Healthnotes Newswire (January 4, 2001)—A traditional treatment for a variety of aches and pains that predates the invention of aspirin has largely been ignored in recent years due to a lack of clinical evidence supporting its ability to relieve pain. But a randomized, double-blind trial now shows that this ancient herbal remedy, willow bark, may be helpful for acute flare-ups of low back pain.¹

This four-week trial randomly assigned 210 men and women with chronic low back pain to take one of two doses of the willow bark extract or a placebo for low back pain flare-ups. The high-dose group took an extract providing 240 mg salicin each day, while the low-dose group took an extract providing 120 mg salicin each day.

Salicin is thought to be the main pain-relieving constituent in willow bark. In the body, it is converted to salicylic acid—the same major active compound into which aspirin is metabolized. The authors point out, however, that other compounds besides salicin, including flavonoids, may also contribute to the willow bark’s pain-relieving actions.

Those taking the willow extracts were much more likely to be free of pain by the end of the trial than were those taking placebo. People in the placebo group also resorted to taking the drug tramadol for additional pain relief significantly more often than did people in either willow bark extract group. When the two doses of willow bark were compared, the high-dose group had greater pain relief and used less additional pain medication than did the low-dose group. There were minimal side effects reported in those people taking willow bark extract.

This clinical trial lends support to the use of willow bark for acute flare-ups of low back pain. It also lends credibility to the practice of using willow bark to help relieve pain associated with osteoarthritis and other inflammatory conditions of joints, muscles, tendons, and ligaments.

The trial is in line with a recent clinical analysis of previous trials of a variety of herbal medicines, including willow bark, which have been shown to alleviate the pain of arthritis more effectively than placebo.² Two previous studies have shown willow bark extract to be specifically beneficial in people with osteoarthritis and rheumatism.^{3 4} A product containing willow in combination with the herbs guaiac, black cohosh, sarsaparilla, and poplar has been shown in a double-blind trial to help ease the pain of osteoarthritis.⁵ Long-term studies are needed to determine whether the effects of willow bark are best used for short-term pain relief or whether the effect is useful for long-term treatment of conditions such as osteoarthritis and low back pain.

Willow is less likely to cause harmful effects, such as stomach irritation and even ulcers, which are sometimes attributed to long-term use of aspirin. However, people choosing to use willow bark for pain should be aware that the herbal extract is slower to relieve pain than is aspirin.

Treatment of low back pain should not be limited to just taking pain-relieving herbs or medication. Management of low back pain is more likely to be successful with a multidisciplinary approach that may include chiropractic, physical therapy, and even psychotherapy.