Efficacy of Harpagophytum procumbens Extract in Osteoarthritis, Low Back Pain and Fibromyalgia: a Review of Researches
Keywords:Harpagophytum procumbens extract, musculoskeletal pain, osteoarthritis, low back pain, fibromyalgia, inflammation
The review presents the results of studies on clinical efficacy of Harpagophytum procumbens in the treatment of musculoskeletal pain. Pharmacological effects of Harpagophytum procumbens are associated with the inhibition of formation and releasing of proinflammatory cytokines IL-1β, IL-6 and TNF-α from macrophages, inhibition of expression of cyclooxygenase type 2 (COX-2) and inducible NO-synthase (iNOS) in fibroblasts and inhibition of development of lipid peroxidation, all of which lead to the suppression of the inflammatory response and, as result, development of analgesic effect and chondroprotection. Clinical Application. In case of osteoarthritis Harpagophytum procumbens extract (Sustamar) reduced the severity of pain by an average of 25–50 % and increased joint mobility of about 35–50 %; in case of lumbar pain it reduced the severity of pain at 40–50 %, the pain completely disappeared in 2.5–20 % of patients; it was effective in generalized and localized forms of fibromyalgia. Usage of Harpagophytum procumbens extract in case of any musculoskeletal pain was associated with the fact that approximately 60 % of patients reduced the dose or completely stop taking non-steroidal and steroidal anti-inflammatory drugs. It is possible that the efficacy of Harpagophytum procumbens extract corresponds to that of a standard dose of rofecoxib 12.5 mg, however, these data need to be confirmed. Safety. When receiving Harpagophytum procumbens extract, mild side effects (mainly dyspeptic) occurred in approximately 3 % of patients that did not exceed the appropriate frequency occurring in patients receiving placebo. Long-term use of Harpagophytum procumbens extract (up to 1 year) is safe and not associated with the development of toxic effects. Patients’ adherence to the treatment was 96.4 %. The tolerability of Harpagophytum procumbens extract seems to exceed that of selective COX-2 inhibitors. Conclusions. Harpagophytum procumbens extract is an effective and safe agent for the treatment of musculoskeletal pain. For further study of this drug it is necessary to conduct larger studies of higher quality.
Sanders M., Grundmann O. The use of glucosamine, devil’s claw (Harpagophytum procumbens), and acupuncture as complementary and alternative treatments for osteoarthritis // Altern. Med. Rev. — 2011. — V. 16, № 3. — P. 228-238.
Kemper K.J. Devil’s Claw (Harpagophytum procumbens) // The Longwood Herbal Task Force and The Center for Holistic Pediatric Education and Research. — 1999.
Inhibition of TNF-alpha synthesis in LPS-stimulated primary human monocytes by Harpagophytum extract SteiHap 69 / Fiebich B.L., Heinrich M., Hiller K.O., Kammerer N. // Phytomedicine. — 2001. — V. 8, № 1. — P. 28-30.
Inhibitory effects of devil’s claw (secondary root of Harpagophytum procumbens) extract and harpagoside on cytokine production in mouse macrophages / Inaba K., Murata K., Naruto S., Matsuda H. // J. Nat. Med. — 2010. — 64, № 2. — P. 219-222.
Harpagophytum procumbens suppresses lipopolysaccharide-stimulated expressions of cyclooxygenase-2 and inducible nitric oxide synthase in fibroblast cell line L929 / Jang M.H., Lim S., Han S.M. et al. // J. Pharmacol. Sci. — 2003. — V. 93, № 3. — P. 367-371.
Downregulation of iNOS expression in rat mesangial cells by special extracts of Harpagophytum procumbens derives from harpagoside-dependent and independent effects / Kaszkin M., Beck K.F., Koch E. et al. // Phytomedicine. — 2004. — V. 11, № 7-8. — P. 585-595.
