Natural Pain Killers

[Guest guest]

from August 2000

Natural Medicine and Pain Relievers: A Review

by Loes, M.D., M.D.(H.)

Health professionals face a real dilemma when treating pain patients. First, patients want quick pain relief. They come in doctor's offices and demand prescriptions they truly believe are going to prove to be the magic bullet. Even though the doctor may know about their complications, particularly the very serious complications associated with the use of corticosteroids, they continue to prescribe these medications.

Obviously, in many cases, particularly acute pain resulting from trauma or surgery, use of powerful pain relievers is indicated. But for other types of pain situations-including chronic soft tissue pain, arthritis, backache and the various types of aches and pains accompanying daily living-that doctors are most likely to encounter, use of such powerful, but potentially toxic painkillers, may be because very often, physicians simply don't know about other much more safe natural medicines that can help to ameliorate chronic pain. At other times, they simply hope that the complications will be minimal and, yet, provide much needed pain relief.

The key is pain. Doctors are attuned to relieving pain. And Americans know all about pain. They react strongly to pain. Take American gymnast Kerri Strugg who hit the mat after her memorable vault at the 1996 Olympics in Atlanta, Georgia. "The whole world winced. Her pain was unmistakable," observe E. O'Brien, M.D. and Donna Hoel in a recent issue of Postgraduate Medicine.[1] Yet, the viewing public loved her gritting her teeth, sticking out her chin, keeping a stiff upper lip and transcending the pain!

Indeed, pain is relevant and prevalent. One in six Americans lives in pain. As an example, more than 25 million Americans who suffer chronic, disabling, painful low back pain and the approximately 65 to 80 percent of the population that will be afflicted with low back pain at some point during their lives.[2, 3]

"No single sickness comes close to equaling pain in terms of the number of people affected," say O'Brien and Hoel. Interestingly, they also observe, "Until recently, pain management, especially chronic pain management, was seldom included in medical curricula. In fact, pain was, and still generally is, considered an essential part of the human experience. Those who bear the greatest pain are accorded the greatest respect, and courage and moral strength continue to be tied up in the ability to withstand pain."[4]

Pain relief is an important issue, but hopefully not the sole issue. Relieving pain should not be confused with enhancing the healing response. Natural medicines frequently both ameliorate pain and enhance the body's healing response.

Conventional PainkillersMost analgesics and non-steroidal anti-inflammatory drugs (NSAIDs) can be safely used for two to three days, and many are sold as over-the-counter drugs with reduced recommended dosages. Obviously, instances occur when the use of these drugs is the best course of action. No one is calling into question their value in appropriate situations. However, using these drugs instead of or without natural medicines is often due to lack insight because these drugs are anti-inflammatories; they do not stimulate healing.

NSAIDs are an important component in balanced analgesia in the management of both acute and chronic pain. NSAIDs have a direct action on spinal nociceptive processing with a relative order of potency which correlates with their capacity to inhibit the enzyme cyclo-oxygenase (also known as COX) activity. There are two isoforms of cyclo-oxygenase¾COX-1 and COX-2. What's important to recognize is that various NSAIDs inhibit the isoforms differently, and it is felt that when the COX-1/COX-2 inhibitory ratio is high, there are fewer gastric or kidney problems. For example, ketorolac, nabumetone and the newer agents meloxicam and celecoxib appear to have favorable profiles.

It is well established that conventional NSAID therapy can lead to gastroduodenal ulceration and associated serious complications of perforation, hemorrhage, and gastric outlet obstruction.[5, 6] There is evidence to suggest that NSAID-induced ulcers and their resulting complications are largely caused by NSAIDs-related inhibition of prostaglandin production in the mucosal lining of the gastrointestinal tract. Prostaglandins have been shown to modulate gastroduodenal mucosal production, without which the stomach becomes susceptible to ulcerations and bleeding. The production of specific prostaglandins is dependent upon cyclooxygenase 1 (COX-1) activity. Unfortunately, conventional NSAIDs inhibit both COX-1 and COX-2 activity.

When these drugs are used for longer periods, virtually all patients suffer some complications which can range from micro-bleeding in the gastrointestinal tract to liver or kidney toxicity. It is extremely important when patients are using these medications that they follow all label instructions and precautions.

What's more, these medications may have interactions with other drugs which patients may be using. Also of note, people over 65, those with ulcers, smokers and especially people on cortisone-type medications may all be advised against using NSAIDs because of the greater risk for complications.

One of the most commonly used OTC drugs is aspirin, which is commonly recommended for osteoarthritis. It does, in fact, relieve pain and inflammation, is inexpensive, and can also help to prevent heart attacks and strokes. But it often must be used at a very high dose, four to eight grams per day; and, at these higher doses, toxicity often occurs including tinnitus and gastric irritation.

Other agents which have anti-inflammatory effects but are not thought of as nonsteroidals are methotrexate, chloroquine, penicillamine, and the gold salts. The major mechanism for these agents is immunological and although they are not steroids and do have anti-inflammatory properties, these drugs are not generally discussed in the same context.

Cyclooxygenase 2 (COX-2) InhibitorsA recent study published in the Journal of the American Medical Association has demonstrated apparent profound advantages for pain (particularly arthritis) sufferers who use the new cyclooxygenase 2 (COX-2) inhibitor drug celecoxib (Celebrex) over conventional non-steroidal anti-inflammatory drugs (NSAIDs). New drugs like celecoxib inhibit COX-2 activity but not COX-1. They appear to dramatically reduce the most serious NSAID-related complications, according to the November 24, 1999 JAMA study.[7]

However, while long-term administration of old-line NSAIDs has resulted in renal papillary necrosis and other renal injury, the most recent clinical trials with celecoxib have shown renal effects similar to those observed with conventional NSAIDs. Patients at greatest risk of this reaction are those with impaired renal function, heart failure, liver dysfunction, those taking diuretics and ACE inhibitors, and the elderly.

