By Paul Bubny

For the typical consumer with a headache, the solution is obvious: Reach for a bottle of aspirin or acetaminophen and wait for it to take effect. Those with more chronic pain might turn to prescription drugs. Less familiar to the general public are the options available at the health food store, although many such products exist.

This lack of awareness holds true even after the highly negative publicity suffered by some formerly prominent NSAIDs (non-steroidal anti-inflammatory drugs—or, as lecturer Michael Murray, N.D., has quipped, “New Sorts of Aspirin in Disguise”). “Because of FDA [Food and Drug Administration] and [Federal Trade Commission] restrictive regulations, consumers are not very aware that there are natural pain relief alternatives available,” said Robert Hunt, president of RZN Nutraceuticals (Miami).

However, Hunt continued, “The restrictions are only part of the problem. A major part of the problem is that consumers have tried using glucosamine and chondroitin products to stop arthritis pain, or products like feverfew and butterbur for migraine headache pain, without much noticeable success.

“Call us funny, but when it comes to migraine pain, RZN believes that the consumer wants immediate relief,” he added. “They don’t want to wait six months to see if they get less of a headache.”

A potential disconnect between consumers’ expectations of drug-like speed and the actual timetable followed by natural pain relief products is a hurdle that manufacturers agreed needs to be overcome with education. “The public is not well informed; they could definitely be better educated in terms of what products do—specifically, what a product is used for,” said David Kulow, president of All Terrain. “This would include pain relief, helping in bruising, etc.” The Sunapee, NH company manufactures what it calls “natural remedies for outdoor enthusiasts”—i.e. products to address the bruises, scrapes, and strains that can be incurred amid outdoor play.

Along with matching up the remedy to its potential use, the consumer needs to understand the difference between the mechanism of action for conventional analgesics and that of their health food store counterparts. “Conventional analgesics—salicylates, acetaminophen, naproxen—work by interfering with the physiological reaction in the body that interprets pain,” said Jay Borneman, president of Los Angeles-based homeopathic manufacturer Hyland’s Inc./Standard Homepathic “The reaction could be either in the brain or it could be peripheral. Either way, these work not by removal of pain, but by removal of the message of pain. Homeopathic remedies work by stimulating the body to remove pain.”

Mark Lubin, CEO and chief scientist at RZN, pointed out, “The reduction of pain, swelling, and inflammation are closely tied together. Virtually every one of the chemicals produced by the body as part of the acute reaction to injury or disease is water-soluble and travels around via the blood plasma and gets through the tissues via cellular fluid. Reduction of pain is accomplished by reducing the number and intensity of pain signals traveling to the brain through nerves and reducing the concentration of substances which promote and/or increase those signals, i.e. the sensitivity of the pain receptor nerve endings.”

The Cause, Not the Effect

Getting to the heart of the matter—that is, addressing the underlying cause of pain rather than simply masking it—is a common element among natural products for pain relief. “Wobenzym is proven to actively regulate the body’s own healing processes (immune system) to normalize the inflammatory response,” said Julia Berg, public relations specialist at Phoenix-based Naturally Vitamins. She said the product “does not inhibit cellular pathways like many pharmaceutical painkillers. Instead, it facilitates the body’s natural healing processes to speed recovery by clearing cellular debris from the injury site and bloodstream while regulating cellular messengers involved in the inflammatory response.”

Lubin broke the discussion down further, enumerating the pain-relieving effects of the individual components in the company’s Arthri-Zen Relief, such as juniper. "Prostaglandins are one of the substances naturally produced as part of the inflammation reaction. One of the most aggressive of all prostaglandins is prostacyclin, which also has the side effect of hyper-sensitizing pain nerves,” he said. “One group of compounds in Juniper reduces production of prostacyclin synthetase, the enzyme needed to produce prostacyclin, thereby reducing the production of prostacyclin itself. Thus, by reducing prostacyclin levels in the tissues, pain receptors are desensitized.

“A similar group of compounds reduces the production of platelet activation factor (PAF) and various Interleukin compounds (IL 1-12), both of which also hyper-activate the pain nerve endings where the signals are generated,” he continued.

