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Possible side effects from NSAIDs and COX-2 inhibitors.

NSAIDs are collectively called non-steroidal anti-inflammatory drugs (NSAIDs). They are the world’s most commonly prescribed class of drugs, and are the most frequently prescribed drugs for osteoarthritis.

The widespread use of NSAIDs has meant that the adverse effects of these drugs have become increasingly prevalent. The two main adverse drug reactions (ADRs) associated with NSAIDs are gastrointestinal (GI) and kidney effects.

Common gastrointestinal
ADRs include:

1. Nausea

2. Dyspepsia

3. Gastric ulceration/bleeding

4. Diarrhea

Elderly patients and those who take the drugs for long periods of time tend to be more susceptible to gastrointestinal, kidney, and liver problems.

These effects are dose-dependent, and in many cases, severe enough to pose the risk of ulcer perforation, upper gastrointestinal bleeding, and death. An estimated 10-20% of NSAID patients experience gastrointestinal problems, and these adverse events are estimated to result in 103,000 hospitalizations and 16,500 deaths per year in the United States. They also represent 43% of drug-related emergency visits.8

COX-2 inhibitors, such as Celebrex, are the newest type of NSAIDS. In some respects, they have fewer side effects, but the side effects they exhibit are much more dangerous. COX-1 and COX-2 inhibitors have been found to increase the risk of atherothrombosis—the underlying condition that results in heart attack, stroke, and vascular death—even with short-term use. A 2006 analysis of 138 randomized trials and almost 150,000 participants showed that some COX-2 inhibitors are associated with a moderately increased risk of vascular problems, mainly due to a two-fold increased risk of myocardial infarction. Also, high doses of some traditional NSAIDs, such as diclofenac and ibuprofen, are associated with a similar increase in heart-related problems.9






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Arthritis Pain Solution

Devil’s Claw Extract Reduces the Pain Associated with Osteoarthritis and Other Musculoskeletal Complaints

What is Devil’s Claw?

Devil’s Claw (Harpagophytum procumbens) has been used for more than half a century in Europe for musculoskeletal pain, and during that time has become an established treatment option.  The European Scientific Cooperative on Phytotherapy (ESCOP) now recommends Devil’s Claw extract for painful osteoarthritis and the relief of low back pain.
 
Research has shown Devil’s Claw extract to be equal to or better than ibuprofen, acetaminophen, and other NSAIDS for pain relief.  Most notably, this natural plant extract is an analgesic, anti-inflammatory, and antidiabetic1 and offers a safer alternative to the now “suspect” COX-2 inhibitors—such as Celebrex® and Vioxx®*—especially since research has found it to be equivalent to them for relieving pain.

* Merck voluntary withdrew Vioxx in September 2004, after it was discovered that long-term use may cause an increased risk in heart attack and stroke.


How does it work?

The main active ingredient in Devil’s Claw is harpagoside, an iridoid glucoside, which is thought to produce anti-inflammatory, anti-rheumatic, and antioxidant effects. Recent research has focused on the possibility that its antioxidant action may explain the anti-inflammatory and anti-rheumatic actions, but the mechanism is unclear. 2

Could you benefit from Devil’s Claw extract?

If you have osteoarthritis—especially of the knee, hip, or spine—there are a number of studies showing there’s a good chance you’ll get relief from Devil’s Claw.

And if you suffer from low back pain, you may benefit as well.

In fact, studies show that Devil’s Claw has proved to be so effective that it allows individuals to lower their dose of other drugs used to treat arthritis pain.

Interesting Facts About Devil's Claw

  1. Devil’s Claw is a shrubby vine native to south west Africa, namely the Kalahari Desert, Namibian Steppes, and the island of Madagascar.

  2. Its name makes reference to claw-shaped, mini grabbing hooks that wrap around the plant’s seeds. The hooks serve to disperse the seeds by sticking to a passing animal.

  3. The root—actually underground tubers—is highly valued by indigenous African Bushmen, Khoikhoi, and Bantu as a bitter tonic for digestion and arthritic conditions.

  4. Indigenous people have also used Devil’s Claw for fever, as a blood purifier, and to ease the pain of childbirth. Externally, it is used for boils and various sores.

Scientific Research:
Devil’s Claw works better than placebo and pain relievers for short-term relief

  • Two trials examining the effects of  Devil’s Claw found strong evidence that daily doses standardized to 50 mg or 100 mg of harpagoside were better than placebo and pain relievers for short-term improvements in pain. Another trial demonstrated the equivalence of taking Devil’s Claw extract to 12.5 mg per day of rofecoxib (Vioxx)—without the side effects.3
  • A double-blind German study comparing Devil’s Claw extract with Vioxx for low back pain found that there were no significant differences between the two. Forty-four patients received Devil’s Claw extract for six weeks, and 44 patients received Vioxx. They were all allowed to take up to 400 mg/day of tramadol, an analgesic used for treating moderate to severe pain, as needed. At the end of the six-week trial, the researchers concluded that no significant differences were demonstrated between the two groups.4

Safer than a new class of pain medication

  • In addition to showing that Devil’s Claw may reduce osteoarthritic pain as effectively as some conventional drugs, a double-blind, four-month study of 122 patients in France showed that patients taking the herb experienced significantly fewer adverse side effects than those taking the drug diacerhein. Most notably, the patients preferred the Devil’s Claw extract over the drug.5

Helps relieve pain from osteoarthritis of the spine, hip, knee, and low back

  • Researchers at the University of Toronto, Canada, searched several databases and other sources to identify trials testing Devil’s Claw extract in adults suffering from osteoarthritis or low back pain. They found strong evidence for the use of Devil’s Claw extract in the treatment of acute, chronic, non-specific low back pain. 6

In a German study, 75 patients who had arthritic hips or knees took Devil’s Claw extract for 12 weeks. The physicians reported a continuous improvement in typical clinical findings such as 45.5% for pain, 35% for limitation of mobility, and 25.4% for joint crepitus (a peculiar crackling, crinkly, or grating feeling from the wearing out of cartilage). There were only two cases of possible adverse reactions reported—indigestion and a sensation of fullness. Although this was an open clinical study in which there was no other drug or remedy used, the results suggest that Devil’s Claw extract is clinically beneficial in the treatment of arthritis of the hip or knee.7

What is Osteoarthritis?

