Many of us will experience pain at some point in our lives. We share the best 5 herbs instead of painkillers.
Most of us will become familiar with pain in one form or another during our lives, and it may come as no surprise that pain is the most common reason that people seek medical care (1). Pain has both sensory and emotional components, and it is often categorised as either acute (short-term), or chronic (long-term) in nature (1).
The definition of pain is ‘an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.’ (2). It is interesting to note that the stimulus of pain sometimes is not proportional to the response, highlighting how emotional factors can influence our perceptions of pain, and how stress may also play a role in our responses to and ability to tolerate pain. This is why healing modalities like hypnotherapy can sometimes be useful. However, most pain has a physiological basis.
Whatever the root cause of pain, it is common to seek relief in the form of conventional painkillers. Painkillers tend to be thought of as tablets, the most common ones being:
- Paracetamol
- Ibuprofen (classified as a nonsteroidal anti-inflammatory or NSAID)
- Co-codamol (codeine-based painkiller)
However, taking painkillers over prolonged periods comes with potential side effects which tend to affect the gastrointestinal tract (especially with NSAIDs which can cause irritation to the gastric lining, and co-codamol which can cause constipation). Long-term use of any painkillers can take its toll on the body in terms of the load for the liver to process.
Topical painkillers are applicable in many cases and recommended in order to provide pain relief whilst avoiding the plethora of side effects often associated with stronger painkillers taken internally. They can also be used alongside painkiller tablets to provide additional relief.
Topical pain relief is delivered directly to the affected area by application to the skin. This type of conventional pain relief tends to be given in cases of:
- Arthritic pain (such as in osteoarthritis)
- Muscular pain (such as backache or injury)
- Neuropathic pain (pain of origin in nerve damage or injury, such as neuralgia following a bout of shingles)
The topical painkillers widely used include:
- Topical NSAIDs such as ibuprofen gel which is a preferred option to begin with topical pain relief
- Capsaicin cream: often given in cases of neuropathic pain or arthritis where the preferred option of topical NSAIDs has not been tolerated
- Lidocaine 5% Patch and EMLA which are local anaesthetics (3, 4)
These topical painkillers do sometimes cause milder side effects of skin irritation local to the area they are applied to.
One of the main advantages of external herbal applications for pain relief is that herbs themselves often have more than one action on the body, and they are often formulated into preparations which include more than one herb with actions that target different areas of pain relief. This synergistic effect means that pain can be targeted in a rounded way which will improve symptoms of pain often more effectively than simply just numbing the pain.
The actions of herbs often employed in pain relief include:
- Analgesics: Reduce sensation of pain
- Rubefacients: Increase circulation to the area which can be helpful in removing congestion
- Anti-inflammatories: Reduce inflammation which is often associated with arthritic pain or injury
- Muscle relaxants: Relax the muscle tissues which can be helpful in cases of pain associated with muscular tension such as injury, backache, and tension headaches
In addition, herbal preparations for topical pain relief are typically without the side effects that are often experienced with conventional painkillers.
Conventional medical approaches to pain relief also recommend lifestyle measures as part of a pain management strategy, in combination with painkillers if necessary.
Although rest is important for healing, being too inactive can contribute to the level of pain experienced. Remaining inactive because of pain can have an impact on our physical and emotional state, where prolonged inactivity can lead to:
- Physically: Tightening of muscles, creating further tension in the body, which can make moving around more difficult and increase the level of pain.
- Emotionally: Lack of motivation, feelings of isolation, and even depression, which can contribute to increased levels of pain (5).
This highlights the importance of finding balance between taking the necessary rest to allow the body to heal and remaining sufficiently active to ensure additional tension does not accumulate, and that muscle mass, strength, flexibility, and joint mobility are maintained.
The following are recommendations given as part of a conventional medicine strategy to manage chronic pain and remain active:
- Exercise little and often, daily if possible (such as walking, swimming, or cycling).
- Gentle stretching on a regular basis (such as dancing, Yoga, or Pilates)
Additional options may include:
- Physical therapy (such as physiotherapy, osteopathy or chiropractic)
- Meditation for pain (5)
These suggestions are of course case dependent on your capability of moving after injury.
