By Maria Noël Groves, RH (AHG), Registered Clinical Herbalist, Owner of Wintergreen Botanicals Herbal Clinic & Education Center in New Hampshire, and Author of Body into Balance: An Herbal Guide to Holistic Self Care
Pain is our task-master. Whether acute or chronic, it lets you know that something in your body is out of balance. In acute pain, such as a simple injury, pain tells you to stop doing whatever you did that caused the injury and to give it time to rest and heal. Chronic pain can be more complicated. It can result from an old injury, lingering infection or wayward immune response, chronic inflammation, or other factor. Technically, all pain is a nervous system phenomenon because that’s how pain signals travel, particularly the substance P neurotransmitter. Yet, pain actually involves multiple body systems and types of tissues, compounds, and transport methods. Here are some examples of the various chemicals and compounds associated with chronic pain, which you may recognize as pain and inflammation buzz words:
- Substance P: a neurotransmitter secreted by the nerves and inflammatory/immune cells that sends pain signals to the brain and increases inflammation
- Prostaglandins: hormone-like compounds created from arachidonic acid (AA, a type of fat) that often promote but sometimes resolve inflammation
- COX-2: a pro-inflammatory enzyme that aids the conversion of AA to prostaglandins, which is stimulated by cytokines and other compounds
- Leukotrienes: pro-inflammatory eicosanoids associated with pain and allergy that are made from AA via the enzyme 5-LOX
- Histamine: an inflammatory compound of the immune system associated with allergies that increases your perception of pain
- Cytokines: proteins secreted by the immune system in response to infections, cell injury, and other conditions that affect cell communication, which can often (but not always) be pro-inflammatory. Interleukins and tumor necrosis factors are inflammatory cytokines that increase the production of substance P and prostaglandins.
- Glutamate: an amino acid in food and produced by the body that can increase or decrease the perception of pain in the brain
- Cortisol: a hormone associated chronic stress and blood sugar imbalance that ultimately prevents the body from being able to down-regulate inflammation, leading to increased inflammation throughout the body
- CRP: a protein secreted into the blood by the liver, the levels of which rise in response to inflammation, which has made it a good marker for overall inflammation in the body
From this list, hopefully some of the things you may have heard about pain will begin to click. You can see why MSG (a glutamate-based food chemical) in your food might trigger pain for some people. Why chronic stress and resulting high cortisol levels are often underlying factors in chronic pain. Why you might experience pain flare ups during allergy season. How the fats in your diet can affect your tendency for inflammation, and so on. If you like to dig through the scientific research around pain-relieving herbs, you’ll often read of them affecting one or more of these chemicals and pathways. For example, turmeric works via multiple pathways, most notably reducing COX-2. Boswellia appears to reduce leukotrienes. Tart cherry juice may reduce CRP. Cayenne, applied topically, depletes substance P. And so on.
Pain is the fire alarm. It’s not the fire. It might help to shut the fire alarm off (so you can think straight and take action), but for long-term care, you want to put out the fire or new alarms will eventually go off.
Whenever we address chronic pain with herbs and natural therapies, we want to look at it holistically. That means, we want to consider the whole person and look for underlying patterns as well as root causes of the inflammation and pain. Blindly taking mega doses of turmeric may be natural (and perhaps even effective), but it’s not necessarily holistic if you’re not taking a closer look at everything going on.
When I teach classes on chronic pain, they’re often several hours long, and the chapter on managing chronic pain in my new book, Body into Balance: An Herbal Guide to Holistic Self Care is one of the longest chapters in the entire book. Therefore, I won’t be able to get into all the nuances of pain and the many, many potentially beneficial herbs in this blog. If you’d like to delve more deeply into the topic, join me for my upcoming talk at ArborVitae and/or check out my book. In this blog, I want to give you a taste of some of the things we’ll discuss and some of the herbs I use most frequently when working with clients in chronic pain.
Using herbs to help address chronic pain can be very rewarding – they’re often quite effective, with some effects seen within just one day and more seen over the coming month or two. But, herbs aren’t quite as simple as over the counter meds. For example, taking an NSAID pain reliever like ibuprofen will at least temporarily improve a wide range of types of pain because it’s a general prostaglandin inhibitor and anti-inflammatory (although it’s really just shutting off the alarm, and long-term more issues often pop up). There is no one “fix it all” pain herb. You have to work a little harder to find the right herb for the right person.
