NMT150 Bot Spotlight Inflamed Knee, Wk4 PDF

BOT MED TERM 2 BOT SPOTLIGHT - JOINT PAIN & INFLAMMATION WRITTEN BY DR. FIONA SMULDERS ND LEARNING OUTCOMES 1. Describe the botanical treatment strategy for inflammation in the musculoskeletal system 2. Identify which herbal actions would be beneficial for joint pain and inflammation...

BOT MED TERM 2 BOT SPOTLIGHT - JOINT PAIN & INFLAMMATION WRITTEN BY DR. FIONA SMULDERS ND LEARNING OUTCOMES 1. Describe the botanical treatment strategy for inflammation in the musculoskeletal system 2. Identify which herbal actions would be beneficial for joint pain and inflammation 3. List the constituents responsible for an anti-inflammatory action 4. Remember both common names and latin binomial for the herbs discussed 5. List herbs that would be indicated in joint inflammation 6. Recognize safety concerns regarding the use of the herbs discussed in today’s lecture. 7. Understand and implement the clinical use of an herbal liniment and compress BOTANICAL TREATMENT STRATEGY 1. Find & treat the cause – toxicity? over-use? irritation? infection? 2. Reduce inflammation 3. Alleviate pain 4. Restore damaged connective tissue 5. Improve mobility and range of motion HERBAL ACTIONS FOR JOINT PAIN & INFLAMMATION Alteratives & hepatics – supports metabolism and elimination, has a cleansing effect on the body Anti-rheumatics – help reduce or resolve symptoms of musculoskeletal disease Anti-inflammatories – modulate inflammation Anodynes/Analgesics – alleviate pain Connective tissue tonics: strengthen/repair damaged connective tissue Diuretics – remove waste (ex: uric acid) Rubefacients & circulatory stimulants – promote circulation and delivery of healing factors HERBAL ANTI-INFLAMMATORIES Reduce or resolve inappropriate inflammation Can have a general action or have tissue specificity: General anti-inflammatory: turmeric Anti-inflammatory to lungs/GIT: licorice Anti-inflammatory to cardiovascular system: hawthorn Anti-inflammatory to MSK: devil’s claw HERBAL ANTI-INFLAMMATORIES MOA Herbal Anti-inflammatories work by: Providing a demulcent or emollient action on inflamed tissues Inhibiting cyclo-oxygenase and lipoxygenase enzymes to reduce inflammatory prostaglandin and leukotriene production Regulating inflammatory cytokine and interleukin production Detoxifying the body to reduce toxic load and restore tissue function ANTI-INFLAMMATORY CONSTITUENTS CLASS ACTION HERBAL EXAMPLES RESINS Anti-inflammatory, rubefacient Turmeric, Devil’s Claw, Frankincense SALICYLATES Anti-inflammatory, analgesic, antipyretic White Willow, Wintergreen VOLATILE OILS Anti-inflammatory, antimicrobial, rubefacient Turmeric, Ginger SAPONINS Anti-inflammatory, adaptogen, Licorice, Wild Yam immunomodulators MUCILAGE Anti-inflammatory, demulcent, emollient, Marshmallow, Slippery Elm vulnerary SULPHUR Anti-inflammatory, anti-microbial, rubefacient Garlic, Onion, Mustard FLAVONOIDS Anti-inflammatory, anti-oxidant, anti-allergy Turmeric, Licorice IIRIDOID GLYCOSIDES Anti-inflammatory Devil’s Claw MATERIA MEDICA JOINT PAIN & INFLAMMATION MATERIA MEDICA FOR JOINT PAIN & INFLAMMATION Arnica montana (topical) Olea europaea Boswellia serrata Rosa canina Capsicum frutescens Salix alba (topical) Symphytum off. (topical) Cichorium intybus Uncaria Curcuma longa tomentosa/guianensis Dioscorea villosa Urtica dioica Harpagophytum Zingiber off. procumbens HARPAGOPHYTUM PROCUMBENS Common name: Devil’s Claw Family: Pedaliaceae Parts used: tuber (secondary roots) Main constituents: Iridoid glycosides (harpagosides) Flavonoids Image retrieved from: https://www.ethnoplants.com/gb/african-plant-seeds/104-harpagophytum-procumbens-devils-claw-seeds.html HARPAGOPHYTUM PROCUMBENS Main Indications: Arthritis (rheumatoid & osteoarthritis) Tendonitis & MSK degenerative disease Main Actions: Significant anti-inflammatory action Anti-oxidant Anti-rheumatic Analgesic HARPAGOPHYTUM PROCUMBENS Safety Concerns: High doses may cause transient mild GIT disturbance, headaches, conjunctivitis, tinnitus, tachycardia, rhinitis Use caution with anxiety, peptic ulcers, gallstones, Hx asthma, bleeding disorders, CHF, HTN, heart disease CI in pregnancy and lactation  1/5/23, 12:51 PM Molecular targets of the antiinflammatory Harpagophytum procumbens (devil's claw): inhibition of TNFα and COX-2 gene expression by preve… RESEARCH Molecular targets of the antiinflammatory Harpagophytum procumbens (devil's claw): inhibition of TNFα and COX-2 gene expression by preventing activation of AP-1 Standardized ethanol extract of H. procumbens inhibits induction of Abstract pro-inflammatory gene expression (TNFa and COX-2) Related information  An official website of the United States government Here's how you know Log in Search Advanced User Guide RESEARCH Save Email Send to Display options Clinical Trial Joint Bone Spine. 