Sherry Haynes is currently pursuing a PharmD degree and has experience in both the clinical and management sides of pharmacy.
Treating Unspecified Lower Back Pain
Unspecified lower back pain is among the top five healthcare visits. While most back pain can result from overwork or an injury, it is sometimes caused by inactivity, a muscle pull, or inflammation. Treatment is difficult to get because less than 15% of patients experiencing lower back pain are diagnosed with a known cause. In such a scenario, treatment focuses on symptom reduction rather than targeting the cause.
NSAIDs are the majorly prescribed therapies for the relief of inflammation accompanying non-specific chronic lower back pain in patients. These include naproxen and COX-2 inhibitors, known as coxibs. Because of the gastrointestinal and cardiovascular risks associated with the long-term use of these meds, their use has been narrowed. A large proportion of people with chronic lower back pain use complementary and alternative medicines (CAM) and visit CAM practitioners.
Many herbs have anti-inflammatory properties, which make them effective back pain remedies. All of these herbal remedies offer plausible alternative therapies to NSAIDs and coxibs. Some of these remedies may be used along with regular prescription medicines after making sure that the herbs do not interact with the prescribed modern meds.
Oral Herbal Remedies for Back Ache
1. Devil's Claw (Harpagophytum procumbens)
Use: The plant has a wide reputation for the treatment of rheumatic disease. Animal studies indicate that the iridoid constituents of the plant (e.g.. harpagoside) are involved in anti-inflammatory and anti-analgesic properties. Several reviews looking at the treatment for low back pain concluded that there is strong evidence for short-term improvements in pain and reduction in rescue medication. A standard dose of 50–100 mg of harpagoside daily is recommended.
Evidence: A six-week double-blind study of 88 subjects comparing devil's claw to rofecoxib found equal improvements in both groups. A follow-up of these subjects for one year found that it was well tolerated and that improvements were sustained. 
In another study that compared the use of Harpagophytum extract with conventional therapy for unspecific lower back pain found both the therapies to be equally effective. 
- Avoid if you take diabetes medications or blood-thinning medications.
- Avoid if you have gallstones or heart problems.
British herbal pharmacopoeia 1996.
Commercially available as:
- Rivoltan Devil's Claw 480 mg capsules
- Biokoma Devil's Claw Root Dried Cut 100 g pouch. You will need to take approximately 50–100 mg per day of the dried root and prepare it as per the instructions on the package.
2. White willow bark (Salix alba)
Use: White willow bark is famous as the source of salicylic acid, the natural precursor of aspirin. Daily doses of Salix alba, standardized to 120 mg or 240 mg salicin may be used for short-term improvements in pain and rescue medication.
Commission E, the expert panel that evaluates herbal medicines for the German counterpart of the FDA, approves white willow bark for the treatment of fever, headache, muscles and joint pain.
In a study including nearly 200 people with low back pain, those who received white willow bark experienced a significant reduction in pain compared to the placebo group. Among these subjects, those who received higher doses (240 mg) had more relief than those who received lower doses (120 mg). 
- Avoid in children under age 16. This precaution is recommended because of its aspirin-like action.
- Avoid if you have ulcers or gastritis.
- Aspirin triggers asthma attacks in some people. If you are sensitive to aspirin, do not use white willow bark.
- Avoid if you use blood-thinning medications.
BP/EP, BHP, ESCOP, Complete German Commission E
- Available as dried cut root from Biokoma in 100 g package.
- Available as White Willow Capsules 500 mg Organic White Willow (Salix Alba) Dried Bark
NOTE: These herbs are potentially unsafe if taken by mouth.
3. Capsaicin (Capsicum frutescens: Cayenne)
Use: Pureed capsicum can be applied topically for effective relief of back pain. It contains capsaicin, which helps to numb the affected area. Technically speaking, capsaicin induces the release of substance P, a neurotransmitter from sensory fibres. It also blocks the transport and synthesis of substance P. Repeated application of capsaicin brings about a long-lasting numbing effect. Its use is suitable for the treatment of neuropathic pain or musculoskeletal disorders, with or without inflammatory components.
Evidence: Capsicum or Cayenne was tested in several forms: plaster, homeopathic gel, cream and ointment. A study by Stam et. al. included 161 patients randomly allocated to two different capsicum gels, Spiroflor SLR and Capsici oleoresin gel for 7 days. Both groups showed a significant reduction in pain. 
Precautions: Creams, gels and other preparations are meant for external use only.
- Rugby Capsaicin 0.025% Cream.
- Any other preparation with concentration of 0.025 to 0.075 should be appropriate.
4. Symphytum officinale (Comfrey)
Use: Comfrey root as a herbal ingredient has anti-inflammatory properties.
Evidence: One trial with 120 participants examining comfrey root extract found that a Kytta-Salbe comfrey extract ointment is better than placebo ointment for short-term improvements in pain as assessed by visual analogue scale. However, The quality of evidence is low. 
- Do not apply Comfrey on broken or damaged skin.
- Don't use comfrey if you have any liver disease.
Available as a herbal oil.
5. Solidago chilensis (Brazilian Arnica)
Use: Arnica has astringent properties; tinctures and infusions of the dried flower-heads and rhizomes have been long used as a domestic remedy for the treatment of sprains and bruises.
A trial with 20 participants (very low evidence) found a reduction in perception of pain and improved flexibility with the application of a gel containing Brazilian arnica for twice daily as compared to placebo gel. 
- The use of arnica is subject to restrictions in some countries.