Turmeric (Curcuma longa): This famous anti-inflammatory herb is a good place to start in chronic pain conditions because it works via multiple inflammatory pathways and has been shown to benefit a range of types of pain including rheumatoid and osteoarthritis and pain from over-exertion. It also has many other “side benefits” such as liver detoxification and protection, and better digestion and is generally safe and well tolerated. It is, however, not very easily absorbed in the gut. Heating it, adding it with oil (the primary constituent curcumin is a fat-soluble carotenoid), and adding black pepper (just 1 percent of piperine in black pepper boosts curcumin’s bioavailability 2,000 times!) all enhance its activity. You’ll find all sorts of lovely and tasty variations of golden milk recipes, which are great for daily use, and you can also take it as a capsule or use it in meals. Aim for 1/4 to 1/2 teaspoon daily, which equates to 2 to 4 homemade capsules. For commercial extracts, follow the label recommendations. I sometimes use turmeric tincture in formula (made fresh 1:2 in 95% alcohol or dry 1:5 in 70% alcohol – it is not very water soluble and you can use the strength of its stain as an indicator for potency), but I prefer other forms when really focusing on turmeric as the main remedy. Even though turmeric can protect against ulcers, it may aggravate active ulcers and overly acidic digestive systems. It blends well with ginger (a hotter anti-inflammatory with noted benefits for muscle pain), ashwagandha and/or holy basil (two anti-inflammatory calm-energy adaptogens), rosemary (a potent anti-inflammatory and circulation enhancing herb), and boswellia (a general anti-inflammatory with benefits for arthritis as well as pain associated with allergies and autoimmune disease).
Blue Vervain (Verbena hastata): This herb is just one example of many herbs that help relax muscle tension and relieve spasms and cramps, though it is among my favorites for headaches and neck/shoulder tension and pain amongst driven, type-A personalities. You can also consider it for nerve pain (like sciatica), insomnia (including pain-related insomnia, etc.), moving stagnant fluids, and boosting digestion and detoxification. It’s almost always taken as a tincture (1:2 fresh flowering tops in 95% or 1:5 dry in ~50% alcohol), and sometimes just a few drops on the tongue or a small percent in the formula will be a miracle worker. If you don’t have blue vervain around, wood betony offers many similar benefits (the Stachys, not the Pedicularis)… although Pedicularis is a nice herb to consider any time there is muscle tension, and you can learn more about it from 7Song and Michael Moore. Whenever there is chronic muscle tension, consider taking a good magnesium and vitamin B supplement in ionic (liquid/powder) form because magnesium deficiency can often be an underlying factor. Also consider things like a new mattress or pillow, office ergonomics, regular exercise, stretching, massage, chiropractic care, and other forms of bodywork. There are also some great clinical studies using ginger capsules for muscle pain like migraines and menstrual cramps.
St. John’s Wort (Hypericum perforatum): St. John’s Wort oil is made by infusing the fresh buds and flowers in olive oil until it turns a deep red hue. It can be profound for gentle yet fast relief for nerve pain (sometimes other types of pain, too – it’s worth trying!), and it may heal nerve damage when applied regularly long term. Consider it for sciatica, new and old injuries, etc. Market quality varies widely. Check the label for one made with fresh buds and flowers (a few leaves are ok, but they’re much weaker). This should make a nice, red oil – the redder, the more potent. Use color as a guide when buying it. The red pigments can vary year from year, but you can optimize by doing the following: harvest after a hot, sunny week; choose a location that is dry, hot, and sunny, with preferably poor soil; harvest primarily buds and flowers (especially buds); place your jar in the sun as it macerates. It may take 2+ weeks for the red hue to develop. You can also apply St. John’s Wort tincture topically. Topical
St. John’s Wort is usually very well tolerated, though internally it can interact with many medications and, in rare cases, increase sun photosensitivity. Cayenne preparations applied topically, such as capsaicin cream, are well-studied for their ability to reduce nerve pain by depleting pain neurotransmitters, though this isn’t particularly holistic.
These are just a few of the many useful herbs in our arsenal for dealing with chronic pain. In the ArborVitae class and my book, you’ll learn about many more herbs including tart cherry juice, boswellia, California poppy, and various flower essences (comfrey being one of my absolute favorites). We’ll also delve more specifically into different types of pain, such as muscle pain, nerve pain, the stress-pain relationship, and pain with an autoimmune or infectious component. Even though we didn’t have time to get into it in this blog, know that an anti-inflammatory diet, exercise, mind-body balance, and lifestyle changes are also core components of any holistic protocol for pain. In fact, sometimes just cleaning up your diet, doing physical therapy, or starting a yoga routine can completely resolve pain.
Happy Herbal Adventures! ~ Maria Noël
All photos provided by Maria Noël Groves.
Maria Noël Groves, RH (AHG), clinical herbalist, runs Wintergreen Botanicals, nestled in the pine forests of New Hampshire. Her business is devoted to education and empowerment via classes, health consultations, and writing with the foundational belief that good health grows in nature. She is the author of Body into Balance: An Herbal Guide to Holistic Self Care. Learn more about Maria and herbs at www.WintergreenBotanicals.com.
If you are interested in learning more, join us for her class at ArborVitae on Thursday, July 14 at 7pm: Managing Chronic Pain – with Maria Noel Groves!