Lubin went on to discuss several other effects of juniper, concluding, “What this all means is that we have lowered, or even stopped, overproduction of certain inflammatory and irritating compounds that hyperactivate the pain signal nerve endings, thus essentially desensitizing them, we have lowered the transmission volume of the pain signals to the brain, we have closed off the source of the continued swelling (edema), and we have increased kidney action to get rid of the excess fluids already on site that contain these irritating chemical compounds.” Other botanicals used in the formula—including willow, meadowsweet, and dandelion—provide comparable and complementary effects, Lubin said.

Deriving not from flora but from fauna, emu oil has a kind of built-in delivery system, according to Natures Benefit (Newark, NJ), which markets Silver Emu and Blue Emu products. The oil includes “a very special series of constituents which are fatty substances that have been used as a clever but natural way of penetrating the skin,” according to the company. “Emu oil is believed to be particularly soothing under a number of circumstances. The oil can act as a carrier agent to help penetrate the skin barrier.

“Researchers in Australia have looked at the potential benefits of emu oil in a number of circumstances including bone and joint disorders and skin ailments,” the company stated. “The health benefits of emu oil are most apparent when the oil is applied to the skin. The value of emu oil is as a basis to produce topical rubs that can assist in managing bone and joint problems and/or pain.”

Along similar lines of multifaceted remedies, noni (Morinda citrifolia) includes a couple of key components that reportedly work together to relieve pain and get at the underlying cause. In his book The Noni Phenomenon (Direct Source Publishing), Neil Solomon, M.D., Ph.D., discussed the noni component scopoletin, which has been shown in laboratory testing to have analgesic properties and which can work hand in hand with another noni component, an alkaloid known as xeronine that strengthens the bonds of the peptides that are the building blocks of cell walls’ protein layers.

In this capacity, noni can be used both internally (to treat sore gums and abdominal pains) and externally (for backache and muscle soreness). To facilitate external use while overcoming one of the chief knocks against noni—its strong and not very sociable smell—Hawaiian Health Ohana (Anahola, HI) last year introduced Lavender Noni Lotion, adding lavender for a more pleasant odor to a base of 99 percent noni fruit leather. Company cofounder Steve Frailey said application of the lotion not only reduces or even eliminates muscle pain within 30 minutes, but also energizes the muscles. The addition of lavender was made at the request of members of a local college football team, who appreciated the lotion’s analgesic effects but also wanted to be able to go out on dates afterwards.

A more recently developed addition to the health food store’s inventory of pain relief options—noni has been used traditionally for centuries, after all—is the joint health ingredient Celadrin, marketed by Proprietary Nutritionals, Inc. (PNI, Brantford, Ontario, Canada) and offered in a number of branded products. “Celadrin is medically and clinically proven to alleviate pain, and was developed through a proprietary process of esterifying fatty acids, so they become stable and do not react with oxygen,” according to the company. “Both humans and animals have shown extensive reduction in pain and swelling and increased range of motion with Celadrin, with no reported side effects.

“Research has shown that the special fatty acids in Celadrin inhibit inflammation in endothelial cells (the thin cells that line the inside of various body cavities) and decrease the pro-inflammatory effects of arachidonic and other fatty acids. Celadrin has also been shown to reduce the production of the negative immune factor IL-6 and to control the immune factors responsible for inflammation. In addition, Celadrin may help to lubricate an affected joint, resulting in pain relief and increased mobility.”

Uncramping Their Style

Just as joint mobility becomes more of an issue as the consumer ages, so too do leg cramps. These tend to occur as the byproduct of heavy exercise after periods of inactivity, and Hyland’s research indicated that 25 percent of all Americans experience such cramps on a recurring basis.

With the aging of the baby boom generation—the oldest of whom are now turning 60—and their consequent refusal to slow down, sales of homeopathic products to relieve cramps and related aches and pains have risen dramatically in the past five years, Borneman said. “The reality is that we’re not going to be less active,” he said—speaking as a baby boomer himself. “After you’ve beaten yourself up at the gym, it’s time for arnica, baby, that’s it!”

