Judith A. Paice, Ph.D., F.A.A.N. is the Director of the Cancer Pain Program, Division of Hematology-Oncology, Northwestern University, Feinberg School of Medicine. She is a member of the Advisory Group for the National Consensus Project, and the President of the Board of Directors of the American Pain Society. Dr. Paice is the co-author of "Use of Herbal Therapies to Relieve Pain: A Review of Efficacy and Adverse Effects" published in Pain Management Nursing, 2005:6(4): 145-167. This article was used to develop Herbal Therapies and Pain in PainEDU’s Clinician Tools.

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Questions

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Evelyn Corsini:

What led you to write a scientific article on herbal treatment for pain?

Judith A. Paice, Ph.D., R.N., F.A.A.N.: Patients commonly use complementary and alternative medicines (CAM) as an alternative approach to their medical problems. These may include acupuncture, biofeedback, meditation, and herbal therapies. The use of CAM is more prevalent in patients experiencing a chronic disease or chronic pain. Pain relief is the most frequently cited reason that people seek complementary and alternative medicine. Studies show that women and older adults are most likely to seek CAM therapy, and they generally perceive the treatments as having fewer side effects than conventional medicine. Herbal therapies are more likely to be used by those with better education, poorer health status, and a holistic orientation to health.

Patients and health care providers have three simple questions about the use of herbal treatment, but their answers are not easy to find.

• 1) Will it work?
• 2) Are there side effects?
• 3) Are there other things I should worry about?


Patients should know if they will face potential side effects, including drug-herb interactions. But they may not tell their health care providers what herbal treatments they are using, and clinicians may not directly ask them. If herbal treatment is discussed a clinician may not be familiar with the efficacy and potential side effects of these treatments. This paper was written to educate nurses and other clinicians, and patients, about the use of herbal therapies.



EC: What was your method of finding and reporting on the research that has been done?

JP: The lack of regulatory scrutiny of herbal supplements helps explain the paucity of reliable clinical data assessing the efficacy and safety of herbal supplements. A lack of standardization of herbal remedies and improper processing can result in unwanted combinations of ingredients.

Review of the scientific literature found few well-controlled studies. To identify articles on the use of herbal therapies to reduce pain, a literature search of MEDLINE ( Jan. 1966 - June, 2005), Allied and Complementary Medicine (Jan. 1985 - June, 2005) and the Cochrane Library (Nov 2003 - June 2005) data bases was conducted. Only English language publications were considered. Search criteria comprised the term pain with the common name, Latin name, and common synonyms for the herb in questions. For example, for Black cohosh, the search included baneberry, cimicifua, and bugbane.

We reported on 24 herbal therapies. Ten of the 24 herbal therapies had research evidence available investigating the ability of the herbal therapy to manage pain. In addition, many herbal therapies were reported to have significant adverse side effects that should be considered when using these treatments.




EC: How have patients and health care professionals responded to the article?

JP: Many clinicians have expressed their gratitude that serious attention was being paid to this topic. They felt that the article was a simple and easy tool for them to use. A few people disagreed with the findings, saying that for them, the herbal therapy worked. We recognize that a limitation of our study was that the literature search was only done in English, as there are many other publications that are not in English.



EC: What do you think the future holds for the use of herbal treatments for pain?

JP: I think patients will continue to use CAM treatment including herbal therapies, and that it will be increasingly important for people taking care of patients to understand this. Clinicians should learn how to ask their questions in a routine, non-judgmental manner, to elicit the most accurate response, i.e., after asking "what medications are you taking?" ask "what other treatments that you bought at a drug store or a natural food store are you taking?" There is clearly a need for more research on this topic. Clinicians sharing what they know, and what they don’t know, about herbal treatments with their patients may result in an increased effort to provide more accurate information to the public.