2000;67(5):462-7. !"#$%&' Cite Harpagophytum procumbens in the treatment of knee and hip osteoarthritis. Four-month results of Collections a prospective, multicenter, double-blind trial versus diacerhein '(!)* D Leblan 1 , P Chantre, B Fournié Affiliations expand PMID: 11143915 +!,* &!.$,!#$%& Clinical trial (2000): H. procumbens was at least as effective as Abstract Title & authors Objective: To evaluate the efficacy and safety of Harpagophytum in the treatment of hip and Abstract diacerhein in the tx of osteoarthritis of the knee and hip and knee osteoarthritis comparatively with the slow-acting drug for osteoarthritis, diacerhein. Patients and methods: A multicenter, randomized, double-blind, parallel-group study was Similar articles conducted in 122 patients with hip and/or knee osteoarthritis. Treatment duration was four reduced the need for analgesic and NSAID therapy. months and the primary evaluation criterion was the pain score on a visual analog scale. Harpagophytum 2,610 mg per day was compared with diacerhein 100 mg per day. Cited by Results: After four months, considerable improvements in osteoarthritis symptoms were seen in both groups, with no significant differences for pain, functional disability, or the Lequesne Publication types score. However, use of analgesic (acetaminophen-caffeine) and nonsteroidal anti- inflammatory (diclofenac) medications was significantly reduced in the Harpagophytum group, MeSH terms which also had a significantly lower rate of adverse events. Conclusion: In this study, Harpagophytum was at least as effective as a reference drug Substances (diacerhein) in the treatment of knee or hip osteoarthritis and reduced the need for analgesic and nonsteroidal anti-inflammatory therapy. Related information Similar articles LinkOut - more resources Harpgophytum procumbens for osteoarthritis and low back pain: a systematic review. Gagnier JJ, Chrubasik S, Manheimer E. BMC Complement Altern Med. 2004 Sep 15;4b13. doi: 10.1186/1472-6882-4-13. PMID: 15369596 Free PMC article. Review. Efficacy and tolerance of Harpagophytum procumbens versus diacerhein in treatment of osteoarthritis. Chantre P, Cappelaere A, Leblan D, Guedon D, Vandermander J, Fournie B. Phytomedicine. 2000 Jun;7(3):177-83. doi: 10.1016/S0944-7113(00)80001-X. PMID: 11185727 Clinical Trial. Multicenter, randomized, double-blind, active-controlled, parallel-group trial of the long-term (6-12 months) safety of acetaminophen in adult patients with osteoarthritis. CURCUMA LONGA Common name: Turmeric Family: Zingiberaceae Parts used: Rhizome Main constituents: Curcuminoids (curcumin) Volatile oils (zingiberene, turmerone) Resins CURCUMA LONGA Main Indications: Rheumatic disorders (Arthritis) Cardiovascular disease by lowering cholesterol and TG IBD Main Actions: Significant anti-inflammatory action via downregulation of COX-2, LOX and inducible nitric oxide enzymes Hepatoprotectant Hypolipidemic RESEARCH 1/5/23, 1:19 PM Efficacy and safety of Meriva®, a curcumin-phosphatidylcholine complex, during extended administration in osteoarthritis patients - PubMed Efficacy and safety of Meriva®, a curcumin- phosphatidylcholine complex, during extended administration in osteoarthritis patients Clinical trial (2010): Significant improvements of both the clinical Abstract and biochemical end points were observed for Meriva compared to control group. Related information LinkOut - more resources Other Literature Sources Medical Research Materials Miscellaneous CURCUMA LONGA Curcumin Dosing: Curcumin: 150-300mg TID; for acute inflammation: 400-600 mg TID (equivalent to 8-60 g