Harpagoside suppresses lipopolysaccharide-induced iNOS and COX-2 expression through inhibition of NF-kappa B activation / Huang T.H., Tran V.H., Duke R.K. et al. // J. Ethnopharmacol. — 2006. — V. 104, № 1–2. — P. 149-155.
Anauate M.C., Torres L.M., de Mello S.B. Effect of isolated fractions of Harpagophytum procumbens D.C. (devil’s claw) on COX-1, COX-2 activity and nitric oxide production on whole-blood assay / Phytother. Res. — 2010. — V. 24, № 9. — P. 1365-1369.
Schulze-Tanzil G., Hansen C., Shakibaei M. Effect of a Harpagophytum procumbens DC extract on matrix metalloproteinases in human chondrocytes in vitro // Arzneimittelforschung. — 2004. — V. 54, № 4. — P. 213-220.
Harpagophytum procumbens (Devil’s Claw) // Alternative Medicine Review. — 2008. — V. 13, № 3. — P. 248-252.
Analgesic effect of Harpagophytum procumbens on postoperative and neuropathic pain in rats / Lim D.W., Kim J.G., Han D., Kim Y.T. // Molecules. — 2014. — V. 19, № 1. — P. 1060-1068.
Anti-inflammatory and analgesic effects of an aqueous extract of Harpagophytum procumbens / Lanhers M.C., Fleurentin J., Mortier F. et al. // Planta Med. — 1992. — V. 58, № 2. — P. 117-123.
Beta-sitosterol exhibits anti-inﬂammatory activity in human aortic endothelial cells / Loizou S., Lekakis I., Chrousos G.P., Moutsatsou P. // Mol. Nutr. Food Res. — 2010. — V. 54. — P. 551-558.
Evaluation of the total peroxyl radical-scavenging capacity of flavonoids: structure-activity relationships / Dugas A.J. Jr., Castaneda A.J., Bonin G.C. et al. // J. Nat. Prod. — 2000. — V. 63. — P. 327-331.
Alkylperoxyl radical-scavenging activity of various flavonoids and other phenolic compounds: implications for the antitumorpromoter effect of vegetables / Sawa T., Nakao M., Akaike T. et al. // J. Agric. Food. Chem. — 1999. — V. 47. — P. 397-402.
Belaiche P. Etude clinique de 630 cas d’artrose traites par le nebulisat aqueux d’Harpagophytum procumbens (Radix) // Phytotherapy. — 1982. — V. 1. — P. 22-28.
Lecomte A., Costa J.P. Harpagophytum in osteoarthritis. Double-blind, placebo-controlled study // Le Magazine. — 1992. — V. 37. — P. 27-30.
Efficacy and tolerance of Harpagophytum procumbens versus diacerhein in treatment of osteoarthritis / Chantre P., Cappelaere A., Leblan D. et al. // Phytomedicine. — 2000. — V. 7, № 3. — P. 177-183.
Wegener T., Lüpke N.P. Treatment of patients with arthrosis of hip or knee with an aqueous extract of devil’s claw (Harpagophytum procumbens DC.) // Phytother. Res. — 2003. — V. 17, № 10. — P. 1165-1172.
Effectiveness of Harpagophytum procumbens in treatment of acute low back pain / Chrubasik S., Zimpfer C., Schütt U., Ziegler R. // Phytomedicine. — 1996. — V. 3, № 1. — P. 1-10.
Effectiveness of Harpagophytum extract WS 1531 in the treatment of exacerbation of low back pain: a randomized, placebo-controlled, double-blind study / Chrubasik S., Junck H., Breitschwerdt H. et al. // Eur. J. Anaesthesiol. — 1999. — V. 16, № 2. — P. 118-129.
A randomized double-blind pilot study comparing Doloteffin and Vioxx in the treatment of low back pain / Chrubasik S., Model A., Black A., Pollak S. // Rheumatology (Oxford). — 2003. — V. 42, № 1. — P. 141-148.