Other gastrointestinal symptoms occur at about the same rate among users of conventional NSAIDs and celecoxib. The incidences of the most frequently reported GI tract adverse events (dyspepsia, diarrhea, abdominal pain, nausea, and flatulence) combined were 19 percent for placebo; 25 to 28 percent for celecoxib; and 31 percent for naproxen.

Natural Medicines for PainNot all types of pain can be adequately addressed by natural medicines, particularly episodes of acute pain involving major trauma and surgery. However, as a pain specialist, I have found that many patients can initiate dramatic improvements in their health by following a comprehensive pain management point program. By doing so, they may be able to reduce their dependency on medically prescribed drugs and their outlook on life can be vastly improved, and one thing to keep in mind with pain patients is that they are often depressed because pain can become a prison. The goal of a doctor dealing with pain patients is to turn that prison into a prism by which new meaning and new vitality can be generated. My own pain management program consists of the following elements:

Proper diet. Food elimination, if necessary. Daily use of healing nutrients and other holistic health strategies. Aerobic and conditioning exercise. Stretching. Weight loss, if necessary. Avoiding repetitive motion. Using biomechanics and ergonomics. Alleviating stress. Maintaining a positive outlook on life¾even in the face of adverse circumstances such as painful joints.

Now let's examine some of the more important clinically validated natural medicines.

Fixed Herbal Combination from GermanyA specially formulated tincture with extracts of common ash (Fraxinus excelsior), aspen (Populus tremula) and golden rod (Solidago virgaurea), this fixed herbal combination, registered with the German government, has recently begun to be imported from Germany into the United States. The formula fulfills the growing need of Americans for safe and effective natural medicines for pain relief. It is clinically validated and will soon find its place in front-line therapy for use either alone in mild to moderate inflammatory conditions or, for persons with more marked clinical symptoms, can be combined with typically prescribed medications.

In total, 1,151 patients have now been studied in some 30 open and controlled studies with this fixed herbal combination. The fixed herbal combination proved to be clearly superior to placebo, and, in comparison with analgesics, an equally good effect could be demonstrated.

In one 1989 study, the efficacy and tolerance of the fixed herbal combination was tested in a 12-week trial on 20 arthritis patients with pain, inflammation, swelling and functional impairment.[8] Three-quarters of patients experienced significant improvement in their symptoms. Some 11 patients felt completely (or almost completely) free of pain symptoms after the full three months of treatment. The researchers concluded that the fixed herbal combination provided a very well tolerated alternative to synthetic painkillers in the treatment of slight to moderately severe stages of chronic polyarthritis. They also noted that the fixed herbal combination could be combined with other pain medications in cases with more marked clinical symptoms.

In a 1991 study, the fixed herbal combination was tested against placebo and the pain medication piroxicam on 108 patients.[9] Duration of treatment was four weeks. There was marked pain on movement in virtually all patients with many suffering degenerative vertebral column diseases. Patients given the fixed herbal combination experienced a statistically significant reduction in pain compared to placebo. These same patients experienced improvement in overall results that were comparable to the painkiller piroxicam. Better yet, no complications were associated with its use, while 20 percent of patients receiving piroxicam suffered complications.

This particular fixed herbal combination was identified through a thorough literature search to be "the remedy for which more randomized clinical have been conducted than any other herbal preparation," reports E. Ernst, M.D., Ph.D., of the Department of Complementary Medicine, School of Postgraduate Medicine and Health Sciences, University of Exeter, UK.[10]

Dr. Ernst further notes that seven clinical trials "conducted against active treatments [such as diclofenac] demonstrate that it is as effective as synthetic drugs." What's more, the fixed herbal combination has much better tolerance and, therefore, patient compliance.

The action of the fixed herbal combination extends from non-inflammatory musculoskeletal pain to inflammatory rheumatic conditions. Studies have repeatedly shown that red blood cell sedimentation rate is normalized through therapy with this fixed herbal combination.

The formula's anti-inflammatory properties are due in part to the salicylate content of aspen. The golden rod portion provides antispasmodic and diuretic effects. Common ash, rich in coumarins, offers a variety of pharmacological properties, including immune modulation and inhibition of the pro-inflammatory arachidonic acid cascade. The authors of one study note, "Various in vitro and especially in vivo studies proved its anti-inflammatory and antirheumatic properties, often comparable to non-steroidal anti-inflammatories, but with little or no side effects."[11]

The formula also has strong antioxidant powers. Since free radical processes are also involved in inflammatory processes, the beneficial activities of the complete formula may at least in part be due to the reported antioxidative functions.[12]

How to Use the Fixed Herbal CombinationMost patients will benefit from taking 20 to 30 drops of the tincture three to four times daily mixed with your favorite juice or water. In cases of severe pain, take 40 drops three to four times daily. Allergic reactions can occur in cases of known salicylate allergy; in rare cases, gastric and intestinal complains may occur. There are no known drug or nutrient interactions.

MSM: Newly Introduced Sulfur CompoundMethylsulfonylmethane (MSM) is naturally found throughout the body with no known side effects or toxicity. It is a natural source of organic sulfur, which is vital to several of the body's connective tissues including hair, joints, muscles and skin, as well as to specific enzymatic and detoxification processes. Thus, MSM is thought to have wide-ranging benefits to human health.

Today, advertisements for its use have proliferated in recent months, and consumer interest in this compound is extremely high. Even though the scientific validation for MSM is scant, many anecdotal reports indicate that MSM may be a truly important pain-relieving compound. There may be good reason in that sulfur is an often overlooked healing compound in modern medicine.

