1.11) (0.07) (0.03) (0.08) (0.09) (0.08) (0.07) (0.05) (0.12) (0.03) (0.06) (0.52)

15

0.36

Species (UV) Curcuma longa (0.32) Zingiber officinale (0.20) Hedychium flavescens (0.14)

ns

FUV

3

0.22

UVs: use values of the species, ns: total number of species within each family FUV¼ UVs/ns; where (Cadena-González et al., 2013).

condition. Similarly, in a study, Amri and Kisangau (2012) reported that the frequency of medicinal plant uses was greatest for plant species used to treat stomach ache. In this present study, preponderance of leaves was noted to be used for herbal preparations. It is of uttermost importance to select the appropriate plant parts containing the secondary metabolites in order to attain the desired therapeutic effect. In addition, leaves harbor a multitude of pharmacologically active phytochemicals which are responsible for the curative effect. A number of ethnobotanical studies conducted in some developing countries showed that leaves are indeed extensively used for preparations because of their ease of collection compared to underground parts. Conservation issues can be another instigating reason as digging out roots might be the cause of death of the plant rendering it vulnerable (Sivasankari et al., 2014). In addition, Traore et al., (2013) reported that most traditional healers used leaves instead of underground parts in order to safeguard the species. Decoction was the most common method of preparation and the oral route was the most frequent route of administration used by herbal users and herbalists. Interestingly, 15 plant species had more than 1 method of preparation. One herbalist narrated: ‘The transmission of knowledge has been from father to elder son since 4 generations. My father has always preferred decoction as the plants usually used in dry forms will have their active principles extracted better by decoction than any other method of preparation'. This finding can be corroborated to a study in which Adnan et al., (2014) which reported that grinding or crushing and boiling are the most prevalent and efficient methods of active ingredient extraction in herbal remedies preparation. This study has also documented 20 polyherbal preparations to be used for pain-related conditions. The majority of the preparations were easily prepared at home by herbal users using fresh ingredients. In addition, some of the mixtures were available in dry form from the local herbalists. Combinations of different plant species can exert a synergistic action and this will consequently increase efficacy and potency of the preparation. Moreover, one herbalist related: ‘Inflammation is directly related to pain and when patients experience pain in particular chronic pain they would want relief at any cost. So in this line, polyherbal preparations at times containing up to 8 plant species are sought as the synergistic effect of the plants contribute to a faster therapeutic effect and consequently quicker pain relief is achieved'. Interestingly, in a study, Kadir et al., (2013) reported that traditional healers commonly used several plant species because of synergistic actions whereby two or more plants produce a greater effect than the sum of the effects of the plants when used alone. In addition, Bussmann et al., (2010) reported that many traditional healers use herbal mixtures comprising of complex constituents for managing diseases rather than using a single plant. However, they also reported that studies documenting these preparations and investigating the composition of the mixtures are scarce. In addition, the quantity of each herb used in polyherbal preparations does not conform to a particular standard but depend on the know-how and experience of the herbalists. Nonetheless, the herbalists accurately specify details relating to the mode of intake, dosage and frequency of


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16

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66

Table 5 Inventory of animal species and products used for pain management and treatment. Class/CEN/ Family Actinopterygii Eel (Anguillidae)

VN

Scientific name

Anguille

Anguilla japonica Skin (Temminck & Schlegel, 1846)

Chilopoda Centipede Centpieds (Scutigeridae)

Parts used

Indication Method of preparation and administration

UV

Reported literature uses

Ear ache

The skin is peeled and heated to extract oil. 1-2 drops of oil is 0.03 Ear infectiona inserted in ear for 3 days.

Scutigera coleoptrata (Linnaeus, 1758)

Whole body

Body ache

Whole body of dead centipede is inserted in ethanol 80% for 0.01 Pain relief in injuries caused by sting of insects 2-3 days. The resulting concoction is used to massage pain site and snake biteb for a week.

Helix aspersa (O. F. Müller, 1774)

Mucus

Ear ache

A small amount of mucus is inserted in ear.

0.04 Anti-wart; anti-callusc

Whole body Fat

Legs ache Headache

Whole body of rat is placed in placed in Cocos nucifera oil for 2-3 days and the oil is applied on pain site. Fatty substance extracted from anthers is wrapped in a cloth and tied to forehead for headache.