- Should not be applied on broken skin and treatment be discontinued should dermatitis develop.
6. Ginger: Peppermint Salve
Use: Ginger has been used as traditional medicine as an anti-inflammatory agent for musculoskeletal diseases in China for ages. Gingerol, capsaicin, caffeic acid and salicylate are found components in Ginger. Ginger inhibits cyclooxygenase and lipooxygenase to prevent leukotriene production.
Dried peppermint contains 0.3%–0.4% of volatile oil which constitutes menthol about 7%–48%, menthone 20%–46%, and menthyl acetate about 3%–10%.
Anne Kennedy in her book Herbal Medicines- Natural Remedies teaches the preparation of a Ginger-Peppermint Salve.
In a slow cooker, add olive oil about 1 cup, ginger root chopped 1 ounce, and dried and crushed peppermint 1 ounce. Cover the cooker and allow the herbs to steep in at the lowest heat settings for about three to five hours. Bring an inch of water to a simmer in the vase of a double boiler. Reduce the heat to low.
Drape a piece of cheesecloth over the upper half of the double boiler. Pour in the infused oil, then wring and twist the cheesecloth until no more oil comes out. Discard the cloth and left herbs.
You are now left with the infused oil. Add beeswax to it and place the double boiler on the base. Let it warm over low heat. When the beeswax melts completely, remove the pan from the heat. Pour the mixture in a clean jar and allow it to cool. Cap the jar after it gets to room temperature.
Apply one teaspoon of the salve on the affected area and massage it gently. Repeat it for up to four times a day.
Precautions: Avoid if you take blood thinners, have gallbladder pain, diabetes, heart disease or have a bleeding disorder.
7. Combination of Wintergreen Oil and Peppermint Oil
Use: A combination of wintergreen oil and peppermint oil is commonly used and found in many commercially available herbal medicines as it is believed that the use of this combination is far better than either alone.
There are no published studies that tested the effectiveness of this combination.
Precautions: No safety issues so far with wintergreen oil of high quality.
8. Lavender oil
Use: Lavender essential oil applied by acupressure may reduce pain and improve spine flexibility.
Evidence: In a trial to investigate the effect of combining acupressure with lavender essential oil for lower back pain of subacute and chronic type, participants who received a three-week course of eight sessions of manual acupressure showed a significant reduction in pain intensity and improvement of functional performance.
The study result supports the acupressure-type massage with lavender oil may help improve back pain. However, this study did not include a group that used acupressure without lavender oil, so it is difficult to say that the results came from the application of lavender oil. However, researchers suggest the use of lavender oil acupressure therapy along with mainstream medical treatment, as add-on therapy in reducing lower back pain in the short term. 
Monographs: Brazilian Herbal Pharmacopoeia.
Herbal remedies for most of the ailments exist and have been in use by people who do not like to use modern medicines for every ache they feel. The herbs I have mentioned in the article have been shown to be effective to various levels of evidence. However, the relative effectiveness of these herbs is yet to be tested. Additionally, there is no evidence of long-term safety and efficacy with the use of these drugs. Most of the trials used the herbs for three to four weeks. Long-term use for months and years is thus not recommended.
Note: The "monograph mentions" only indicate the mention of the particular herb in those monographs. It does not imply that the herb has been specifically indicated for lower back pain.
1. Chrubasik S, Model A, Black A, Pollak S. A randomized double-blind pilot study comparing Doloteffin and Vioxx® in the treatment of low back pain. (2003). Rheumatology. 42 (1):141–8.
2. Schmidt A, Berghof U, Schmidt E. Effectiveness of harpagophytum procumbens in treatment of unspecific low back pain.(2005) Physikalische Medizin Rehabilitationsmedikin Kurortmedizin.15(5):317–21.
3. Chrubasik S, Eisenburg E, Balan E, et al. Treatment of low back pain exacerbations with willow bark extract: a randomized double blind study. (2000). Am J Med.109:9-14.
4. Stam C, Bonnet MS, van Haselen RA. The efficacy and safety of a homeopathic gel in the treatment of acute low back pain: a multi-centre, randomised, double-blind comparative clinical trial. (2001) British Homeopathic Journal. 90(1):21–8.
5. Rannou F. Is Symphytum officinale (comfrey) root extract ointment useful in the treatment of back pain. (2010). Focus Altern Complement Ther. 15:119–20.
6. da Silva AG, de Sousa CPG, Koehler J, Fontana J, Christo AG, Guedes-Bruni RR. Evaluation of an extract of Brazilian Arnica (Solidago chilensis Meyen, Asteraceae) in treating lumbago. (2010). Phytotherapy Research. 24(2):283–7.
7. Yip Y.B. ,Tse S.H.M. The effectiveness of relaxation acupoint stimulation and acupressure with aromatic lavender essential oil for non-specific low back pain in Hong Kong: a randomised controlled trial. (2004). Complementary Therapies in Medicine. 12(1):28–37.
This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
© 2019 Sherry Haynes
BRENDA ARLEDGE from Washington Court House on January 31, 2020:
This is a wonderful article.
Many people would rather do something a little bit different than taking medications.
You have some great ideas, many of which I do occasionally try to use.
I also use a combination of heat and ice then put on a lidocaine patch. You can buy patches over the counter but each one is different. Some stick better than others.
Liz Westwood from UK on December 04, 2019:
As an occasional back pain sufferer I have read your article with interest. Usually I treat it with strong painkilers and exercises. You have given me some interesting alternative options.