As the authors of The Miracle of MSM, the definitive book on MSM note, "Sulfur also has a long history of healing but it has been overlooked in our current fascination with vitamins and minerals. When asked to think of minerals important for health, most people know that calcium is good for their bones, that iron is important for their blood, that zinc is needed by the prostate. But rarely does anyone mention sulfur."[13]

A metabolite of dimethylsulfoxide (DMSO) but without its annoying odor, MSM is valued for its ability to support healthy cells by supplying readily bioavailable sulfur. However, it is not possible to directly compare DMSO and its derivative, MSM, although both belong to the same chemical family. MSM is a dietary factor found abundantly in dairy; DMSO is not. DMSO also has certain unpleasant attributes (such as its odor) that are not qualities of MSM. Still, each contributes to patient well-being but in differing ways, and it was out of research on DMSO that pain specialists have come to know MSM as a potential healing agent.

In fact, MSM's rising popularity stems from the fact that studies of its parent compound DMSO have not progressed as projected some 20 to 30 years ago, largely due to the rejection of most of its uses in medicine by the Food and Drug Administration and the fact that the cost of the drug approval process is prohibitive.[14] As noted in the ls of the New York Academy of Sciences, "One product of DMSO appears to have a bright scientific and commercial future: the stable metabolite methylsulfonylmethane (MSM)."

Interestingly, quite apart from a recent book by one of the principle MSM investigators Stanley W. , M.D., there is actually very little published data on MSM. Almost all of what we know is from anecdotal clinical reports. Its first use commenced about twenty years ago after an article was published on its use in an equine journal. At that time , a physician at the DMSO Clinical at Oregon Health Sciences University in Portland, began using it with patients.

Although MSM occurs naturally in the body and some foods, unless our diet is almost solely milk, it appears that our bodies have a critical deficiency, notes Dr. . Research suggests that a minimum concentration in the body may be critical to both normal function and structure. Also, limited studies suggest that the concentration of MSM drops in mammals with increasing age.

Pain: Key Area of ApplicationOne important area of use includes inhibition of pain impulses along nerve fibers; lessening of inflammation; increasing of blood supply; reduction of muscle spasm; softening of scar tissue. Thus, patients suffering from a wide range of chronic pain conditions may find MSM extremely useful.

According to and co-authors, "Many people experience rapid relief after starting MSM. We have often heard the statement, 'Within a few days my pain was gone.'" The authors go onto note, "MSM is a surprising supplement. When you start taking it, you may notice a number of good things happening in your life in addition to pain and allergy relief: more energy; cosmetic benefits such as softer skin, thicker hair, stronger nails; decreased scar tissue; and relief of constipation."

Research continues on the action of MSM in other medical problems as well. One fascinating aspect of this work is that MSM appears to be pharmacologically inactive in normal situations. Only when abnormality is present does MSM influence a return towards normalcy, defined as being within the measurable parameters of good health.

Osteoarthritis patients may profitably use a combination of MSM with glucosamine sulfate. In this regard, such formulas have the blessing of Dr. who has observed, "In 1997, one patient told me that she had better results when she took both MSM and glucosamine sulfate. There was less pain when she took both, she said, than when she took one or the other. I decided to test her observation and recommended to about two dozen osteoarthritis patients then taking MSM that they now add 1,500 milligrams of glucosamine, the generally recommended daily dosage. The feedback was quite positive. Less pain, the patients said. Thus there may be a synergistic effect from combining these two supplements. As a tribute to MSM's potency, some supplement companies have already begun adding MSM to their glucosamine sulfate formulations."

However, Dr. has not found the same synergy with chondroitin sulfate. "Patients have frequently asked my opinion about chondroitin sulfate, another popular nutritional supplement suggested for arthritis. I have not see patients improve after adding chondroitin sulfate, however."

It's true that MSM is largely unproven by standards of rigorous science, still, chronic pain is such an intractable condition, for which any help is welcome. What's more, the anecdotal reports lead us to believe that "where there's smoke, there's fire."

Since MSM formula is completely safe and without drug interactions, its risk of complications is almost nil.

Most patients will benefit from use of two to six grams daily. MSM should be taken daily. Pain relief may require a few days to a few weeks.

Systemic Oral EnzymesSystemic oral enzymes are not quick-acting pain relieves and cannot replace NSAIDs and other painkillers for acute pain but they can certainly help to minimize the need for drug intervention in cases of chronic pain. Systemic oral enzymes are particularly indicated in autoimmune disorders.

In this sense, systemic oral enzymes may be superior to medically prescribed painkillers. Their influence on the immune system is profound, helping to cleave or break up circulating immune complexes (CICs) at the center of the body's immune/inflammation firestorm.

Excellent early results using systemic oral enzymes were noted by researchers writing in 1985 in Zeitschr. f. Rheumatologie. In this study, arthritis patients took eight tablets of a proprietary enzyme mixture four times daily. Sixty-two percent of patients improved.[15]

A 1988 report in Natur- und Ganzheitsmedizin showed that the same formula can prevent further flare-ups and helps to lower levels of inflammatory-related circulating immune complexes in rheumatoid arthritis patients.[16]

Another study also published in Natur- und Ganzheitsmedizin in 1988 noted that systemic oral enzymes have demonstrated similar benefits to gold therapy for rheumatoid arthritis patients, but without toxic side effects.[17]

Systemic oral enzymes will also be helpful with non-inflammatory active osteoarthritis, as has been shown for more than 20 years. In one study among eighty patients systemic oral enzymes were pitted against the NSAID diclofenac.[18] Patients received either seven coated systemic oral enzyme tablets four times daily and two capsules or placebo or seven coated tablets of placebo four times daily and two 50 mg capsules of diclofenac. The groups were similar with respect to symptoms. An evaluation of all principal criteria examined revealed equivalent therapeutic results in both groups after four weeks. This means that even in cases of osteoarthritis, systemic oral enzymes can be considered equivalent treatment.

