By Jane Hart, MD

Ointment made from comfrey root extract may soothe lower and upper back pain caused by muscle strain according to a new study published in the British Journal of Sports Medicine. Comfrey products have certain safety issues, however, that must be considered.

Comfrey ointment eases back pain

Comfrey (Symphytum officinale L) root has been known for its anti-inflammatory properties and prior studies have suggested that the root may help relieve various joint and muscle pains.

In this study, 120 patients with acute muscle-related upper or lower back pain were randomly assigned to receive comfrey root extract (Kytta-Salbe) ointment or placebo ointment. For each participant 4 grams of ointment was applied to the treatment area three times a day at eight-hour intervals for five days. Participants were assessed for their levels of back pain before and after use of their assigned ointment.

Results showed that over the course of the trial pain intensity decreased by 95% in the comfrey group and by 37.8% in the placebo group. Adverse reactions occurred among 6.7% in the comfrey group and included eczema, nausea, and rhinitis. In the placebo group 5% experienced adverse reactions, such as headache and itching.

According to the study authors, “Comfrey root extract showed a remarkably potent and clinically relevant effect in reducing acute back pain. For the first time a fast-acting effect of the ointment (one hour) was also witnessed.” Further research is needed to understand the long-term risks and benefits of comfrey ointment in the treatment of muscle-related back pain and what amount and duration of use is safe.

Warnings

In 2001 the Food and Drug Administration (FDA) advised dietary supplement manufacturers to remove oral comfrey products from the market due to the fact that comfrey plants are a source of pyrrolizidine alkaloids, which when ingested, have been implicated in serious health problems such as liver toxicity. Evidence also suggests that these alkaloids may be toxic to other tissues and may have cancer-causing properties, according to the FDA. The Federal Trade Commission also issued a warning that comfrey products that contain pyrrolizidine alkaloids should not be taken internally, used as a suppository, or applied to broken skin or an open wound. While it has not been demonstrated that comfrey applied to healthy skin has similar effects the long-term effects are not entirely known, patients should consult a doctor before using comfrey products.

Dealing with muscle-related back pain

• See a specialist. The most important step is to see a doctor who can diagnose the cause of your back pain and recommend the proper treatments.

• Discuss the risks and benefits of complementary therapies. If you are interested in complementary therapies, always consult a knowledgeable doctor before using herbal products so you may weigh the risks and benefits and known safety issues.

• Consider an integrative approach. An integrative approach to muscle-related back pain may include conventional medications, complementary therapies, avoiding certain activities, and following a physician’s advice regarding rest, stretching, and exercise.

• Adjust your posture and activities. Ask your doctor to give you tips on proper posture and lifting and bending techniques to help avoid further back strain.

(Br J Sports Med 2009; 0:1–5. doi:10.1136/bjsm.2009.058677)

Jane Hart, MD, board-certified in internal medicine, serves in a variety of professional roles including consultant, journalist, and educator. Dr. Hart, a Clinical Instructor at Case Medical School in Cleveland, Ohio, writes extensively about health and wellness and a variety of other topics for nationally recognized organizations, Web sites, and print publications. Sought out for her expertise in the areas of integrative and preventive medicine, she is frequently quoted by national and local media. Dr. Hart is a professional lecturer for healthcare professionals, consumers, and youth and is a regular corporate speaker.

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