A 1-year follow-up after a pilot study with Doloteffin for low back pain / Chrubasik S., Künzel O., Thanner J. et al. // Phytomedicine. — 2005. — V. 12, № 1-2. — P. 1-9.
Effects of Harpagophytum procumbens LI 174 (devil’s claw) on sensory, motor und vascular muscle reagibility in the treatment of unspecific back pain / Göbel H., Heinze A., Ingwersen M. et al. // Schmerz. — 2001. — V. 15, № 1. — P. 10-18.
Ribbat J.M., Schakau D. Tratamiento de los dolores crónicos activos en el sistema de locomoción // Natura Med. — 2001. — V. 16, № 3. — P. 23-30.
Comparison of outcome measures during treatment with the proprietary Harpagophytum extract doloteffin in patients with pain in the lower back, knee or hip / Chrubasik S., Thanner J., Künzel O. et al. // Phytomedicine. — 2002. — V. 9, № 3. — P. 181-94.
Effectiveness and safety of Devil’s Claw tablets in patients with general rheumatic disorders / Warnock M., McBean D., Suter A. et al. // Phytother. Res. — 2007. — V. 21, № 12. — P. 1228-1233.
Chrubasik J.E., Roufogalis B.D., Chrubasik S. Evidence of effectiveness of herbal anti-inflammatory drugs in the treatment of painful osteoarthritis and chronic low back pain // Phytother. Res. — 2007. — V. 21. — P. 675-683.
Denner S.S. A review of the efficacy and safety of devil’s claw for pain associated with degenerative musculoskeletal diseases, rheumatoid, and osteoarthritis // Holist Nurs. Pract. — 2007. — V. 21. — P. 203-207.
A review of the biological and potential therapeutic actions of Harpagophytum procumbens / Grant L., McBean D.E., Fyfe L., Warnock A.M. // Phytother. Res. — 2007. — V. 21. — P. 199-209.
Vlachojannis J., Roufogalis B.D., Chrubasik S. Systematic review on the safety of Harpagophytum preparations for osteoarthritic and low back pain // Phytother. Res. — 2008. — V. 22. — P. 149-152.
Community herbal monograph on Harpagophytum procumbens DC and/or Harpagophytum zeyheri Decne, radix // European Medicines Agency. — 2008. — Doc. Ref.: EMEA/HMPC/251323/2006.
Harpagophytum radix // www.plantzafrica.com.
Copyright (c) 2020 PAIN, JOINTS, SPINE
This work is licensed under a Creative Commons Attribution 4.0 International License.
Our edition uses the copyright terms of Creative Commons for open access journals.
Authors, who are published in this journal, agree with the following terms:
- The authors retain rights for authorship of their article and grant to the edition the right of first publication of the article on a Creative Commons Attribution 4.0 International License, which allows others to freely distribute the published article, with the obligatory reference to the authors of original works and original publication in this journal.
- Directing the article for the publication to the editorial board (publisher), the author agrees with transmitting of rights for the protection and using the article, including parts of the article, which are protected by the copyrights, such as the author’s photo, pictures, charts, tables, etc., including the reproduction in the media and the Internet; for distributing; for the translation of the manuscript in all languages; for export and import of the publications copies of the writers’ article to spread, bringing to the general information.
- The rights mentioned above authors transfer to the edition (publisher) for the unlimited period of validity and on the territory of all countries of the world.
- The authors guarantee that they have exclusive rights for using of the article, which they have sent to the edition (publisher). The edition (the publisher) is not responsible for the violation of given guarantees by the authors to the third parties.
- The authors have the right to conclude separate supplement agreements that relate to non-exclusive distribution of their article in the form in which it had been published in the journal (for example, to upload the work to the online storage of the journal or publish it as part of a monograph), provided that the reference to the first publication of the work in this journal is included.
- The policy of the journal permits and encourages the publication of the article in the Internet (in institutional repository or on a personal website) by the authors, because it contributes to productive scientific discussion and a positive effect on efficiency and dynamics of the citation of the article.