Most recently, researchers from the Ukrainian Rheumatology Centre, in Kiev, tested systemic oral enzymes on 78 patients with severe, crippling rheumatoid arthritis and who were using other prime treatment drugs.[19] Half the patients had chronic fevers, some 23 percent had rheumatic nodules, and more than half were suffering from low hemoglobin/red blood cell counts. Many of these people had tried gold salts, methotrexate, and other non-steroidal anti-inflammatory drugs without success.

All of the RA patients showed a decrease in CIC concentrations, averaging between 28 and 42 percent, and decreases in rheumatoid factors. Twenty percent of patients reduced their NSAID doses by 50 to 75 percent. One patient stopped taking methotrexate and experienced a clinical remission of the disease. Morning stiffness scores improved. More than half the patients rated their treatment with systemic oral enzymes as good, compared to only about a third of the patients using only medical drugs.

At this same conference, researchers presented findings on systemic oral enzymes and juvenile arthritis. In the study, among 10 children from the Pediatric Clinic of the Institute of Rheumatology of the Russian Academy of Medical Science, 10 children with JCA were given five tablets three times a day.[20] They could also receive treatment with one NSAID in addition to systemic oral enzymes. In the children, the number of actively inflamed joints was reduced from 44 to 15, especially in the second month. One youthful patient with psoriatic arthritis experienced a significant reduction in dermal signs of the disease. The drug proved effective generally after four to five months of treatment.

Ankylosing SpondylitisOne of the most painful arthritis conditions, published reports confirm the positive influence of systemic oral enzymes on ankylosing spondylitis. In 1980, Reinbold reported of his astonishing therapeutic success in the treatment of a 35-year-old patient with the condition whose complete remission had persisted for at least 12 years.

This report and other case histories led Dr. K.M. Goebel to test the effect of systemic oral enzymes compared with indomethacin in a randomized, clinical, double-blind study on 40 patients with this painful condition.[21] The cumulative pain scores were evaluated statistically at the end of therapy. The analgesic potency of the enzymes was found to be less than that of the NSAID at the beginning of therapy-but was found to be significantly superior after three months of therapy. The tolerance of the systemic oral enzyme preparation was rated by physicians and patients as "good," whereas tolerance was found to be "moderate" for the NSAID.

SurgeryAnother important area of application for systemic oral enzymes is for persons who must undergo various types of surgery. Systemic oral enzymes help to stave off edema, inflammation, and excessive scarring and sclerosing of tissues, both internal and external.

Systemic oral enzymes have been used successfully throughout Europe for over 20 years in surgery and traumatology, and their use been described in numerous published reports and case histories.

Among their extremely well documented uses are the prevention and treatment of edema and inflammation in operative dental procedures; proctological operations; surgery to repair fracture of the upper and lower leg; arthroscopic knee surgery; and vascular reconstructive surgery of the lower legs; burns.[22, 23]

Every doctor knows that following trauma to the body, edema, hematomas (blood clots caused by tissue breakage), and preexisting inflammatory reactions make surgical intervention very difficult and can increase the risk of wound-healing impairment.

Meanwhile, postoperative swelling hampers blood flow and nutrients supplied to the tissues, thus increasing the likelihood of wound infections and delaying regeneration. The risk of embolisms and clotting complications also rises, due to the impaired microcirculation and additional immobility caused by injuries leading up to surgery and surgery itself.

Of course, very strong painkillers are sometimes required in acute situations, but the use of systemic oral enzymes can help to reduce the patient's need for such medication, in some cases eliminating the need for stronger painkillers altogether, and certainly making post-surgical recovery less eventful.

Systemic oral enzymes fulfill the highest standards and requirements for a substance that can safely and effectively modulate edema, inflammation and fibrinolytic action. Systemic oral enzymes decrease blood viscosity and thereby improve microcirculation, and in this way support the healing process. Since they also have an effect on the absorption of hematomas and an analgesic effect without side effects, they provide comprehensive therapeutic concept.[24, 25, 26]

Because of these potent modulatory properties, systemic oral enzyme therapy therefore finds a broad range of application in surgery, traumatology, and sports medicine. Systemic oral enzymes have been used successfully for over 20 years in surgery and traumatology, and they have been described in numerous published reports and case histories. To a great extent, the advances in research on the inflammatory mechanisms and immunological reactions associated with use of systemic oral enzymes have yielded explanations for the clinically verified effects of enzyme therapy. Adding greatly to their validity, the success of oral enzymes in these fields of application has also been documented extensively in controlled clinical studies-the gold standard for all medicines.

Operative Dentistry Due to the plentiful blood supply to the region of the mouth, the incidence of postoperative edema in surgical dental interventions is high. Numerous reports of the successful application of enzyme preparations in density have been published.

Dr. K. Vinzenz reported on the therapeutic usefulness of systemic oral enzymes in a randomized, placebo-controlled, double-blind study in Die Quintessenz in1991.[27] Prior to surgical dental intervention, he prescribed ten coated systemic oral enzyme tablets twice daily for 36 patients. In a similar regimen, 44 patients in the control group received placebo. This dosage was continued until the seventh postoperative day. None of the test subjects had received any preoperative therapy with other anti-inflammatory drugs.

Control examinations were performed two days preoperative, immediately prior to the operation, as well as on the first, third, fifth and seventh postoperative days. To make a clinical evaluation, Dr. Vinzenz determined the distance between the edge of the incisors with open mouth, the deviation of the midline with maximally opened mouth, as well as the thickness of the mucosal flap in the area of the periodontal membrane (i.e., the collagenous fibrous connective tissue between the cementum of the tooth and the socket in the jawbone in which the root or roots of the teeth are set). In addition to local inspection, Dr. Vinzenz analyzed the patients' blood serum in order to monitor the inflammatory process.