Herbal treatment
There is also a lot that can be done to help manage pain through topical applications of herbs.
Arnica
Arnica is a well-known remedy for bruises, and has been traditionally applied in cases of sprains, swelling, muscle pain, inflammation, and muscle and joint issues. It can be thought of as a go-to for injuries such as sprains, strains, bumps and bruises, where there is pain, inflammation, and perhaps before any bruising has even occurred. Arnica can also be helpful for general muscle aches such as after exercising, and in cases of arthritic pain (particularly osteoarthritis). This is due to its anti-inflammatory and analgesic actions applied either as a cream, ointment, or plaster (by applying the liquid tincture diluted on a cloth and placing on the skin). It also makes a very soothing foot soak. The tincture or infused oil of arnica can be added to a bowl of warm water and aching feet soaked in this (6).
Interestingly clinical trials now seem to support the traditional uses of arnica for aches and pains. A recent study of 200 participants with musculoskeletal pain was conducted. Half of the participants were given a herbal preparation containing the active ingredient of arnica, and it was concluded that pain and stiffness were reduced within minutes of the preparation being applied. Overall, the pain and mobility improved over the 14 days of the trial. Whilst arnica was the main ingredient of the preparation, it contained 3 other herbal/herbal-based ingredients (hypericum, calendula, melaleuca, and menthol). Therefore, it cannot be clear that arnica was the only component affecting the symptoms, and it is likely due to the synergistic effect of the other herbs working in combination with the arnica (7).
A recent literature review looked at the research for arnica for different types of pain such as post-operative pain, arthritic pain, lower back pain, and other types of musculoskeletal pain. The authors concluded that arnica was comparable in effectiveness of pain management to conventional pain medications, with fewer adverse effects (8).
Notes of caution with arnica: Avoid applying to broken skin, and do not take herbal preparations of arnica internally (as it is toxic when taken internally).
Capsicum
Capsicum is undoubtedly a heating herb which is excellent in cases of pain where the application of heat helps, and where circulation to the area needs stimulating.
The initial application of capsicum may feel slightly burning, but the way it works means that after this initial stimulation it actually desensitises certain pain receptors, reducing the feeling of pain (9, 2). This can be particularly helpful in the management of chronic pain disorders such as osteoarthritic, diabetic and other types of neuropathy (nerve pain), and post-herpatic neuralgia (nerve pain following shingles) (10). Capsicum can generally be applied blended in a cream or ointment, and is best avoided on sensitive mucous membranes and eyes (if you have ever had this misfortune after cooking with chillies then you will understand!).
An interesting note is that the active ingredient of capsaicin cream is extracted from the plant capsicum.
Lavender
When applied to the skin lavender acts as a rubefacient increasing circulation to the area which can be helpful to relieve congestion and inflammation. Lavender has an antispasmodic effect which helps to reduce muscle spasms, so can be particularly helpful in cases of pain associated with muscular tension or injury, and in arthritis where congestion and inflammation may be a factor. Lavender essential oil is usually applied topically diluted either in a base oil, or another form of cream or balm to apply to the skin. Studies have demonstrated that Lavender essential oil applied as part of an aromatherapy massage is effective in reducing the pain associated with osteoarthritis of the knee (11).
Lavender is effective for headaches associated with stress and may be applied topically in these cases. Additionally, because of its relaxing and tonic effect on the nervous system lavender may be beneficial when stress or anxiety accompany pain.
Peppermint
Peppermint is cooling in nature and has analgesic properties (10). A compound in peppermint called menthol has been used topically for sore muscles (9). Topical application of menthol seems to act as a local anaesthetic relieving pain. Peppermint oil has a rubefacient action, seeming to increase skin blood flow when applied locally. The cooling qualities of peppermint can be welcome in easing the heat often associated with painful inflammation.
A clinical trial on 41 patients experiencing tension headaches used peppermint oil diluted to 10% in an ethanol extract (for blinding purposes so that the control group would have the ethanol extract alone). They applied to the forehead during a headache, over 164 headache episodes in participants. The results were that peppermint oil was as effective for the treatment of headache as a group who took paracetamol (12). So, if you experience tension-type headaches, keeping a bottle of peppermint essential oil handy may well be a helpful measure. If using essential oils, be sure to dilute it in a carrier oil so as not to irritate the skin.
