Weronika Krasocka, Anna Marchelak, Anna Magiera

 

Phytotherapy for pain and/or inflammation associated with the musculoskeletal system according to the recommendations of the European Medicines Agency

 

2025-07-23

Object of review. Musculoskeletal pain, defined as pain affecting various structures of the musculoskeletal system, such as bones, joints, ligaments, muscles, and tendons, is considered a significant medical and socioeconomic problem. The pathophysiology of musculoskeletal pain is complex and includes, among others, inflammatory processes. The most common inflammatory diseases of the musculoskeletal system include osteoarthritis and rheumatoid arthritis. Conventional therapy, including the use of drugs from various groups, such as paracetamol, nonsteroidal anti-inflammatory drugs, opioids, and glucocorticosteroids, is burdened with the risk of many adverse effects. Plant substances/preparations are characterized by a much more favorable safety profile than synthetic drugs, and thanks to their multidirectional action, including the ability to inhibit inflammation and relieve pain, they can be used as supplements to conventional treatment or as a form of therapy in the case of mild to moderate symptoms. A review of the European Union herbal monographs showed that 16 herbal substances/products are recommended by the European Medicines Agency (EMA) for the treatment of pain and/or inflammation associated with the musculoskeletal system.

Goal of the review. Presentation of information on herbal substances/preparations, recommended by EMA for the treatment of pain and/or inflammation associated with the musculoskeletal system, which are components of medicinal products available on the Polish market. To introduce the subject, the pathophysiology of musculoskeletal diseases and currently used conventional therapies were discussed. In addition, information on the process of preparing EU herbal monographs was presented.

Material and methods. The literature was collected using EU herbal monographs and the following databases: Cochrane Library, PubMed, ScienceDirect, Scopus, Web of Science, and Google Scholar. 44 scientific publications, 9 monographs of herbal substances/preparations, 6 websites, and 1 book were used.

Results and conclusions. The paper provides a detailed description of 9 herbal substances/preparations, the indications for use of which, according to EU herbal monographs, include the relief of pain and/or inflammation associated with the musculoskeletal system that are found on the Polish market in preparations with the status of a medicinal product. Information on the sources of acquisition, taxonomy, botanical features, phytochemical profile and molecular mechanisms of action are included. The results of clinical trials and meta-analyses/systematic reviews (if available) are described, and data on the safety profile are presented. In addition, the characteristics of preparations and pharmaceutical forms listed by the EMA are provided, and a summary of medicinal products present on the Polish market is made. The efficacy and safety of herbal substances such as willow bark and capsicum, respectively, in the short-term treatment of lower back pain and muscle pain relief, have been confirmed in clinical and preclinical studies. The remaining herbal substances/preparations described in this article have a documented tradition of over 30 years, including at least 15 years in the EU, of use in relieving pain associated with the musculoskeletal system. Studies show that various compounds/groups of natural compounds can determine the analgesic and anti-inflammatory activity of herbal substances/preparations, and the mechanism of action is associated with, among other things, the inhibition of inflammatory processes. Compared to synthetic drugs, herbal substances/preparations have a more favorable safety profile.

Keywords: pain, inflammation, musculoskeletal system, phytotherapy, EU herbal monograph.

© Farm Pol, 2024, 80(12): 851–870