The laboratory data specific for inflammation revealed better results for the group receiving the systemic oral enzyme preparation. The differences between the two groups were significant with respect to three important inflammation markers: C-reaction protein; (1-trypsin; and the erythrocyte sedimentation rate. The changes in general state of health (e.g., dysphagia [difficulty in swallowing] and swelling of the lymph nodes) and all objective variables of wound healing were clear-cut evidence of the clear superiority of systemic oral enzyme therapy.

ProctologyProctology is the branch of medicine dealing with the rectum and anus. Aside from a few exceptions, anal wounds generally heal by secondary intention. Local therapy consists of sitz baths and the support of wound cleansing with chains of complex sugars derived from sucrose called dextran polymers. Regular digital palpation hinders the development of superficial adhesions and pocketing. Since the anal region is very sensitive to pain, the use of analgesics is generally unavoidable. Regulation of bowel movements must be ensured during the first two weeks.

Systemic oral enzymes can be extremely useful in helping persons with such problems, including hemorrhoids, anal fissures, and spreading abscesses within the anus that can erode the tissue and which are known medically as anal fistulas.

Using a topical preparation of systemic oral enzymes, Drs. Chappa-Alvarez and Werk achieved a substantially more rapid healing rate following proctological operations, as they reported in 1979 in Proktologie.[28] Thirty patients in two groups of 15 persons each took part in this study. All patients were treated conventionally, and one group received systemic oral enzyme ointment locally in addition. Pain, edema, secretion, hemorrhage and scar formation served as evaluation criteria for the progress of healing during the treatment period, which lasted an average of 15 days. The investigators objectified the clinical findings as far as possible by histological examination.

Within only a few days, the number of leukocytes in the surgical wound increased threefold in patients treated with enzymes, a sign of excellent, non-infectious wound healing.

As an indicator of beginning granulation (remodeling of the wound), levels of large white blood cells called monocytes that are formed in the bone marrow increased by 100 percent. Aside from the rate of healing, which was 40 percent faster in the group receiving the topical systemic oral enzymes, the group receiving this preparation also demonstrated substantially less pain.

The clinical complaints disappeared completely after only 40 to 50 days. The persistence of symptoms lasted substantially longer in the control group-for up to 100 days.

Lower Extremity Bypass Surgery Knowing that the antiedema and anti-inflammatory characteristics of systemic oral enzymes have been strongly verified for various surgeries prompted Dr. H.-D. Rahn to examine the use of systemic oral enzymes for vascular reconstructive surgery of the lower extremities. Dr. Rahn examined its efficacy in a clinical, placebo-controlled, double-blind study on 80 patients who were undergoing heart bypass surgery.[29]

Patients taking part in the study all had stage IIB to IV arterial occlusion or occlusive arterial disease. Obviously, recovery is relatively extended and may require several days in intensive care with attention to be paid both to the condition of the heart as well as the leg or legs. (In this study, patients who had taken non-steroidal antirheumatic agents within the last three preoperative days were excluded from the study.) Assignment of patients to two groups of 40 patients was at random.

Three days prior to surgery, the patients of the preparation and control groups began taking one measuring spoon of granulated systemic oral enzymes or an equal amount of granulated placebo three times daily. The therapy was continued during the entire in-hospital period up to 14 days.

Assessment of treatment efficacy was based on measurements of the circumference of the afflicted leg at three defined positions, the extent of edema and the cumulative pain score. The other clinical parameters (e.g., local temperature, wound healing) as well as the length of hospitalization were recognized as additional criteria for evaluation. Laboratory data included ESR, white blood cell and platelet counts, Quick's time and antithrombin III. Systemic oral enzyme therapy resulted in a significantly better treatment outcome with respect to these main and additional criteria. Aside from ESR, the differences in laboratory data were not substantial.

TraumatologyIn 1972, Dr. A.R. Carillo and co-investigators examined the efficacy of systemic oral enzymes in 100 patients with various injuries or burns in order to verify the numerous positive reports and obtain an idea of the possibilities for applying oral enzymes.[30]

Ten to twenty coated systemic oral enzyme tablets were prescribed daily in addition to the necessary conservative or surgical therapeutic measures. The average duration of treatment with enzymes was six days.

Even though systemic oral enzymes have modulating properties on the body's blood flow, the Carillo team noted no increased risk of hemorrhage. He evaluated the fibrinolytic action of the enzyme preparation as being positive in every respect. The healing of injuries and burns was substantially accelerated with systemic oral enzymes.

Only four patients complained of slight gastric intolerance. The symptoms resolved after simply increasing the time between individual doses.

In summary, Carillo found that systemic oral enzymes have a rapid and convincing anti-inflammatory action which substantially accelerates the rate of healing.

Pre- and Postoperative Enzyme Therapy for Fracture Reduction Optimally, one should prepare for surgery. In the case of surgical fracture, for example, reduction of the fractured region requires optimal preparation-which always includes the rapid and efficient treatment of posttraumatic edema and hematoma. Systemic oral enzymes can be extremely beneficial in such surgeries.

The efficacy of preoperatively initiated enzyme therapy was verified by Drs. H.-D. Rahn and M. Kilic in a placebo-controlled, double-blind study of 120 patients requiring operative fracture reduction that was published in 1990 in Allgenmeinarzt.[31, 32]

Both study groups of 60 patients each began by taking ten coated systemic oral enzyme tablets or placebo three times daily prior to surgery. Relief of pain and reduction of the edema were substantially better in the systemic oral enzyme group after only three days. This significant difference between the two comparative groups continued postoperatively. An added bonus that should be emphasized is that the patients on oral enzymes were able to leave the hospital earlier!

