A Cochrane review [Abstract] 1 included 14 studies with a total of 2050 subjects.
One trial on Solidago chilensis M. (Brazilian arnica) (20 participants) found evidence on reduction in perception of pain and improved flexibility with application of Brazilian arnica-containing gel twice daily as compared to placebo gel. Capsicum frutescens cream or plaster probably produced more favourable results than placebo in people with chronic LBP (three trials, 755 participants). Based on current evidence, it is not clear whether topical capsicum cream is more beneficial for treating people with acute LBP compared to placebo (one trial, 40 participants). Another trial found equivalence of C. frutescens cream to a homeopathic ointment (one trial, 161 participants). Daily doses of Harpagophytum procumbens (devil's claw), standardized to 50 mg or 100 mg harpagoside, may be better than placebo for short-term improvements in pain and may reduce use of rescue medication (two trials, 315 participants). Another H. procumbens trial demonstrated relative equivalence to 12.5 mg per day of rofecoxib (Vioxx®) (one trial, 88 participants). Daily doses of Salix alba (white willow bark), standardized to 120 mg or 240 mg salicin, are probably better than placebo for short-term improvements in pain and rescue medication (two trials, 261 participants). An additional trial demonstrated relative equivalence to 12.5 mg per day of rofecoxib (one trial, 228 participants). S. alba minimally affected platelet thrombosis versus a cardioprotective dose of acetylsalicylate (one trial, 51 participants). One trial (120 participants) examining Symphytum officinale L. (comfrey root extract) found low quality evidence that a Kytta-Salbe comfrey extract ointment is better than placebo ointment for short-term improvements in pain as assessed by VAS. Aromatic lavender essential oil applied by acupressure may reduce subjective pain intensity and improve lateral spine flexion and walking time compared to untreated participants (one trial, 61 participants). No significant adverse events were noted within the included trials.
Comment: The quality of evidence is downgraded by indirectness (differences in studied interventions: inadequate standardisation of herbal medicine products) and imprecise results (few patients and outcome events).
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