Herbs For Pain

Pain is one of the signs of inflammation. Acute pain is what we feel immediately after an injury. It is the inflammatory response related to the normal healing process and is our body’s way of communicating the need for rest and relaxation. . Chronic pain is acute pain every day and also is an inflammatory response communicating the need for a change in lifestyle habits that injure our body. Changes in habits such as:  sleep, mind set/ stress response, diet, movement/exercise and our relationship with others are needed to  allow healing. Herbs can be used to provide symptom relief with fewer side effects, as well  as support metabolism and pathways of elimination while necessary life style habits are being changed.

Extracts of herbs used for pain include: California poppy (Eschscholzia californica), Valerian root (Valeriana officinalis), Hops (Humulus lupulus), Corydalis (Corydalis yanhysuo), Kratom ( Mitragyna speciosa),and Cannabis/Hemp (Cannabis sativa).There is a strong relationship between pain and sleep quality. These herbs can also be helpful with sleep. Many times combinations of the herbs can provide greater benefit and be less expensive to use. Effective dosing and your experience with herbs will vary depending on your age, genetics, mind set/beliefs, your ability to absorb and metabolize, and interactions with other medications or supplements. It is always better to start low and go slow. Doses can be increased until the desired effect is achieved or an adverse effect occurs. It is important to do your own research. Do a Pubmed search using the scientific name (Genus species). Consulting your medical doctor and a qualified herbalist is always recommended.

The following information is the result of my own research using Pubmed, information gathered from the University of Vermont Medical School, the Society of Cannabis Clinicians, and the American Herbalist Guild.  It is provided for educational purposes only and not intended to treat any disease or condition. Again, do your own research and seek advice from your medical doctor and herbalist. A trusted source for California poppy, Valerian root, Hops and Corydalis is Herb Pharm (herb-pharm.com) and may also be purchased on amazon.com. Only purchase products thathave been tested for content and purity.

1. California poppy extract: Dosing,20-40 drops, and has been used as an opioid substitute
2. Valerian root: Dosing 10-20 drops
3. Hops:  Is in the same family as Cannabis and is a component of beer. Dosing 10-20 drops
4. Corydalis: Dosing, 10-60 drops, and has been used as an opioid substitute.
5. Kratom:  Is in the same family as coffee. It is subject to some state and local regulation. For sourcs go to the American Kratom Association website. Dosing can vary from 1-20 grams per day in powder form as a tea. The green variety seems to be easier on digestion. Lower doses tend to be more stimulating while higher doses tend to be more sedative for anxiety and pain.
6. Cannabis:  Most health advisors recommend a 1:1 ratio of THC to CBD. There many more plant chemicals that contribute to the medicinal effect. Concentrations of THC greater than 0.3% is not legal on the Federal level and can be intoxicating. High CBD low THC may be subject to state and Federal regulation. For severe pain a 5:1 THC:CBD ratio may be necessary. Doses of 5-10 milligrams per day in three doses may be a safe start. For those with no cannabis experience it is better to use less THC and more CBD during the day and increase THC during the evening /bed time. When using Hemp extracts (Low THC/High CBD), while not intoxicating will require higher doses of CBD (in the range of 100-600 milligrams per day). This can be very expensive. Costs can be decreased by combining with less expensive herbs or making your own extracts from hemp flower at home. When purchasing hemp flower or an extract, look for products with accredited laboratory test results for content and purity. The hemp grower should use organic and regenerative farming techniques. It is my professional opinion that growing your own flower and/or making your own extract is best. Alcohol tinctures may be preferable oil infusions due to shorter shelf life from carrier oil breakdown. Oil infusions may be tolerated better and can be applied topically for localized pain.

To minimize side effects, always use the lowest effective dose. More is not always better. Combining herbs may allow lowering the dose of each individual dose. Side effects include, but are not limited to,  sleepiness/drowsiness, dry mouth, interactions with drugs metabolized by liver, especially the CYP450 pathway. They may also potentiate the effect of other sedative medications. High THC cannabis products in addition to being intoxicating can have addictive qualities. High doses of Kratom can cause nausea and be addicting with continued use. 

To summarize my thoughts on using medicinal herbs singly or in combination, it will be wise to discuss the process for selecting an herb, their safety and improving their effectiveness.

Selecting the correct herb

Herbalists usually categorize patients according to their energetic state. This could be an imbalance of one or a combination of imbalances:

• Energy production (metabolism)

         Excess: too hot, stimulated, increased metabolism, irritated and inflamed,

       Deficient: Too cool, depressed, sedated, decreased metabolism

• Tissue density (moisture)

Excess: too damp, congestion, stagnation and swelling

Deficient: too dry, atrophied, hard , brittle, lack of water and good fats

• Muscle and tissue tone

Excess: constricted increased tone, loss of range of motion, (sympathetic dominant)

Deficient: decreased tone, muscle weakness (parasympathetic dominant)

Herbs can be categorized by their taste and energetic effect (warming/cooling, moistening/drying, constricting/relaxing). Balancing herbs tend to bring tissues back from stagnation or atrophy. Nourishing herbs provide nutrients to help healing and restore normal function.  