With the goal of verifying the antiedema effects of systemic oral enzymes more exactly, Dr. Schwinger performed an open, prospective, randomized clinical study on parallel groups. The efficacy and tolerability of systemic oral enzymes was compared with that of aescin, an extract from the horse chestnut seed.

Fifty-nine patients with injuries of the knees or ankle joints requiring surgical treatment took part in this study. Depending on the group assignment, 29 patients received five coated systemic oral enzyme tablets three times daily and 30 patients two coated tablets of aescin three times daily. The duration of therapy was ten days. The groups were matched for age, sex, edema, joint effusion, inflammation, pain, ability to raise the extended leg, and their cumulative pain scores.

The circumference of the joint and the pain score were established as the main inflammatory criteria for the study. Additional criteria were further clinical and laboratory data and the use of analgesics.

Although aescin is another excellent natural medicine, it must be said that, all in all, the joint swelling in the enzyme group diminished to a greater extent. The substantial reduction in the swelling of the ankle joint was statistically significant. The drop in pain scores was nearly equal for both groups, although it must be mentioned that the aescin group required substantially greater amounts of analgesics. No statistically significant differences were seen between the therapy with systemic oral enzymes versus aescin for any of the other criteria examined.[33]

Knee Surgery (Meniscectomy and Arthroscopic) Another form of knee surgery is meniscectomy. A double-blind study was conducted on 80 patients who had to undergo total meniscectomy. Whereas 40 patients were treated with systemic oral enzymes postoperatively, the other 40 test subjects received a placebo. The patients were instructed to take 30 coated systemic oral enzyme tablets or the dummy pills daily. The duration of therapy was seven days for both groups. Edema, swelling, inflammation, pain and limitation of mobility were examined to evaluate the efficiency of the therapy. The symptom complex responded significantly better to the postoperative administration of systemic oral enzymes. It was possible to mobilize the patients earlier to restore the mobility of the knee joint.[34, 35]

Arthroscopic operations on the knee joint have become well established in recent years, the technique being superior to open surgery. It therefore appeared relevant to examine the efficacy of systemic oral enzymes especially in arthroscopic meniscectomies-in a further clinical, placebo-controlled, double-blind study, 80 patients with 40 patients each in the enzyme preparation and placebo groups.[36] The test subjects received systemic oral enzymes for an average of nine days. The patient groups were matched with respect to age, sex, height, weight and severity of the injury. The statistical evaluation was based on a defined cumulative score consisting of data on edema, pain and limitation of mobility. Additionally assessed was improvement of further clinical parameters and the duration of the hospital stay. The cumulative scores of the systemic oral enzymes group dropped significantly faster and more substantially, confirming clinical effectiveness.

Comments on Surgery Hundreds of published scientific studies have shown that systemic oral enzymes act to quickly reduce inflammation, swelling, and internal bleeding, all of which are extremely important to control following surgery. What's more, systemic oral enzymes are extremely safe, especially compared to other anti-inflammatory medical drugs that were designed for this purpose.

Doctors recognize that surgery produces edema, inflammation and excessive fibrinolytic activity, all of which must be treated to insure the patient's rapid recovery. Because systemic oral enzymes provide a comprehensive therapeutic effect in all of these areas of need and without complications, they are considered as pre- and post-operative frontline therapy throughout Europe.

How to Use Start patient use of systemic oral enzymes two days before surgery. The recommended dosage before surgery is ten tablets three times a day 30 to 45 minutes before meals. Contraindications include patients who are at risk of post-operative hemorrhage because of blood coagulation deficiency, heavy bleeders, hyperfibrinolysis, use of various blood thinning agents, and severe liver cirrhosis. However, systemic oral enzyme therapy can be used after most surgeries.

In cases of acute trauma, upon stabilization, an initial dose of 10 to 20 systemic oral enzyme tablets three times daily is advisable in acute cases of trauma in contrast to the usual maintenance dose of two to three coated tablets three times daily.[37]

Glucosamine SulfateGlucosamine is a member of the glycosaminoglycan family.38 Glycosaminoglycans are found in high concentration in sea shells, from which glucosamine is harvested. Glucosamine sulfate is a natural aminosugar. A simple, very small molecule composed of glucose, glutamine, and sulfur, it is highly soluble in water. Glucosamine is now known to be used by the body to manufacture glycosaminoglycans, which are integral to joint integrity.

The scientific studies that validate modern glucosamine sulfate therapies now date more than four decades, starting with fundamental test tube studies, animal modeling and pharmacokinetic investigations, and human clinical trials. In total, more than 6,000 patients have been studied.[39]

Although glucosamine sulfate is not technically an anti-inflammatory, its ability to stabilize the joint matrix and prevent further deterioration, particularly in cases of osteoarthritis, make it an essential component of any pain management program involving joint damage. It is classified as a slow acting arthritis drug by the World Health Organization.

TurmericAlso known as Curcuma longa, turmeric is a potent anti-inflammatory. As an anti-inflammatory agent, it may be on a par with cortisone and phenylbutazone. Turmeric may also be used post-surgically.[40]

BromelainAn enzyme derived from the pineapple plant, bromelain is a potent anti-inflammatory agent on a par with aspirin (but safe) and one whose benefits have been suggested in numerous clinical studies.[41] Bromelain was shown to reduce joint swelling in cases of arthritis and has worked where long-term steroids have not. Moreover, bromelain is absorbable from the gastrointestinal tract, if placed in enterically coated capsules.[42] Bromelain is effective for helping joints to function normally by attacking redness and swelling.[43] Unlike medical drugs used for inflammation associated with arthritis, the health-promoting effects of bromelain are without dangerous complications.