Osteoarthritis is a joint disease that mostly affects cartilage. Cartilage covers the ends of bones, which allows them to glide over each other. It also helps absorb the shock of movement. In osteoarthritis, the top layer of cartilage breaks down and wears away, and consequently, the bones under the cartilage rub together. The rubbing causes pain, swelling, and loss of motion of the joint. Over time, the joint may lose its normal shape. Also, bone spurs may grow on the edges of the joint. Bits of bone or cartilage can break off and float inside the joint space, which causes more pain and damage.

People with osteoarthritis often have joint pain and reduced motion. Unlike some other forms of arthritis, osteoarthritis affects only joints and not internal organs.

Osteoarthritis is the most common type of arthritis. It results from a number of factors including:

  • being overweight
  • aging
  • joint injury
  • joints that are not properly formed
  • a genetic defect in the joint cartilage
  • stresses on the joints from work and/or sports
Osteoarthritis

What to look for in a reliable
Devil’s Claw product

A reliable Devil’s Claw extract product should be correctly standardized and properly extracted to supply the full spectrum of active ingredients and clinical benefits that have been scientifically documented over many years of research.

Most products will not provide the excellent results found in the cited studies due to improper standardization and/or incorrect extraction methods. And if the resulting extract is not identical to the Devil’s Claw extracts that have given the best results in scientific and clinical studies, it will not provide the same level of pain relief.

For best results, look for a Devil’s Claw extract product standardized to contain harpagoside, the active ingredient.

Does Devil’s Claw produce any side effects?

Devil’s Claw appears to be quite safe, with no evidence of toxicity at doses many times higher than recommended.10 A 6-month open study of 630 people with arthritis showed no side effects other than occasional mild gastrointestinal distress. 11

Conclusion

Although Devil’s Claw has been suggested for many conditions, the best evidence supports its use for the treatment of osteoarthritis and low back pain. It provides a safer alternative to traditional pain relief medicines which have numerous long-term side effects. Most importantly, Devil’s Claw extract has been shown to provide pain relief that is equal to or better than traditional over-the-counter and prescription pain relievers.  And much to the relief of everyone, it has no serious side effects when used in numerous long-term, human clinical studies. 

References:

  1. Mahomed IM, Ojewole JA. Analgesic, anti-inflammatory and antidiabetic properties of Harpagophytum procumbens DC (Pedaliaceae) secondary root aqueous extract. Phytother Res. 2004 Dec;18(12):982-9.

  2. Bhattacharya, A & S, Anti-oxidant Activity of Harpagopytum procumbens. British Journal of Phytotherapy, V. 5, No. 2, 1998.

  3. Presser, Arthur M. Pharmacist’s Guide to Medicinal Herbs. Smart Publications, 2000, Petaluma, CA.

  4. Gagnier JJ, van Tulder M, Berman B, Bombardier C. Herbal medicine for low back pain. Cochrane Database Syst Rev. 2006 Apr 19;(2):CD004504.

  5. Chrubasik S, Model A, Black A, Pollak S. A randomized double-blind pilot study comparing Doloteffin and Vioxx in the treatment of low back pain. Rheumatology (Oxford). 2003 Jan;42(1):141-8.

  6. Chantre P, Cappelaere A, Leblan D, et al. Efficacy and tolerance of Harpagophytum procumbens versus diacerhein in treatment of osteoarthritis. Phytomedicine 2000;7(3):177-183.

  7. Gagnier JJ, Chrubasik S, Manheimer E. Harpgophytum procumbens for osteoarthritis and low back pain: a systematic review. BMC Complement Altern Med. 2004 Sep 15;4:13.

  8. Wegener T, Lupke NP. Treatment of patients with arthrosis of hip or knee with an aqueous extract of devil’s claw (Harpagophytum procumbens DC.). Phytother Res. 2003 Dec;17(10):1165-72.

  9. Green GA. Understanding NSAIDs: from aspirin to COX-2. Clin Cornerstone. 2001;3(5):50-60.

  10. Kearney PM, Baigent C, Godwin J, Halls H, et. al. Do selective cyclo-oxygenase-2 inhibitors and traditional non-steroidal anti-inflammatory drugs increase the risk of atherothrombosis? Meta-analysis of randomised trials. BMJ. 2006 Jun 3;332(7553):1302-8. PMID: 16740558.

  11. European Scientific Cooperative on Phytotherapy. Harpagophyti radix (devil’s claw). Exeter, UK: ESCOP; 1996-1997. Monographs on the Medicinal Uses of Plant Drugs. Fascicule 2.

  12. Shaw D, Leon C, Kolev S, et al. Traditional remedies and food supplements: a 5-year toxicological study (1991–1995). Drug Safety. 1997;17:342–356.

  13. Shaw D, Leon C, Kolev S, et al. Traditional remedies and food supplements: a 5-year toxicological study (1991–1995). Drug Safety. 1997;17:342–356.





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