• Pungent herbs are stimulating and tend to be warming and drying. Examples are Capsicum, Ginger, Black Pepper and Thyme.
• Aromatic herbs also tend to be warming and drying to a lesser extent. Many are used as essential oils (terpene content) such as: Peppermint, Chamomile, Basil and Lemon Balm
• Bitter herbs are usually cooling and drying. There are alkaloids (Goldenseal, Lobelia and California Poppy) and non Alkaloids (Alfalfa, Kale and Hops)
• Acrid herbs are relaxing, cooling and drying. Examples are Echinacea, Kava Kava, Black Cohosh
• Astringent herbs are drying and constricting. Examples are White Oak, Yarrow and Plantain.
• Sour herbs are drying and balancing (nourishing). Examples are Lemon, Cranberry and Blueberry. 
• Salty herbs are cooling and balancing. They have a high content of mineral salts. Examples are Dandelion, Spinach and Celery.
• Sweet herbs are balancing and moistening. Examples are Licorice, Astragalus and Ginseng.
• Mucilant herbs are cooling moistening and tonic (increasing tone). Examples are Aloe Vera, Comfrey, Okra, Chia Seeds and Fenugreek.
• Oily herbs are cooling, moistening and balancing. Examples are Flax Seed, Hemp Seed, Coconut, Olives and Pumpkin Seeds.

Once the patient and plant energetic are matched, herbs that affect specific organ systems can be chosen to achieve the desired effect.

1. Horne Steven. “The 12 categories of Herbs”. The School of Modern Herbal Medicine 2015
2. Rose Lori. Hill College Holistic Wellness Pathway

There is adequate information to support the effectiveness of herbal medicine. Safety is another concern. “The dangers in using herbal preparations for treatment includes the following:

• Unproven therapeutic effect
• Undisclosed toxicities
• Interaction of chemicals of chemicals in herbal preparations with each other and with concomitantly taken drugs at the level of functionally important biological entities such as plasma proteins, receptors, ion chemical channel transporters and others.
• Incompatibilities with patient age, sex genetic background and organs responsible for eliminating the effects of chemicals in herbal preparations such as liver or kidney
• Difficulty in standardizing treatments
• Inclusion of regular drugs with herbal preparations without disclosure”

Shimaan J A. “Herbal medicine what physicians need to know”. J Med Liban 2009 Oct-Dec; 57(4): 215-7

There are many herbal stimulants may have adverse effects for cardiac patients. Herbs that are contaminated with pesticides, heavy metals, bacteria or pharmaceutical agents are cause for concern. Herbal formulations with many herbal contents can have unpredictable effects. Cohen Pieter A. “Safety of Herbal Supplements a Guide for Cardiologists”. Cardiovascular Therapeutics 2010 Aug; 28(4):246-253

There Is also concern about herbal interactions with general anesthetics. The main concern is herbs that have a sedative effect. It would be wise to discuss herbal supplements with the practitioners involved prior to general anesthesia. Bajwa S J S etal. “Alternative medicine and anesthesia: implications and considerations in daily practice”. Ayu 2012 Oct-Dec; 33(4): 475-480

Herbal supplements are generally safe unless proven otherwise. Using best practices,  the practitioner would:

• Make a thorough client evaluation and base herbal recommendations on the findings for that individual.
• Make herbal preparations from wild herbs that are locally grown, if possible.
• Recommend herbal preparations that are manufactured by reputable companies that use Good Manufacturing Practices that have been established by the FDA and have their products tested for quality of the content.

In conclusion, herbalists should recommend an herb only after considering the pharmacodynamics (how an herb or drug acts on the body), pharmacokenetics (how the body acts on an herb or drug) and energetics to provide the maximum safety and effectiveness.

“We are in the mist of a global pandemic of obesity, diabetes, cancer, dementia, depression and other chronic diseases caused by modern life styles and their associated lack of physical activity, high intake of sugar, fat, salt, alcohol, tobacco and exposure to a toxic cocktail of industrial chemicals. The solutions for this current health crisis are therefore more likely to be found in the homes of individuals than in medical clinics, hospitals or pharmacies.” Marc M. Cohen. “Ocimum sanctum: an herb for all reasons”. J Ayurveda Integr 2014 Dec; 5(4): 251-259. This may be the key to medical practice achieving effective and lasting results with cannabis and other herbal therapies.