Willow BarkWillow bark, the natural source of aspirin, is a rich source of salicylate, the world's oldest, most revered painkiller.[44]

Licorice RootA complement to bromelain and willow bark, licorice root's active ingredient, glycyrrhizin, has also demonstrated potent anti-inflammatory powers. In fact, licorice root concentrate effectively inhibits some of the "most potent" inflammatory agents in the body.[45]

FeverfewKnown as Tanacetum Parthenium, feverfew is an excellent herbal anti-inflammatory which has long been used in traditional healing for relieving fever, migraine and arthritis. Several studies have validated its headache relieving and prophylactic effects. Feverfew inhibits pro-inflammatory compounds.

Desmodium adscendensBack problems are perhaps the most searingly painful, disabling common condition people suffer. They're also among the least likely condition to respond favorably to standard medical treatment, including drugs and surgery, often leaving physician and patient feeling helpless. Researchers working in the rain forests of Central America for the National Cancer Institute, however, have brought a powerful, clinically supported rain forest remedy back to America.

Known scientifically as Desmodium adscendens, this perennial herb with light purple flowers grows along the ground in fields and along roads in areas of the Central American rain forest.

We now know through scientific research that the active ingredients in this herb: (1) activate the body's calcium-dependent potassium ion channels which are responsible for the maintenance of tone in smooth muscles; in essence, when potassium ions cross cell membranes, they stimulate cells to release toxic calcium ions that became trapped in muscle tissue by the spasm;[46] (2) competitively occupy receptor sites on the cells that would otherwise be occupied by spasm-causing toxins produced by the body when its tissues are injured; and (3) inhibit the body's metabolism of proinflammatory leukotrienes and arachidonic acid.

Researchers writing in 1993 in Biochemistry claim the triterpenoid glycosides in this plant "are the most potent potassium channel agonists found to date."[47]

In short, according to the report in Biochemistry, "the plant contains several different components that contribute to [the] relaxation of smooth muscle" and its significant spasm-relaxing properties.[48]

More recently, researchers once again cited evidence, this time in the Journal of Ethnopharmacology, that the herb is a strong pain reliever and helps to prevent spasms.[49]

How to UseFor acute symptoms of back ache and muscle spasm, less is more. Take ten drops in a half glass of room temperature water per hour with hot compresses of the formula applied externally. After acute symptoms have subsided and for chronic back ache and muscle spasm pain, take one dropper full in a half glass of room temperature water three times per day before meals.

About the Author W. Loes, M.D., M.D.(H/), is director of the Arizona Pain Institute. He is board certified in internal medicine with subspecialty board certifications in pain medicine and management, addictionology, acupuncture, clinical hypnosis and homeopathy. He is a faculty assistant professor at the University of Arizona Health Science Center, Tuscon, and a former faculty consultant to the Mayo Clinic sdale Pain Center. He has helped hundreds of pain patients over the years to regain their health by enhancing their bodies' healing powers, using many of the techniques detailed in this report.