The company’s Arnica Montana 3X HPUS (quinine) cream, “for leg pain that starts low and moves up [the] leg,” is only one of eight homeopathic formulas in the Hyland’s Leg Cramps with Quinine line. Some of the others include Cinchona Officinalis 3X HPUS, “for pain in the limbs and joints, worse with slight touch but relieved with hard pressure;” Viscum Album 3X HPUS, “for pains in knees and ankles, shooting pains, worse in bed;” Gnaphalium Polycephalum 3X HPUS, “for cramps in calves of legs and feet when in bed;” and Magnesia Phosphorica 6X HPUS, “for cramps in calves, sciatica, feet very tender, fingertips stiff and numb.”

“In homeopathy, the intent is to match the substance with the symptoms,” Borneman said. “The allopathic approach is ‘pain is pain is pain.’ ”

Nothing On The Side

Besides efficacy, the Hyland’s Leg Cramps with Quinine line—in common with other pain relief products from Hyland’s and other homeopathic manufacturers—claims to offer freedom from the side effects and contraindications that may accompany the use of NSAIDs. The most dramatic of the possible side effects, of course, is the apparent risk for heart attack, which in late 2004 led pharmaceutical giant Merck to withdraw its arthritis drug Vioxx from the market and Pfizer to stop advertising its competing drug Celebrex.

The first of many lawsuits against NSAID manufacturers ended with a Texas jury last August awarding a Texas widow more than $250 million over what the jury concluded was a Vioxx-induced heart attack that led to her husband’s death. Merck, which maintained that the man suffered from clogged arteries and that this was the actual cause of death, said it would appeal.

Last April, FDA ordered a change in the labeling for all NSAIDs to include a warning to highlight “the potential increased risk of [cardiovascular] events, and the well-known risk of serious, and potentially life-threatening, stomach bleeding.” The agency also ordered a revision on the package insert for all NSAIDs to include a warning that patients who have just had heart surgery should not use them. In a consumer advisory, FDA also cited other serious risks of using NSAIDs, including damage to the liver or kidneys and fluid retention.

“In addition to their negative side effects in the stomach and intestinal tract, NSAIDs may actually accelerate the progression of joint destruction,” according to PNI.

For purposes of these warnings, NSAIDs are not limited to prescription drugs such as Vioxx and Celebrex. They also include ibuprofen, naproxen, diclofenac, and ketoprofen, among others—many of which are available over the counter (OTC). Their side effects may be exacerbated by interaction with other medications, both prescription and OTC, ranging from aspirin to warfarin. Information about these side effects and contraindications can be found in any pharmaceutical reference guide, whether in print or online, and passed along to your store’s customers.

In spite of these potential risks, manufacturers said that NSAIDs do have their place in terms of providing immediate relief. “Where you run into trouble is habitual dependence” on acetaminophen and comparable OTC products, Borneman said. “They’re finding now that even teenagers are having liver problems.”

Commented RZN’s Hunt, “That is one of the biggest problems with many drugs—they take care of one problem but create adverse side effects that most often have to be medicated with entirely other drugs or they create an ‘acceptable’ level of tissue damage in other organ systems.”

Having called the safety of NSAIDs into question, where do the health food store’s alternatives rate in terms of research into their own safety as well as efficacy? “All the herbs used in RZN products, and herbs in general, have been used by mankind since before the dawn of recorded history for their curative and treatment properties,” said Hunt. “Over the 5,000 years that the herbs used in Arthri-Zen Relief and Migra-Zen Relief Plus have documentably been used in various herbal medicine cultures, no adverse side effects resulting from moderate and intelligent usage have made themselves known. If any of them had, then it makes sense that the offending herb would have lost its popularity. And yet these herbs are still popular and in use around the world. Surely, so many peoples displaced from each other by time and geography would not have arrived at and kept the same solution to the same symptoms if the answer held no validity or was dangerous.”

Naturally Vitamins’ Berg cited more than 165 clinical trials validating the safety and efficacy of the Wobenzym formula, “making it one of the most researched nutritional formulas available. Unlike many formulas that use clinical studies on one or two ingredients as proof of efficacy, the Wobenzym clinical trials investigate the entire formula to ensure that the components work synergistically. Hundreds of additional studies support Wobenzym sister formulas, which are available in Germany by prescription.”

Berg and others mentioned promotional and educational materials their companies make available, ranging from floor and counter displays to brochures and third-party literature. Borneman urged retailers to make full use of the opportunity to educate their customers one-on-one about pain relief products, adding, “As in any category, it’s what separates the health food store from the Wal-Mart.” VR