Hi Sandra. My partner suffers from complex regional pain syndrome. Are there any plant medicines that can be used to help with chronic pain?

Thank you for your question. Complex regional pain syndrome (CPRS) is pain that follows soft-tissue, bone or nerve injury. The pain is considered neuropathic, meaning that the nerve fibres themselves may be damaged, dysfunctional or injured. The damaged nerve fibres then send incorrect signals to pain centres, resulting in a state of long-lasting and often severe pain. The pain is typically more severe than what would be expected for the original damage.

CPRS is challenging to manage, and because the cause is still poorly understood and the pain is typically long-term, depression, anxiety and anger can be common in people with the condition. Treatment is usually multi-faceted, and may include physiotherapy, massage, counselling and pharmaceutical medication among other interventions.

Plant medicines which have an affinity for the nervous system can be a wonderful ally in the treatment of CPRS. Below are some of the plants I have successfully used for chronic pain:

Cayenne (Capsicum annum): Analgesic and anti-inflammatory, cayenne is a powerful local circulatory stimulant that brings increased blood and nutrients to an area of injury or pain, relieving congestion and inflammation of tissues. Its effectiveness in reliving chronic pain and neuralgia (including post-herpetic neuralgia and diabetic neuralgia) has been confirmed by a number of scientific studies.

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Repeated topical applications leads to desensitisation, meaning the cayenne feels less hot while the analgesic and anti-inflammatory activity continues. This is a well-known phenomenon. The longer cayenne is applied, which is preferable for therapeutic results, the less pain and heat that is experienced. The desensitisation of nerve fibres is a temporary effect related to the frequent use of cayenne.

Clinically I recommend the use of a fresh extract of cayenne in a cream base, applied 2-4 times daily. Cayenne combines well with other pain-relieving medicinal plants such as arnica, willow bark and St. John's wort. Take care when applying topically and start with small regular applications as sensitivity to cayenne is highly individualised. An initial reddening and mild to moderate stinging sensation over a period of several hours is normal at the outset, this lessens with repeated applications.

St John's wort (Hypericum perforatum): Whilst many people are aware of the widely researched antidepressant action of St John's wort, it also has the lesser-known ability to heal damaged nerve tissue. It also has analgesic, anti-inflammatory and sedative actions, making it the first plant of choice for chronic pain stemming from nerve injury. It is excellent for sciatica, disc damage, for the recovery of nerve sensation and function after surgery, phantom limb pain post-amputation and for the nerve pain associated with shingles and herpes lesions.

The St John's wort that grows wild in the alpine regions of Central Otago is some of the best in the world. Clinically I use the fresh flower heads infused into certified organic olive oil, gently massaged into the area of discomfort between 2-5 times daily. Topical application of St John's wort oil is compatible with pharmaceutical drug treatment, meaning it is an excellent first line option for those looking to plant medicine to manage pain.

In CPRS where pain is usually more severe and long-term, I recommend both external application of the oil and internal consumption of St John's wort. Best taken as an oral liquid or medicinal tea, this will promote nerve healing from the inside out. Its anti-depressant and anti-anxiety effects provide additional support since managing chronic pain brings many challenges to wellbeing. Although certain preparations of St John's wort can interfere with pharmaceutical medication, Medsafe New Zealand said St John's wort which is low in the active constituent hyperforin (less than 3%), as in the case of traditionally prepared tinctures or medicinal teas, is unlikely to produce interactions.

Californian Poppy (Eschscholzia californica): The official state flower of California, this beautiful plant was used traditionally to reduce pain without the dangers of the more powerful opiates such as the opium poppy. Although the narcotic effect of Californian poppy is much less potent than that of morphine or codeine it will still have pronounced sedative and hypnotic (sleep-inducing) effects when taken in high doses. In moderate amounts it is non-sedating but still able to relieve nerve pain. The combination of analgesic, anti-inflammatory and anti-anxiety actions in the body makes it an excellent choice for multi-faceted conditions such as CPRS. It is best taken as an oral liquid.

I hope this has given you some insight into the use of plant medicine for chronic pain. Due to the complexity of CPRS, being guided by a qualified medical herbalist who can ensure plant medicine will safely complement your conventional treatments is always recommended.

References

Orhan, IE, Kartal, M, Gulpinar, AR, Yetkin, G, Orlikova, B, Diederich, M, & Tasdemir, D (2014). Inhibitory effect of St John׳ s wort oil macerates on TNFα-induced NF- κB activation and their fatty acid composition. Journal of Ethnopharmacology, 155 (2), 1086-1092.

Chrubasik, S, Weiser, T, & Beime, B (2010). Effectiveness and safety of topical capsaicin cream in the treatment of chronic soft tissue pain. Phytotherapy Research, 24(12), 1877-1885. doi: 10.1002/ptr.3335

Genovese T, Mazzon E, Menegazzi M, et al (2006). Neuroprotection and enhanced recovery with Hypericum Perforatum extract after experimental spinal cord injury in mice. Shock, 25(6), 608-617. doi: 10.1097/01.shk.0000209560.54328.69

Hanus, M, Lafon, J, and Mathieu, M (2004). Double-blind, randomised, placebo-controlled study to evaluate the efficacy and safety of a fixed combination containing two plant extracts (Crataegus oxyacantha and Eschscholtzia californica) and magnesium in mild-to-moderate anxiety disorders. Current Medical Research & Opinion, 20(1), 63-71.

Hautkappe M, Roizen MF, Toledano A, et al (1998). Review of the effectiveness of capsaicin for painful cutaneous disorders and neural dysfunction. Clinical Journal of Pain, 14(2), 97-106.

Rolland, A, Fleurentin, J, Lanhers, MC, Younos, C, Misslin, R, Mortier, F & Pelt, JM (1991). Behavioural effects of the American traditional plant Eschscholzia californica: sedative and anxiolytic properties. Planta Medica, 57(3), 212-216.

Sarris, J, Panossian, A, Schweitzer, I, Stough, C, & Scholey, A (2011). Herbal medicine for depression, anxiety and insomnia: a review of psychopharmacology and clinical evidence. Eur Neuropsychopharmacol, 21(12), 841-860. doi:10.1016/j.euroneuro.2011.04.002

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