Common tenrec Tang (Tenrecidae)

Rattus rattus (Linnaeus, 1758) Odocoileus virginianus (Zimmermann, 1780)s Tenrec ecaudatus (Schreber, 1778)

Whole body

Lower back ache

0.01 Decrease pain after conceptiond 0.01 Heart diseases, ophthalmological problems, Didelphis virginianae 0.01 Renal failuref

Sheep (Bovidae)

Ovis aries (Linnaeus, 1758)

Fat

Back ache

Gastropoda Snail(Helicidae) Courpa Mammalia Rat (Muridae)

Lerat

Deer (Cervidae) Cerf

Chandelle (Graisse mouton)

Common tenrec is cooked using white wine and seasoning such as Cinnamomum verum, Syzygium aromaticum, Murraya koenigii are added to enhance it. Concoction is taken once per week. Fatty substance is extracted and applied locally on pain site. 0.02 Fissures on feet, rheumatism, arthritis, back ache, ear aches and inflammationsg

CEN ¼Common English Name; VN ¼Vernacular Name; UV ¼ use value a

Nunkoo and Mahomoodally (2012); Alves, Rosa (2007); c Quave et al., (2010); d Chakravorty et al., (2011); e Alves and Alves (2011a); f Mootoosamy and Mahomoodally (2014); g Ferreira et al., (2009). b

dose to patients. This finding can be correlated to Traore et al., (2013) study who reported that the quantities of herbs used are not standardised and depend on the experience of individual traditional healers. A total of 7 quantitative indices were used to evaluate the medicinal plants used for pain management and treatment. The RFC was used to determine the local importance of each species. The plant species with highest RFC were Morinda citrifolia, Aloe vera and Ricinus communis which tend to show that they were locally important for pain management and treatment. Hypericum spp. and Salvia hispanica had lowest RFC but this could be because they were not so well known for their medicinal virtues. Morinda citrifolia and Ricinus communis with highest use reports had the highest UV further endorsing their importance in pain management and treatment. Plants with low UV such as Ananas bracteatus, Dracaena reflexa, and Hypericum spp. among others were rarely used despite being known to local herbalists. The FUV was also used and the biological plant taxon with highest FUV was Xanthorrhoeaceae which reported one plant species, Aloe vera. Interestingly, in a study, Amoo et al., (2014) reported the genus Aloe of the Xanthorrhoeacea family is of great importance from taxonomic, ethnomedicinal, chemical, ecotouristic and horticultural views. The IAR for specific use categories for pain-related conditions were high. This showed that there was a high level of consensus among users which could result from a well defined medicinal plant tradition (Inta et al., 2013). Consequently, this showed that herbal users were fully knowledgeable about the specific uses of the plant species possibly resulting from well-informed sources such as family and traditional herbalists. In addition, IAR values are high when there is a definite selection standard in the community and/or when information is shared between informants (Panyaphu et al., 2011).

Conversely, low IAR may be characterized by high level of confidentiality amongst herbalists concerning medicinal plants. In addition, this shows that every herbalist possesses his own knowledge about natural remedies which may be dissimilar to that possessed by other healers. Consequently, it is fundamental to document this valuable knowledge (Zheng and Xing, 2009). A total of 54 plant species scored an FL of 100% of which 5 were indigenous/endemic to Mauritius. In addition, 21 plant species had FL of 100% for the GI pain category which included stomach ache and abdominal pain. This finding can be endorsed by a recent study in which Islam et al. (2014) reported that 40% of plants with FL of 100% were used for GI disorders. Likewise, elevated values of FL for a plant species confirm its distinct characteristics to treat a particular illness (Shil et al., 2014). On the other hand, plant species with low FL infer that they were less preferred. However, it can also entail that medicinal plants used to manage and treat one aliment have 100% fidelity level compared to those that are used as remedies for more than one type of aliments (Teklehaymanot and Giday, 2007). For example, Morinda citrifolia (FL¼63.3) is used to treat legs pain, headache, body ache, lower back ache and joint pain. RI values were calculated to evaluate the diversity of medicinal uses of a plant. The high RI values of Morinda citrifolia showed its high versatility and consequently it endorsed the large diversity of active compounds contained by the species. This data also showed that some plants have more diversified medicinal uses or applications than others (Sivasankari et al. 2014). In addition, in a study, Gilani et al. (2010) showed that Morinda citrifolia has innumerable pharmacological properties including antithrombotic, antioxidant, analgesic and anti-inflammatory amongst many others. The EI of 11.5% was obtained which means that the plants species cited in the survey which are known to be useful in TM


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Table 6 Reasons for using TM. Reasons

Percentage*

Tried all possible conventional therapies but there was no pain relief TM is more is conformity with your beliefs and your inner self You prefer to use a combination of TM therapies and conventional therapy TM is known to be successful for the problem I am suffering from TM gives explanations for the problems that I am suffering from Other reasons

30.1

n

12.2 63.2 46.5 3.0 2.4

Percentage of cases ¼one informants may have cited more than 1 reason.