turmeric) Curcumin is often formulated with bromelain and black pepper for increased absorption and enhanced anti-inflammatory effects Curcumin is primarily lipophilic CURCUMA LONGA Safety Concerns: Caution with biliary obstruction, gallstones, hyperchlorhydria or stomach ulcer SALIX ALBA Common name: White Willow Family: Salicaceae Parts used: Bark & leaf Main constituents: Salicylates (salicin) Flavonoids Tannins CONVERSION OF SALICIN TO SALICYLIC ACID Hydrolyzed by intestinal bacteria, oxidized in the liver and bloodstream Figure retrieved from: https://www.sciencedirect.com/science/article/pii/S1319610310000578 SYNTHESIS OF ASPIRIN Salicylic acid is acetylated within a lab setting Figure retrieved from: http://www.umsl.edu/~orglab/experiments/ASPIRIN.html SALIX ALBA Main Indications: Painful rheumatic disorders (myalgia, neuralgia, arthritis) Headaches & fever Main Actions: Analgesic Anti-inflammatory Anti-rheumatic SALIX ALBA Safety Concerns: High doses may cause ototoxicity and induce transient hearing loss in zinc-deficient individuals Avoid in children with the flu d/t Reye’s syndrome (theoretical) Avoid with concomitant use of other salicylate drugs BOSWELLIA SERRATA Common name: Frankincense Family: Burseraceae Parts used: Bark Main constituents: Volatile oils Oleo-resin (boswellic acids) Mucilage Image retrieved from: https://www.botanichealthcare.net/boswellia-serrata-extract/ BOSWELLIA SERRATA Main Indications: Osteoarthritis & rheumatoid arthritis Inflammation of the GIT and respiratory tract Main Actions: Anti-rheumatic Inflammatory modulator Hepatoprotective BOSWELLIA SERRATA Safety Concerns: High doses may cause stomach upset d/t resin content  1/13/23, 2:09 PM Efficacy and tolerability of Boswellia serrata extract in treatment of osteoarthritis of knee--a randomized double blind placebo controlled trial - P… RESEARCH Efficacy and tolerability of Boswellia serrata extract in treatment of osteoarthritis of knee--a randomized double blind placebo controlled trial Clinical trial (2003): Reduced knee pain, increased knee flexion, reduced swellingAbstract and increased walking distance with Boswellia serrata use. Related information LinkOut - more resources Full Text Sources Other Literature Sources Medical TOPICAL CONSIDERATIONS Arnica montana Capsicum frutescents Curcuma longa Symphytum off. Urtica dioica Viburnum spp. Zingiber off. Castor oil Rosemary, Wintergreen, Peppermint, Eucalyptus essential oils  1/5/23, 12:55 PM Effect of a blend of comfrey root extract (Symphytum officinale L.) and tannic acid creams in the treatment of osteoarthritis of the knee: random… RESEARCH Effect of a blend of comfrey root extract (Symphytum officinale L.) and tannic acid creams in the treatment of osteoarthritis of the knee: randomized, placebo-controlled, double-blind, multiclinical trials Multiclinical trials (2011): Topical comfrey formulations were Abstract effective in relieving pain and stiffness and in improving physical functioning for osteoarthritis of the knee. Figures https://pubmed.ncbi.nlm.nih.gov/22014903/ 1/2 RESEARCH Clinical trial (2020): Topical administration of 5% curcumin ointment significantly reduced knee pain.  1/13/23, 2:19 PM Anti-osteoarthritis potential of peppermint and rosemary essential oils in a nanoemulsion form: behavioral, biochemical, and histopathological e… RESEARCH Anti-osteoarthritis potential of peppermint and rosemary essential oils in a nanoemulsion form: behavioral, biochemical, and histopathological evidence Animal Study (2021): A nanoemulsion gel containing essential oils of Abstract peppermint and rosemary reduced osteoarthritis pain via increasing antioxidant capacity and improving the histopathological features of the knee joint of rats. Figures https://pubmed.ncbi.nlm.nih.gov/33563269/ 1/2  1/13/23, 2:29 PM Topical herbal therapies for treating osteoarthritis - PubMed RESEARCH Topical herbal therapies for treating osteoarthritis Abstract Syst. Review (2013): Arnica gel probably improves symptoms of osteoarthritis as effectively as a gel containing non-steroidal anti- inflammatory. https://pubmed.ncbi.nlm.nih.gov/23728701/ 1/3 TOPICAL APPLICATIONS FOR JOINT PAIN & INFLAMMATION Herbal Liniments Typically an application