Chronic pain is a serious issue affecting individual families and public health as a whole. Millions of people live with chronic pain and effective interventions that are truly safe and free of undesirable side-effects are scarce. According to the 2016 National Pain Strategy from the National Institutes of Health, nearly 20 percent of U.S. adults experience chronic pain and 8 percent have high-impact chronic pain that limits major life activity. The financial burden of chronic pain was estimated near $560 billion annually in direct medical costs, lost productivity, and disability programs since chronic pain is linked to restricted mobility, opioid dependency, anxiety, depression, and reduced quality of life.

But chronic pain does not have to be a life sentence, nor opioid dependency the only alternative. There are several select herbs with powerful biological activities that target the pain pathways in a safe and effective manner without creating dependency.

White Willow Bark (Salix species)

Willow bark has been used for centuries as an anti-inflammatory, antipyretic, and analgesic. Its biologically active component is familiar to most of us in the form of aspirin. Willow bark contains approximately 1.5 to 12 percent salicin glycosides and esters that are precursors to the therapeutic component, salicylic acid. It is generally standardized according to its salicin concentration; however, willow bark also contains other salicylates, polyphenols (tannins), and flavonoids that contribute to its therapeutic value. In vitro and animal studies have shown its pharmacological actions include downregulating inflammatory mediators such as tumor necrosis factor-α (TNFα) and nuclear factor-kappa B, as well as inhibiting the protein expression of TNFα, cyclooxygenase 2 (COX-2), nitric oxide release, and inducing apoptosis of pro-inflammatory activated monocytes. Compared to aspirin and other NSAIDs, willow bark has fewer adverse effects but it may still be contraindicated in individuals allergic to salicylates.

Frankincense (Boswellia species)

Frankincense is another ancient botanical, used for centuries as an analgesic as well as an anti-inflammatory, anti-bacterial, and anxiolytic. The therapeutic potential of frankincense is found in the resins, which make up 60 to 85 percent of the plant’s biologically active compounds and contain the powerful boswellic acids (the standardization criteria). Boswellic acids inhibit pro-inflammatory enzymes including 5-lipoxygenase (5-LO), preventing the release of leukotrienes which play major roles in common inflammatory conditions such as arthritis, bronchial asthma, chronic colitis, ulcerative colitis, Crohn’s disease, and cancer. A randomized, double-blind, placebo-controlled crossover study of 12 healthy subjects assessed 250 mg of Boswellia serrata for influencing pain threshold and tolerance using a mechanical pain model. The mean percentage change in the force and time of pain threshold and tolerance increased significantly in the group receiving Boswellia serrata, demonstrating a direct analgesic effect of frankincense.

Ginger (Zingiber officinale)

Ginger is a powerful analgesic whose efficacy has been compared to that of ibuprofen. In a randomized, double-blind clinical trial using a dental pain model, 60 healthy adults were given ibuprofen, ginger, or placebo and evaluated for inflammation by measuring cheek swelling, mouth opening ability, serum C-reactive protein (CRP), and visual analog scale (for pain scoring). The study showed ginger to be as effective as ibuprofen in reducing cheek swelling, CRP levels, and pain scores. In another randomized, controlled trial evaluating 500mg of ginger or placebo to control pain in 120 females with severe primary dysmenorrhea, compared to placebo, ginger resulted in significant improvement in the severity and duration of pain.

Like willow bark and frankincense, the primary action by which ginger reduces pain is through modulating inflammatory pathways. The primary anti-inflammatory components of ginger are gingerol and zingerone, which inhibit leukotriene and prostaglandin synthesis as well as NF-κB. It is also worth noting that ginger is a member of the Zingiberaceae family, which also includes turmeric, another herb with powerful analgesic and anti-inflammatory actions. 

White willow bark, frankincense, and ginger are only a few of the many powerful herbs with analgesic effects. Traditional opioids, with their strong potential for dependency, do not have to be the sole answer for chronic pain. With far fewer adverse effects and no risk of dependency, herbals offer an alternative solution for those who would like to try a different approach.