Herbal analgesics (Part 2)

A range of herbs available as oral supplements and topical preparations may be useful as analgesics (pain medications) in individuals with RA. It is important to note that herbal supplements are not a replacement for proven disease-modifying anti-rheumatic drugs (DMARDs), including both conventional DMARDs and newer biologics, which have been shown to slow or prevent the progression of joint damage in RA. Herbal supplements may be useful as adjunctive treatments (this means secondary treatments used in conjunction with a primary treatment).

As with any supplement, whether vitamins, minerals, herbal or chemical products, consult with your doctor before you start taking an herbal supplement. There may be health risks associated with use of any supplement, including interactions with medications that you are taking and negative effects associated with existing health conditions you may have. Your doctor is in the best position to determine the proper and safe dosage for any supplement.



The jelly-like interior of the aloe vera plant has been used topically for thousands of years to treat wounds and burns. It has immunomodulatory and anti-inflammatory effects. There is currently no scientific evidence that aloe is effective in relieving pain associated with arthritis (osteoarthritis and RA). However, it has been used historically for this purpose.1,2



Ginger (Zingiber officinale) preparations made from the roots and stems of the plant have played an important role in Eastern (e.g. Chinese, Indian, and Japanese) medicine for over 500 years. Ginger has potent antioxidant and anti-inflammatory properties. In terms of its anti-inflammatory properties, it blocks different biochemical pathways involved in chronic inflammation by inhibiting several genes that are involved in producing chemicals involved in the inflammatory response, including key cytokines and chemokines.3

Use of ginger as a treatment in RA has been evaluated in one study in which patients received 1 to 2 grams of powdered ginger daily. Patients reported benefits including pain relief and those patients who received higher doses of ginger (2 to 4 grams, taken by mistake) appeared to achieve more rapid and superior relief of pain. In other studies, daily supplements of ginger (50 mg/kg daily) resulted in improvement in clinical disease activity scores, joint swelling, and destruction of cartilage, as well as decreases in biomarkers of inflammation.3


St. John’s Wort

St. John’s Wort refers to any one of a number of species of plants in the genus Hypericum. It is a perennial herb originating in Europe that can now be found throughout the world. An extract of the herb is prepared using the leaves and flowers of the plant. Use of St. John’s Wort for medicinal purposes, specifically treatment of depression, spans more than 2,000 years. St. John’s Wort has also been used as an analgesic. There is limited scientific evidence for its use in relief of pain after surgery, menopausal and premenstrual pain, and nerve pain. Traditionally, St. John’s Wort has also been used for relief of joint pain and pain associated with rheumatic disorders.4

St. John’s Wort should be avoided in patients with suicidal ideation, in transplantation patients, and in patients with bleeding disorders. It should be used with caution in patients with diabetes, and mania or hypomania (bipolar disorder). Because it is metabolized in the liver by CYP 450 enzymes, St. John’s Wort can interact with many medications, resulting in changes in levels of these drugs, including anticonvulsants, warfarin, antidepressants, and oral contraceptives. If you are considering St. John’s Wort, you should talk to your doctor before taking it.4


Black mustard

Black mustard is one of several species in the genus Brassica. A natural antimicrobial, black mustard oil is used topically to promote healing and also has analgesic and antioxidant properties. Although black mustard has been used historically as a topical pain reliever, there is no scientific evidence to support its use in arthritis.5


Stinging nettle

Stinging nettle is a perennial plant found in Africa, Europe, and the Americas and was used medicinally by the ancient Greeks as early as the third century BC. Thin hairs covering stem and leaves cause burning or stinging on contact, giving the plant its name. There is some evidence that supports use of this plant as an analgesic for joint pain. Studies have shown that certain components of the stinging nettle have anti-inflammatory and immunomodulatory properties that may provide symptom relief in RA and other forms of arthritis. Currently, there is no scientific evidence supporting the use of stinging nettle extracts for relief of pain or other symptoms in RA. Stinging nettle extracts should be used with caution in patients with diabetes and bleeding disorders. It should also be used with caution in patients who are being treated with diuretics or anti-inflammatory drugs. Stinging nettle should be avoided during pregnancy or while nursing.1,6



Also known as marijuana or hemp, the subspecies Cannabis sativa is used as a recreational and medicinal drug. The active ingredients responsible for its psychoactive properties are tetrahydrocannabinol (THC) and cannabidiol (CBD). These compounds are available alone or in combination in the medicinal products dronabinol (Marinol), nabilone (Cesamet), and THC + CBD (Sativex), which have been tested in various formulations for the treatment of conditions including chronic pain, multiple sclerosis, and wasting syndrome associated with certain diseases such as HIV/AIDS or cancer. Cannabis has been shown to be effective in relief of chronic pain. However, there have been a limited number of studies of the THC + CBD combination Sativex to treat pain associated with RA. Results from these preliminary studies have been promising, showing reductions in pain on movement, level of morning pain, and improved sleep.7

Go back to Part 1.

Written by: Jonathan Simmons | Last reviewed: September 2013.
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