Rosemary
Rosemary oil (which can be the essential oil diluted in a neutral carrier oil, or an oil infused with the plant material) has a rubefacient action when applied to the skin, helping to improve circulation to the area (13). Traditionally, rosemary has been used topically to ease gout and rheumatism (6). It is also wonderful at relaxing muscle spasms, and can be helpful in cases of muscle aches, sciatica, neuralgia, and wound healing (10).
Summary
From a herbal medicine perspective, pain relief is still a symptomatic treatment, and this approach would only be recommended alone for short-term pain such as recovering from an injury or surgery for example.
Herbal medicine approaches health in a holistic manner, taking into account all factors affecting a condition and aiming to work on a deeper level than simply dealing with symptoms. The aim is to rebalance the body systems so that resilience, better health, and quality of life can be re-established.
If you are seeking herbal support for long-term or chronic pain, consulting a herbalist will ensure that treatment can be tailored specifically to your condition to address the root cause, alongside providing pain relief. You can see the where to find a herbalist page on our website for details of how to find a herbalist.
For home herbalism and making your own balms, you can read this article on making muscle rubs.
References
- Merck. Overview of Pain https://www.msdmanuals.com/professional/neurologic-disorders/pain/overview-of-pain?query=pain. Accessed January 5, 2023.
- van Rensburg R & Reuter H. An overview of analgesics: NSAIDs, paracetamol, and topical analgesics Part 1. South African Family Practice. 2019;61:1. 0.1080/20786190.2019.1610228.
- Merck. Treatment of Pain https://www.msdmanuals.com/professional/neurologic-disorders/pain/treatment-of-pain?query=topical%20treatment%20of%20pain#v1033443. Accessed January 5, 2023.
- NHS Lanarkshire. Drugs for the Treatment of Soft Tissue Disorders and Topical Pain Relief https://nhslguidelines.scot.nhs.uk/medicines-guidance/joint-adult-formulary/chapter-10-musculoskeletal-and-joint-diseases/drugs-for-the-treatment-of-soft-tissue-disorders-and-topical-pain-relief/. Accessed January 5, 2023.
- NHS. Ways to Manage Chronic Pain https://www.nhs.uk/live-well/pain/ways-to-manage-chronic-pain/. Accessed January 10, 2023.
- Grieve M. A Modern Herbal. Chatham, Kent: Cresset Press; 1994.
- Ramon S, de Unzurrunzaga R, Nishishinya B, Lucenteforte G, García M, Barastegui D, et al. Immediate and mid-term effect of a natural topical product in patients with musculoskeletal pain: randomized, double-blinded, and placebo-controlled clinical trial. MedRvix. 2021. doi: https://doi.org/10.1101/2021.11.04.21265860.
- Smith AG, Miles VN, Holmes DT, Chen X, Lei W. Clinical Trials, Potential Mechanisms, and Adverse Effects of Arnica as an Adjunct Medication for Pain Management. Medicines. 2021; 8(10):58. https://doi.org/10.3390/medicines8100058.
- Bone K, Mills S. Principles And Practice Of Phytotherapy. China: Churchill Livingstone Elsevier; 2000.
- Bone, K, The Ultimate Herbal Compendium. Warwick, Queensland: Phytotherapy Press; 2007.
- A, Mahmodi MA, Nobakht Z. Effect of aromatherapy massage with lavender essential oil on pain in patients with osteoarthritis of the knee: A randomized controlled clinical trial. Complementary Therapies in Clinical Practice. 2016:25;75-80. https://doi.org/10.1016/j.ctcp.2016.08.002.
- Göbel H, Fresenius J, Heinze A, Dworschak M, Soyka D. Effektivität von Oleum menthae piperitae und von Paracetamol in der Therapie des Kopfschmerzes vom Spannungstyp [Effectiveness of Oleum menthae piperitae and paracetamol in therapy of headache of the tension type]. Nervenarzt. 1996;67(8):672-681. doi:10.1007/s001150050040.
- Hoffmann D. The New Holistic Herbal. Shaftesbury, Dorset: Element Books Limited; 1996.