References

O'Brien, M.E. & Hoel, D. "Overpowering pain. A serious problem comes out of the closet." Postgraduate Medicine, October 1997: 4-10. Brown, R.L., et al. "Chronic opioid analgesic therapy for chronic low back pain." Journal of the American Board of Family Practice, 1996; 9(3): 191-204. Wittenberg, R.H., et al. "Injection treatment of non-radicular lumbalgia." Orthopade, 1997; 26(6): 544-552. O'Brien, M.E. & Hoel, D. Op cit. , S.E., et al. "Risk for serious gastrointestinal complications related to use of nonsteroidal anti-inflammatory drugs: a meta analysis." Ann Intern Med. 1991; 115: 787-796. Mac, T.M., et al. "Association of upper gastrointestinal toxicity of non-steroidal anti-inflammatory drugs with continued exposure: cohort study." BMJ, 1997; 315: 1333-1337. Simon, L.S., et al. "Anti-inflammatory and upper gastrointestinal effects of celecoxib in rheumatoid arthritis. A Randomized Controlled Trial." JAMA, 1999; 282(20): 1921-1928. Reiter, W., et al. "What is the effect of an antirheumatic agent with plant-based active substances in the therapy of chronic polyarthritis?" Therapiewoche, 1989; 39(46): 3409-3414. Bernhardt, M., et al. "Double-blind, randomized comparative study of Phytodolor® N and placebo, and open comparison with piroxicam on patients with arthroses." Internal Research Report, 1991. Ernst, E. "The efficacy of Phytodolor® for the treatment of musculoskeletal pain-a systemic review of randomized clinical trials." Department of Complementary Medicine, School of Postgraduate Medicine and Health Sciences, University of Exeter, UK. von Kruedener, S., et al. "A combination of Populus tremula, Solidago virgaurea and Fraxinus excelsior as an anti-inflammatory and antirheumatic drug. A short review." Arzneimittelforschung, 1995; 45(2): 169-71. Meyer, B., et al. "Antioxidative properties of alcoholic extracts from Fraxinus excelsior, Populus tremula and Solidago virgaurea." Arzneimittelforschung, 1995; 45(2):174-6. , S.W., et al. The Miracle of MSM. New York, NY: Putnam, 1999. , S.W. & Herschler, R. "Biological actions and medical applications of dimethyl sulfoxide." Ann NY Acad Sci, 1983; 411: 13-17. Steffen, C., et al. "Enzymtherapie im vergleich mit immunkomplexbestimmungen bei chronischer polyarthritis." Zeitschr. f. Rheumatologie, 1985; 44: 51. Streichhan, P., et al. "Resorption partikulärer und makromolekularer Darminhaltsstoffe." Nature- und Ganzheitsmedizin, 1988; 1: 90. Miehlke, K. "Enzymtherapie bei rheumatoider arthritis." Nature- und Ganzheitsmedizin, 1988; 1: 108. Singer, F. "Aktivierte arthrosen knorpelschonend behandeln." In': Medizinische Enzym-Forschungsgesellschaft e.V. (ed.): Systemische Enzymtherapie, 10th Symposium, furt, 1990. Mazurov, V.I., et al. "Systemic enzyme therapy in combination therapy for rheumatic disease." Oral Enzyme Therapy. Compendium of Results from Clinical Studies with Oral Enzyme Therapy. Second Russian Symposium, St. sburg, Russia, 1996. Shaikov, A.V., et al. "Wobenzym in combination therapy for juvenile chronic arthritis." Oral Enzyme Therapy. Compendium of Results from Clinical Studies with Oral Enzyme Therapy. Second Russian Symposium, St. sburg, Russia, 1996, pp. 28-32. Goebel, K.M. "Enzymtherapie bei spondylitis ankylosans." In: Medizinische Enzym-Forschungsgesellschaft e.V. (ed.): Systemische Enzymtherapie, 17th Symposium, Vienna, 1991. Guggenbichler, J.P. "Einflu( hydrolytischer enzyme auf thrombusbildung und thrombolyse." Die Medizinische Welt, 1988; 39: 277 Klein M.-W., H. Pabst. "Die wirkung einer oralen enzymtherapie auf experimentell erzeugete hämatome." Forum des prakt. Und Allgemeinarztes, 1988; 27: 42. Chappa-Alvarez, R. "Pankreatitisbehandlung mit Wobenzym®." Publication in preparation, 1992. Guggenbichler, J.P. "Einfluß hydrolytischer Enzyme auf Thrombusbildung und Thrombolyse." Die Medizinische Welt, 1988; 39: 277. Kleine, M.-W. & Pabst, H. Op cit. Vinzenz, K. "Ödembehandlung bei zahnchirurgischen eingriffen mit hydrolytischen enzymen." Die Quintessenz, 1991; 7: 1053. Werk, W. "Polyenzympräparat zur Beschleunigung der Narbenbildung." Proktologie, 1979(3). Rahn, H.-D. "Wobenzym® nach Gefäßbypassoperationen am bein." In: Medizinische Enzymforschungsgesellschaft e.V. (ed.): Systemische Enzymtherapie, 17th Symposium, Vienna, 1991. Carillo, A.R. "Klinische untersuchung eines enzymatischen entzündungshemmers in der unfallchirurgie." Ärztl. Praxis, 1972; 24: 2307. Rahn, H.-D. & Kilic, M. "Die wirksamkeit hydrolytischer enzyme in der traumatologie. Ergebnise nach 2 prospektiven randomisierten doppelblindstudien." Allgemeinarzt, 1990; 19: 178. Rahn, H.D. "Efficacy of hydrolytic enzymes in surgery." In: G.P.H. Hermans, W.L. Mosterd (ed.): Sports, Medicine and Health. Amsterdam-New York-Oxford: Excerpta Medica, 1990: 1134. Schwinger: "Wobenzym® bei der behandlung von knie- und sprunggelenksoperationen." Publication Rahn, H.-D., Kilic, M. "Die wirksamkeit hydrolytischer enzyme in der traumatologie. Erggbnise nach 2 prospektiven randomisierten doppelblindstudien." Allgemeinarzt, 1990; 19: 178. Rahn, H.-D. "Enzyme verkürzen rekonvaleszenz." In: Medizinische Enzym-Forschungsgesellschaft. E.V. (eds.): Systemische Enzymtherapie, 13th Symposium, u, 1990. Rahn, H.-D. "Wobenzym® begleitend bei arthroskopischer meniskektomie." Publication in preparation. Inderst, R. "Enzymtherapie-grundlagen und anwendungsmöglichkeiten." Natur und Ganzheitsmedizin, 1991(3). Krajickova, J. & Macek, J. "Urinary proteoglycan degradation production excretion in patients with rheumatoid arthritis and osteoarthritis." ls of the Rheumatic Diseases, 1988: 468-471. Murray, M. Encyclopedia of Nutritional Supplements. Rocklin, CA: Prima Publishing, 1996, p. 262. Bucci, L.R. Nutrition Applied to Injury Rehabilitation and Sports Medicine, Boca Raton: CRC Press, 1995. pp. 208-214. Cohen, A. & Goldman, J. "Bromelain therapy in rheumatoid arthritis." Pennsylvania Medical Journal, 1964; 67: 27-30. Isaka, K. "Gastrointestinal absorption and anti-inflammatory effect of bromelain." Journal of Japanese Pharmacology, 1972; 22: 519-534. Lotz-Winter, H. "On the pharmacology of bromelain: an update with special regard to animal studies on dose-dependent effects." Planta Medica, 1990; 56: 249-253. Vane, J. "The evolution of non-steroidal anti-inflammatory drugs and their mechanisms of action." Drugs, 1987; 33 (Suppl. 1): 18-27. Akamatsu, H., et al. "Mechanism of anti-inflammatory action of glycyrrhizin: effect on neutrophil functions including reactive oxygen species generation." Planta Medica, 1991; 57: 119-121. Addy, M.E. "Some secondary plant metabolites in Desmodium adscendens and their effects on arachidonic acid metabolism." Prostaglandins Leukot Essent Fatty Acids, 1992; 47(1): 85-91. McManus, O.N., et al. "An activator of calcium-dependent potassium channels isolated from a medicinal herb." Biochemistry, 1993; 32(24): 6128-6133. Ibid. N'gouemo, P., et al. "Effects of an ethanolic extract of Desmodium adscendens on central nervous system in rodents." Journal of Ethnopharmacology, 1996; 52(2): 77-83.

home | editorial | feature article | clinical commentary | research bulletinsregister with NMO | journal archives | search | symposium | 1-click download | editorial board | contact us

Copyright 2000, Natural Medicine Online