account for 11.5% of the total flora in the Mauritius. This value is quite reasonable for an area with total flora of approximately 685. This can be corroborated to a study in which Leto et al., (2013) reported that for a total flora of 800 in the region of Molise in Italy, an EI of 6.00 was obtained and for a total flora of 1500 in another region of Italy (Sicily), an EI of 6.66 was obtained. In addition, the reasons commonly cited for using herbal remedies were that these therapies were easily available and cheap. Informants also stated that herbal remedies have been part of their culture and they have always been using it. This finding can be corroborated to a study by Arome et al., (2014) who reported that the widespread use of herbal medicine is due to its availability, affordability, accessibility and little or no associated adverse effects if administered appropriately. The traditional uses of some of the recorded plants were validated by previous pharmacological studies as 21 plants have recorded analgesic and/or anti-nociceptive properties. Based on the important quantitative indices calculated; Aloe vera, Azadirachta indica, Bryophyllum pinnatum, Curcuma longa, Morinda citrifolia and Ricinus communis with generally high UV, RFC, RI and FL were found to be most useful for pain management and treatment. Indeed these 6 plant species have been extensively documented for pain management and treatment with animal studies endorsing their antiinflammatory/analgesic and anti-nociceptive properties. In a study, Khosla et al., (2000) evaluated the analgesic potential of Azadirachta indica using tail flick reaction time using thermal stimulus and glacial acetic acid induced writhing. They reported that the tail flick reaction time showed significant increased in rats with both Neem leaf extract and seed oil endorsing the anti-nociceptive potential of the plant. In addition, Bryophyllum pinnatum leaves extract produced significant anti-nociceptive effect when evaluated by the hot-plate and acetic acid test models of pain in mice (Ojewole, 2005). Acclaimed since antiquity for its anti-inflammatory potential which has been scientifically validated (Bagad et al., 2013), Curcuma longa was also found to possess significant anti-nociceptive activity at all doses studied when evaluated using acetic acid-induced writhing movement in mice (Liju et al., 2011). Morinda citrifolia is another medicinal plant with proven versatility in treating a number of diseases, including hypertension, atherosclerosis, colic and diarrhea (Gilani et al., 2010). In addition, in a study, Singh et al., (2013) reported that Morinda citrifolia showed significant and dose dependent increase in the reaction time in radiant heat and tail immersion model endorsing its vital anti-nociceptive effect. In another study, it was demonstrated that a 10% solution of freeze concentrated Noni fruit juice in the drinking water of mice dwindled the pain threshold when compared to an analgesic drug endorsing the effectiveness of Morinda citrifolia in reducing pain and joint destruction caused by arthritis (Basar et al., 2010). In another study, Kore et al., (2011) investigated the analgesic potential of Ricinus communis using hot-plate, tail clip and tailimmersion methods in mice and rats, respectively. It was reported that the analgesic activity of castor oil treated animals was significantly higher in all models compared to vehicle control animals.

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On the other hand, scant literature is available on the antiinflammatory/analgesic and anti-nociceptive potential of some plant species such as Acalypha wilkesiana, Coix lacryma-jobi, Hedychium flavescens and Thymus vulgaris which were also found to be useful for pain management and treatment based on the quantitative indices calculated. In a study, Ikewuchi et al., (2011) found that Acalypha wilkesiana commonly possessed hypoglycemic, antioxidant and cardio-protective properties which supported its traditional use in managing diabetes and hypertension. However, no data is available about its anti-inflammatory properties or possible use for painrelated conditions. Coix lacryma-jobi seeds have been found to possess anti-inflammatory, anthelmintic, anticancer and anti-allergic activities (Bhandari et al., 2012). However, scant data is available on the pharmacological properties of other parts of the plant particularly regarding its use for pain management and/or treatment. In this study 7 medicinal animals belonging to 7 families have been reported to be used by less than 10% of users. This showed that use of medicinal fauna is Mauritius is quite scarce for pain management and treatment. However, some developing countries (Alves and Alves, 2011a; Alves et al., 2011b; Deb and Haque, 2011; Chakravorty et al., 2011) animal-derived remedies were commonly used for treating various diseases including pain conditions such as headache, migraine, ear ache and stomach ache. The animal species with highest UV were Helix aspersa, Anguilla japonica and Ovis aries. Helix aspersa extracts was used for ear ache possibly resulting from ear infection. Interestingly in a study, Gabriel et al., (2011) cited that snail's extracts are characterized by mucus and thus when instilled into the ear may provide lubricating effect. TM was found to be effective in reducing pain intensity level when compared to initial pain intensity assessment. It was found that the mean pain intensity level before TM use is statistically significantly different from the mean pain intensity level following TM use. This can indeed validate the mounting popularity of TM use for pain management and treatment. Similarly, in a study, Rehberg (2010) reported a high preponderance of TM use among patients with chronic pain. Interestingly, in a recent study, Denyer et al., (2012) reported the widespread use of TM particularly for chronic painful musculoskeletal conditions.

