Willow Bark: A Safe and Effective Alternative to NSAIDs

Greetings folks, the following is an article distributed to practitioners from Mediherb and Dr Kerry Bone, one of the Australia’s and possibly the worlds leading professors of herbal medicine and manufacturers of the finest quality herbal products. This is supposed to be information for practitioners only but due to the constant smear campaigns and misinformation distributed by some medical doctors and pharmaceutical companies, mainly idiotic American based, I am going to publish the articles sent to me so that you, the discerning public, have more accurate and honest information upon which to base your decision to use herbal therapies. Mainstream pharmaceutical companies and some doctors have their heads in the sand when it comes to herbal medicine and the real threat it poses to their “Illness Industry”. Much of the so called science behind pharmaceuticals is questionable as are the side effects whilst much of the science behind herbal medicine is very sound indeed. Modern science is even proving more and more that natural therapies, herbal medicine and energetic medicine is the way forward. The ones who stand to lose the most profits would have you believe otherwise!

Enjoy the articles!

Craig Hitchens. B.HSc.(Natural Health Care) NESCP, Dip. Massage, Dip. Reflexology, TFTCP.

Willow Bark: A Safe and Effective Alternative to NSAIDs

 

by Kerry Bone

Nonsteroidal anti-inflammatory drugs are the mainstay of

the conventional treatment for osteoarthritis and related

conditions. These drugs act by inhibiting the enzyme cyclooxygenase

(COX) which produces pro-inflammatory

prostaglandins. Because this activity often results in the

undesirable side effects of gastric erosion and increased

bleeding tendency, sometimes leading to death by

gastrointestinal hemorrhage, a more selective class of COX

inhibitors were developed. The goal with these COX-2

inhibitors was that the anti-inflammatory activity would be

preserved, but the undesirable side effects would be

minimized. Unfortunately this goal was not realized.

We have already witnessed the 2004 withdrawal from sale

of rofecoxib (Vioxx), one of the main COX-2 inhibitors, due

to increased cardiac deaths. In addition, recent studies

have emerged which raise serious concerns regarding the

long-term safety of all NSAIDs in this regard, not just the

selective COX-2 inhibitors.

Some of the most commonly used nonselective NSAIDs are

in fact more likely to cause heart attacks than rofecoxib.

 

 

 

 

 

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case-control study of more than 9000 people aged 25 to

100 who had suffered their first ever heart attack was

published last year in the prestigious

 

 

 

 

Journal

 

 

 

 

a significantly increased risk of myocardial infarction was

observed for diclofenac (55% increase), ibuprofen (24%

increase), rofecoxib (32% increase) and naproxen (27%

increase). Also for other nonselective NSAIDs (viewed as a

whole) there was a significant 21% higher risk of heart

attack. The authors concluded that their study suggested

that enough concerns may exist to warrant a

reconsideration of the cardiovascular safety of ALL NSAIDs.

NSAIDs have also taken a hammering concerning their

clinical efficacy. A recent meta-analysis and systematic

review of 23 clinical trials including more than 10,000

patients found that NSAIDs as a whole (including selective

COX-2 inhibitors) were ineffective for long-term pain relief

in osteoarthritis of the knee.

 

 

 

 

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concluded that while NSAIDs can reduce short term pain in

osteoarthritis of the knee slightly better than placebo, the

long-term use of NSAIDs for this condition is not supported

on the current evidence. They added that as serious

adverse events are associated with NSAIDs, only their

limited use can be recommended.

Clearly the message from the current research is that

NSAIDs should not be the first option for the treatment of

arthritis and muscle pain. One frontline option that is

receiving much research attention in Europe is the

standardized extract of willow bark. The clinical efficacy of

willow bark in pain management has already been

demonstrated in several randomized controlled clinical

trials.

 

 

 

 

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this herbal product, when tested in a clinical setting, had a

superior safety and efficacy profile compared to NSAIDs.

Two large-scale observational clinical studies have been

presented at recent conferences confirming the safety and

efficacy of standardised willow bark extract in the

management of osteoarthritis and chronic low back pain.

The first study, which was presented at a Berlin conference

in early 2004, involved 922 physicians and 4,731 patients

in Germany.

 

 

 

 

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back pain took various doses of willow bark extract (an

average of around 3 tablets per day, see comment below

regarding the standardisation of the product used) and

rated their pain intensity from 1 to 10 (with 10

representing pain of the highest intensity). Most of the

patients had previously been taking NSAIDs, but had

generally discontinued these because of either a lack of

efficacy or side effects. During the observation period, only

15.5% needed supplementary antirheumatic drugs in

addition to their willow bark. Average pain intensity

reduced from 6.4 to 3.7 points in the first 4 weeks of

treatment and had fallen further to 2.7 after 8 weeks, with

97% of patients reporting a reduction in pain and 18%

reporting no pain at all. Side effects were judged as minor

and occurred in only 1.3% of patients. These were mainly

abdominal pain or an allergic skin rash.

