Cochrane review – in their own words
Topical herbal therapies for treating osteoarthritis Melainie Cameron University of the Sunshine Coast, School of Health and Sport Sciences, Queensland, Australia
The original Cochrane Review was published in 2000 (1), and the separation of its updating into orally and topically used herbal medicines partly reflects the fact that some topical herbal medicines have a skin irritating effect that contributes to their mechanism of action, or they are toxic when used orally. We found seven studies for this review (2), investigating seven herbal medicines: Arnica montana, Capsicum species, Symphytum officinale (that is, comfrey), Urtica dioica (stinging nettle), and three polyherbal mixtures. These are two Chinese herbal mixtures: Fufang Nanxing Zhitong Gao (FNZG) and Shangshi Jietong Gao (SJG), and Marhame-Mafasel. This research evidence suggests that there might be some benefits for some of these treatments, but further studies are needed to confirm the effects beyond doubt. We have found that the proprietary gels from Arnica, and comfrey, and adhesive patches containing the Chinese herbal mixtures may alleviate osteoarthritic complaints, based on single studies with a confirmatory study design. The head-to-
200
head comparisons of the two Chinese herbal mixtures don’t show a preference for one over the other. Considering the other treatments, the 0.0125% capsaicin preparation used in the one included study of this treatment is a lower dose than commonly used in clinical practice, and the results did not show clinically relevant improvement. While, the low quality of the studies of nettle leaf and the polyherbal compress Marhame-Mafasel mean that they are inadequate to allow judgement of the clinical effectiveness of these products. Serious side effects were not reported with any intervention, but skin irritations were common, particularly with stinging nettle leaf and Capsicum extract gel. In summary, when considering topical herbal medicines for osteoarthritis, there is a need to increase the body of evidence on their effects through new, high quality clinical studies, and to conduct further research to identify their active constituents and to better understand their mechanisms of action. 1. Little CV, Parsons T, Logan S. Herbal therapy for treating osteoarthritis. Cochrane Database of Systematic Reviews 2000, Issue 4. Art. No.: CD002947. 2. Cameron M, Chrubasik S. Topical herbal therapies for treating osteoarthritis. Cochrane Database of Systematic Reviews 2013, Issue 5. Art. No.: CD010538.
C 2013 Wiley Publishing Asia Pty Ltd and Chinese Cochrane Center, West China Hospital of Sichuan University JEBM 6 (2013) 200
Topical herbal therapies for treating osteoarthritis Melainie Cameron University of the Sunshine Coast, School of Health and Sport Sciences, Queensland, Australia
The original Cochrane Review was published in 2000 (1), and the separation of its updating into orally and topically used herbal medicines partly reflects the fact that some topical herbal medicines have a skin irritating effect that contributes to their mechanism of action, or they are toxic when used orally. We found seven studies for this review (2), investigating seven herbal medicines: Arnica montana, Capsicum species, Symphytum officinale (that is, comfrey), Urtica dioica (stinging nettle), and three polyherbal mixtures. These are two Chinese herbal mixtures: Fufang Nanxing Zhitong Gao (FNZG) and Shangshi Jietong Gao (SJG), and Marhame-Mafasel. This research evidence suggests that there might be some benefits for some of these treatments, but further studies are needed to confirm the effects beyond doubt. We have found that the proprietary gels from Arnica, and comfrey, and adhesive patches containing the Chinese herbal mixtures may alleviate osteoarthritic complaints, based on single studies with a confirmatory study design. The head-to-
200
head comparisons of the two Chinese herbal mixtures don’t show a preference for one over the other. Considering the other treatments, the 0.0125% capsaicin preparation used in the one included study of this treatment is a lower dose than commonly used in clinical practice, and the results did not show clinically relevant improvement. While, the low quality of the studies of nettle leaf and the polyherbal compress Marhame-Mafasel mean that they are inadequate to allow judgement of the clinical effectiveness of these products. Serious side effects were not reported with any intervention, but skin irritations were common, particularly with stinging nettle leaf and Capsicum extract gel. In summary, when considering topical herbal medicines for osteoarthritis, there is a need to increase the body of evidence on their effects through new, high quality clinical studies, and to conduct further research to identify their active constituents and to better understand their mechanisms of action. 1. Little CV, Parsons T, Logan S. Herbal therapy for treating osteoarthritis. Cochrane Database of Systematic Reviews 2000, Issue 4. Art. No.: CD002947. 2. Cameron M, Chrubasik S. Topical herbal therapies for treating osteoarthritis. Cochrane Database of Systematic Reviews 2013, Issue 5. Art. No.: CD010538.
C 2013 Wiley Publishing Asia Pty Ltd and Chinese Cochrane Center, West China Hospital of Sichuan University JEBM 6 (2013) 200