of an alcohol-based medium directly onto the affected area with rubbing action Can be warming or cooling in nature Herbs can be infused into rubbing alcohol, vodka, witch hazel extract or vinegar as a solvent Carrier oils and essential oils can also be added ARTHRITIS LINIMENT 50 ml infused Comfrey (Symphytum off.) Oil 25 ml Harpagophytum procumbens tincture 25 ml Viburnum opulus tincture 10 ml Essential oil (Peppermint, rosemary, wintergreen, eucalyptus, etc) Apply to joints using friction as needed. TOPICAL APPLICATIONS FOR JOINT PAIN & INFLAMMATION Herbal Compress Can be made hot or cold Typically made from an infusion or decoction, but can also be made from essential oils or tincture diluted in water Use a cloth to apply the herbal solution directly to the affected area HERBAL COMPRESS 1) If using tea, infuse or decoct herbs in water for approximately 15 min. The amount depends on area to be covered, but 2 oz. of herb to 2 cups of water should be sufficient for a small area (double this for a large area). Optional: Once brewed, add additional medicinal component to water or tea, such as diluted tincture, essential oils, etc. 2) Dip absorbent cloth into tea & allow to soak for 2-5 minutes to absorb liquid. 3) Lift cloth out of liquid (tongs are useful for this, if hot), wring out excess liquid & apply over area to be treated. 4) Cover wet cloth with a towel and/or plastic wrap. If compress is to be hot, keep heat in by applying a hot water bottle or heating pad over towel (not directly on plastic wrap). Add an extra towel to retain heat. 5) Leave on for 20 minutes or more and re-soak the cloth regularly to retain heat. IN SUMMARY There are a number of diverse herbal constituents responsible for an anti-inflammatory action Anti-inflammatories work by soothing inflamed tissues, inhibiting cyclo-oxygenase and lipoxygenase enzymes, and regulating inflammatory cytokine and interleukin production Detoxification using herbal alteratives and hepatics is an important consideration for chronic inflammatory conditions Herbs can be used internally and topically to alleviate pain and inflammation of the MSK system THANK YOU. A N D H AV E A LO V E LY D AY REFERENCES Cameron M, Chrubasik S. Topical herbal therapies for treating osteoarthritis. Cochrane Database Syst Rev. 2013 May 31;2013(5):CD010538. doi: 10.1002/14651858.CD010538. PMID: 23728701; PMCID: PMC4105203. Fiebich BL, MuÑoz E, Rose T, Weiss G, McGregor GP. Molecular targets of the antiinflammatory Harpagophytum procumbens (devil's claw): inhibition of TNF α and COX-2 gene expression by preventing activation of AP-1. Phytother Res. 2012 Jun;26(6):806-11. doi: 10.1002/ptr.3636. Epub 2011 Nov 10. PubMed PMID: 22072539 Impellizzeri D, Esposito E, Mazzon E, Paterniti I, Di Paola R, Morittu VM, Procopio A, Britti D, Cuzzocrea S. Oleuropein aglycone, an olive oil compound, ameliorates development of arthritis caused by injection of collagen type II in mice. J Pharmacol Exp Ther. 2011 Dec;339(3):859-69. Epub 2011 Aug 31. PubMed PMID: 21880869. Kimmatkar N, Thawani V, Hingorani L, Khiyani R. Efficacy and tolerability of Boswellia serrata extract in treatment of osteoarthritis of knee--a randomized double blind placebo controlled trial. Phytomedicine. 2003 Jan;10(1):3-7. doi: 10.1078/094471103321648593. PMID: 12622457. Mohammadifar M, Aarabi MH, Aghighi F, Kazemi M, Vakili Z, Memarzadeh MR, Talaei SA. Anti-osteoarthritis potential of peppermint and rosemary essential oils in a nanoemulsion form: behavioral, biochemical, and histopathological evidence. BMC Complement Med Ther. 2021 Feb 9;21(1):57. doi: 10.1186/s12906-021-03236-y. PMID: 33563269; PMCID: PMC7871606. Smith DB, Jacobson BH. Effect of a blend of comfrey root extract (Symphytum officinale L.) and tannic acid creams in the treatment of osteoarthritis of the knee: randomized, placebo-controlled, double-blind, multiclinical trials. J Chiropr Med. 2011 Sep;10(3):147-56. Epub 2011 Jul 22. PubMed PMID: 22014903; PubMed Central PMCID: PMC3259911. Leach MJ, Kumar S. The clinical effectiveness of Ginger (Zingiber officinale) in adults with osteoarthritis. Int J Evid Based Healthc. 2008 Sep;6(3):311-20. doi: 10.1111/j.1744- 1609.2008.00106.x. PubMed PMID: 21631828.