The second study was undertaken in Switzerland and

involved 204 physicians and 807 patients.

 

 

 

 

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suffered osteoarthritis (44%) or chronic back pain (36%).

In 69% of patients the problem had existed for more than

6 months. In 55% of patients the willow bark was

prescribed on its own, whereas in 39% it was combined

with conventional medications (mainly NSAIDs) that the

 

Not for Public Distribution. For Education of Health Care Professionals Only. 2

patients were already taking. The average daily dosage of

willow bark extract was 3.4 tablets at the beginning of the

study and 2.8 at the end. Throughout the 6 to 8 week

observation period, mean pain intensity decreased from

6.4 points to 3.3 and at the final visit 15% of patients were

pain free. A substantial reduction of physical impairment

was also observed. Suspected adverse reactions occurred

in 4.5% of patients and none of them were rated as

serious. More than two thirds of patients rated the

tolerability of the willow bark extract as better than

conventional antirheumatic drugs.

The willow bark extract used in the two studies was

standardised to contain 60 mg of salicin per tablet. It is

important to note that only preparations and doses of

willow bark capable of providing this activity will be likely

to reproduce the impressive results of these trials. Taken

together these studies show that standardised willow bark

is safer and more effective than antirheumatic drugs.

Professor Reinhard Saller, a rheumatologist based in

Zurich, was recently interviewed concerning these two

studies and his clinical perspective on willow bark extract.

 

 

 

 

 

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He highlighted the high tolerability demonstrated for

willow bark extract in the trials and emphasised that these

studies provided useful information concerning its effective

dose in a clinical setting. He also observed that the

excellent results he had encountered with willow bark in

his own practice attested to its anti-inflammatory and

analgesic potential. When questioned on the relative value

of willow bark extract versus NSAIDs, he suggested that

the herbal product had a large advantage because of its

complex of active principles that had an overall

modulating effect. The mixture of actives neither provoked

a complete blockage nor a maximal stimulation of

biochemical phenomena. This resulted in a broader

spectrum of action and a greater tolerability than NSAIDs,

which he then advised the patients to use on a limited “as

required” basis once they had started willow bark.

Given the current disillusionment with COX-2 inhibitors,

Professor Saller stressed the advantages of using willow

bark extract, which had complex and multiple activity.

 

 

 

 

 

3,7,8

He felt that such treatments gave the body sufficient

margin to manoeuvre in its proper use of regulatory

mechanisms to influence pathological phenomena. This

contrasted with COX-2 inhibitors that actually block

important compensatory and regulatory mechanisms in

the body, which leads to serious side effects.

 

REFERENCES

 

 

 

1

 

 

Hippisley-Cox, Coupland C. Risk of myocardial infarction in patients

taking cyclo-oxygenase-2 inhibitors or conventional non-steroidal antiinflammatory

drugs: population based nested case-control analysis.

 

 

BMJ

2005;

 

 

330

: 1366-1372

2

 

 

Bjordal JM, Ljunggren AE, Klovning A et al. Non-steroidal antiinflammatory

osteoarthritic knee pain: meta-analysis of randomised placebo controlled

trials.

 

BMJ 2004; 329: 1317-1322

 

 

 

 

 

 

 

 

 

 

3

 

 

Bone K. Willow Bark: A High Potency Extract for Pain Management

.

Phytotherapy Review & Commentary from Townsend Letter for Doctors

and Patients

 

 

. 2002; 226

: 65-68

4

 

 

Werner G, Scheithe K. Congress Phytopharmaka and Phytotherapy

.

Berlin, February 26-28, 2004.

5

 

 

Zenner-Weber MA.

Gemeinsamer Kongress der Schweizerischen

Gesellschaft für Rheumatologie und für Physikalische Medizin und

Rehabilitation

 

 

, Locarno, September 16-17, 2004.

6

 

 

Saller R. [Willow bark extract: more than a natural alterantive for the

treatment of rheumatism?]

 

 

Rev Med Suisse 2005; 1

(14): 971

7

 

 

Marz RW, Kemper F. [Willow bark extract-effects and effectiveness.

Status of current knowledge regarding pharmacology, toxicology and

clinical aspects].

 

 

Wien Med Wochenschr 2002; 152

(15-16): 354-359

8

 

 

Khayyal MT, El-Ghazaly MA, Abdallah DM et al. Mechanisms Involved in

the Anti-inflammatory Effect of a Standardized Willow Bark Extract.

Arzneimittelforschung

 

 

2005; 55(11): 677-687