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- Arnica (Arnica montana)
- Muscle Pain
- Homeopathy
| Date:
02-15-2011 | HC# 101014-418
|
Re: Study Finds Homeopathic Arnica Cream Not Effective on Acute Muscle Pain
Adkison
JD, Bauer DW, Chang T. The effect of topical arnica on muscle pain. Ann Pharmacother. October 2010;44(10):1579-1584.
Arnica
(Arnica montana) flower and stem has
historically been used topically for inflammation, muscle pain, sprains, and
bruises as a liniment or homeopathic cream. Internal use of arnica extract should
be avoided. If taken internally, arnica extract causes adverse side effects
including gastroenteritis, muscle paralysis, and cardio-toxicity. Homeopathic
arnica is a safe form of arnica that can be applied topically as a cream or
taken internally in pill form. An alcohol extract can also be applied directly
or in cream form.
Herbal
arnica preparations have a much higher extract concentration than homeopathic
preparations. Homeopathic remedies are produced by multiple dilutions of a
plant extract. Strength is determined by the amount of dilution in the extract
that is expressed with letters that correspond to the factored dilution as "X"
or "D" (factor of 10), "L" (factor of 50), or "C"
(factor of 100). Arnica 30X is arnica tincture diluted to 1·1030 in solvent. In several studies using oral
homeopathic arnica to treat post-exercise delayed-onset muscular soreness, a
tendency toward relief was noted in some data, but preparations and results
were inconsistent.
Previous
studies performed with animals and in vitro have shown that arnica possesses
antimicrobial, anti-inflammatory, analgesic, anti-rheumatic, and uterus-stimulating
properties primarily due to its sesquiterpene lactones. Arnica lactones "inhibit
human platelet function and nuclear factor κ-B (NF-κB)."1 This
action results in the reduction of inflammation by reducing synthesis of
pro-inflammatory cytokines, cyclooxygenase 2, and nitric oxide synthase.
One
study compared the anti-inflammatory benefits for hand arthritis of arnica gel
(50 g tincture/100 g gel) and ibuprofen gel (5%). Similar improvement was
observed in both test groups for pain intensity and hand function (95.2%
difference for confidence intervals and inferiority thresholds).2
This result showed that topical herbal arnica gel was comparable to the
effectiveness of ibuprofen gel for pain and mobility improvement in arthritis
occurring in the hand.
Another
study on patients with knee osteoarthritis showed that pain, stiffness, and
functionality index scores were improved from baseline, with the use of arnica
gel applied topically to the localized area (50 g tincture/100 g gel).3
This
randomized, placebo-controlled, double-blind study was conducted at The
University of Texas Health Science Center at Houston to confirm the findings of previous
studies on arnica use for muscle soreness. Fifty-three subjects, male (19) and
female (34) of ages 18-65, completed the study. Data were collected from
December 2007 to August 2008. All of the subjects were interviewed and
determined to be free of any chronic disease associated with muscle pain,
tenderness, or stiffness. The subjects were given 1 tube of homeopathic
(manufactured according to the Homeopathic
Pharmacopeia of the United States) 1X-7% arnica cream and 1 tube of placebo
cream (both provided by Boiron Group; Sainte-Foy-les-Lyon, France) randomly.
The tubes were marked with the words "left" or "right" to
indicate which leg to apply the cream. Each subject served as their own
control. Subjects participated in filling out a 10-point visual analog scale
(VAS) to assess pain. Two secondary endpoints assessed were range of motion and
level of pain associated with muscle tenderness. Muscle pain associated with
tenderness was also rated along a VAS.
Subjects
on a stair-step used 1 leg at a time and performed two-second heel lifts
placing the ankles in plantar-flexion 25 times consecutively. This sequence was
repeated with the other leg. The sequence of repetitions was repeated 20 times
on each leg, followed by 15 times on each leg to induce muscle soreness. The
creams were applied to each appropriate leg directly after the exercise
regimen. The subjects rated their pain along the VAS scale 24 hours after the
initial exercise. At that point, subjects applied the cream to each leg for a
second time. Forty-eight hours after the exercise the subjects had ankle range of
motion and calf tenderness measured. Tenderness was rated on day 3 by placing a
5 lb. weight across the mid-calf of each leg, and subjects ranked the
tenderness of each leg on the 10-point VAS scale. They also rated their pain on
the VAS scale, and then applied the cream the final time. At 72 hours, the
final pain assessment was measured by the subjects on the VAS scale.
Data
results showed that patients initially experienced more pain in the leg that
received the application of homeopathic arnica cream, compared to the placebo. Non-paramagnetic
statistics were used to analyze the data. Leg pain scores were analyzed with a
Wilcoxon signed ranks test to compare the difference in scores between the
arnica cream and placebo on days 1, 2, 3, and 4. There was only a difference
reported on day 2, where subjects reported having more pain in the leg that
received the arnica cream than the placebo cream (3.04 vs. 2.36, respectively,
P < 0.005). Manufacturer assays confirmed that the placebo/active key for
identifying the creams was correct. A t-test was used to analyze the secondary
range of motion measure. Scores from baseline (day 1) compared to day 3 showed
no significant difference in range of motion (t = -1.942, df = 52, P = 0.058).
No statistically significant difference in tenderness was documented by the
subjects, with 35 experiencing tenderness on pressure in the arnica leg
compared to 29 subjects in the placebo leg.
In
conclusion, subjects who used the homeopathic arnica cream on their legs exhibited
little or no pain relief. This was a double-blind study which would have
eliminated any bias toward the active ingredient. Theoretically, symptoms may
have worsened due to homeopathic "healing crisis" where symptoms
increase before improvement, but no evidence of this was demonstrated on the
final two days. Further studies with topical arnica are important to develop
optimal strength and extract form for pain and inflammation.
—Erin
Miner
References
1Jäger C, Hrenn A,
Zwingmann J, Suter A, Merfort I. Phytomedicines prepared from arnica flowers
inhibit the transcription factors AP-1 and NF-kappaB and modulate the activity
of MMP1 and MMP13 in human and bovine chondrocytes. Planta Med. 2009;75(12):1319-1325.
2Oliff HS. Arnica gel
as effective as ibuprofen gel in osteoarthritis of the hands. HerbClip. May 31, 2007 (No. 050571-329).
Austin, TX: American Botanical Council. Review of Choosing between NSAID and arnica for
topical treatment of hand osteoarthritis in a randomised, double-blind study by
Widrig R, Suter A, Saller R, Melzer J. Rheumatol
Int. 2007;27(6):585-591.
3Knuesel O, Weber M,
Suter A. Arnica montana gel in osteoarthritis of the
knee: an open, multicenter clinical trial. Adv
Ther. 2002;19(5):209-218. |