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Compared with placebo or rofecoxib, how effective are herbal medicines for non-specific low back pain?
Specific herbal medicines were effective for short-term (4-6 weeks) improvement in pain and functional status for individuals with acute episodes of chronic, non-specific low back pain (LBP). There was moderate evidence for cayenne, and less for devil’s claw, white willow bark, comfrey, Brazilian arnica and lavender essential oil. Adverse effects were limited to mild, transient gastrointestinal complaints or skin irritation.
Most trials were at low risk of bias but the quality of the evidence was mainly very low to moderate. Trials only tested the effects of short-term use (up to 6 weeks). Rofecoxib has now been withdrawn due to adverse effects. Authors of 8 of the included trials had a potential conflict of interest and 4 other authors did not disclose conflicts of interest. There was no evidence that any of these substances were safe or efficacious for long-term use.
LBP is a common condition, affecting up to 35% of the population in any given month. A large proportion of people with chronic LBP use complementary and alternative medicines, including herbal medicines.
Oltean H et al. Herbal medicine for low-back pain. Cochrane Reviews, 2014, Issue 12. Art. No.: CD004504.DOI: 10.1002/14651858. CD004504.pub4. This review contains 14 studies involving 2050 participants.
Cochrane Systematic Reviews for primary care practitioners
Developed by the Cochrane Primary Care Field, New Zealand Branch of the Australasian Cochrane Centre at the Department of General Practice and Primary Health Care, University of Auckland and funded by the Ministry of Health and New Zealand Doctor. PEARLS are meant for educational use and not to guide clinical care. New Zealanders can access the Cochrane Library free via www.cochrane.org.nz
Otolaryngologist, head and neck surgeon Francis T. Hall discusses the evaluation of thyroid nodules, which primarily aims to determine the likelihood of malignancy. He then reviews the treatment of thyroid nodules and thyroid cancer, including recent advances in management
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