5. Conclusion There is no contesting to the fact that chronic pain remains a plaguing condition worldwide with significant impact on quality of life of individuals. It is therefore of uttermost importance to undertake ethnopharmacological investigations to be able to discover and develop new therapeutic options. This pioneering study has been designed to appraise TM use for pain management and treatment in Mauritius. Chronic pain was found to be challenging to assess and treat with negative effects on the daily life of informants. Among the various pain types surveyed, back pain was most reported by the informants. The elderly was found to be a vulnerable age group who experienced pain as a result of several disorders such as sciatica, rheumatoid arthritis, osteoarthritis and gout. Conventional therapies including analgesics and NSAIDs were effective in managing and treating mild and chronic painrelated conditions. Herbal remedies were found to be the most influential therapy in the management of pain-related conditions with a total of 79 plant species and 20 polyherbal preparations reported by informants. Several plant species such as Acalypha wilkesiana and Coix lacryma-jobi amongst others have not been previously documented for use against pain-related conditions. In addition, 6 indigenous/endemic plants to Mauritius have been reported for the first time to be in use for pain management and treatment. Plants species from the Lamiaceae family were most common with 6 reported species. This endorses the fact that


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18

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66


herbal remedies are deeply rooted in Mauritians' culture and are also preferred for their accessibility and availability. Zootherapy was rather scant for pain management and treatment with Helix aspersa extracts most commonly reported for earache. A few mild adverse events have been associated with herbal analgesics. Nonetheless, due to mounting concern in relation to pharmacovigilance in health care, the collaboration of TM professionals and mainstream health care practitioners is of uttermost significance to ensure enhanced safety of therapies and practices. This study has therefore documented several herbal and animalbased therapies with potential analgesic and/or anti-nociceptive properties. This may consequently present new frontiers for the scientific community to investigate into their specific phytochemicals for the discovery of novel therapeutic compounds.

Acknowledgments The authors are grateful to all participants and TM practitioners for participation in the present survey. We also extend our thanks to the local botanist and Dr. M. Hosany for his help during field studies.

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Ethnopharmacological study of medicinal plants used in the treatment of CNS disorders in Sinai Peninsula, Egypt.

Medicinal Plants Used in the Management of Diabetes Mellitus 2015.

Medicinal plants for the treatment of obesity: ethnopharmacological approach and chemical and biological studies.

Medicinal plants used in treatment and management of cancer in Kakamega County, Kenya.

Ethnopharmacological assessment of medicinal plants used against livestock infections by the people living around Indus River.

Medicinal plants used for the treatment of hepatitis in Taiwan.

An ethnopharmacological survey of natural remedies used by the Chinese community in Mauritius.

A quantitative ethnopharmacological documentation of natural pharmacological agents used by pediatric patients in Mauritius.

Medicinal plants used in treatment of inflammatory skin diseases.

Efficacy and safety of medicinal plants used in the management of diabetes mellitus.

Ethnopharmacological survey of medicinal plants used by traditional healers and indigenous people in chittagong hill tracts, bangladesh, for the treatment of snakebite.

An ethno-medicinal study of medicinal plants used for the treatment of diabetes.

An ethnopharmacological survey and in vitro confirmation of the ethnopharmacological use of medicinal plants as anthelmintic remedies in the Ashanti region, in the central part of Ghana.

Survey of medicinal plants used as antimalarials in the Amazon.

Profile of Trace Elements in Selected Medicinal Plants Used for the Treatment of Diabetes in Eritrea.

Study of Rwandese medicinal plants used in the treatment of scabies.

Tracheal relaxation of five medicinal plants used in Mexico for the treatment of several diseases.

Medicinal plants used in Mexican traditional medicine for the treatment of colorectal cancer.

Medicinal Plants Used for Neuropsychiatric Disorders Treatment in the Hauts Bassins Region of Burkina Faso.

Ethnobotanical survey on medicinal plants used by Guinean traditional healers in the treatment of malaria.

Phylogenetic exploration of commonly used medicinal plants in South Africa.

Appraisals of Bangladeshi Medicinal Plants Used by Folk Medicine Practitioners in the Prevention and Management of Malignant Neoplastic Diseases.

Medicinal plants and finished marketed herbal products used in the treatment of malaria in the Ashanti region, Ghana.

Ethnobotanical study of medicinal plants used in the management of diabetes mellitus in the Urmia, Northwest Iran.