Botanical Treatment Of Chronic Pelvic Pain: Anti-inflammatories

Dong Quai

Dong quai possesses antispasmodic, analgesic, anti-inflammatory antioxidant, uterine tonic, as well as specific immunomodulatory effects (see Plant Profiles). Immunostimulatory and anti-inflammatory effects have been attributed to isolated ferulic acid. It has been used traditionally in Chinese medicine for the treatment of “blood vacuity” and “blood stasis,” which may be considered related tochronic pelvic pain.

Evening Primrose Oil

It is thought that the use of evening primrose oil (evening primrose oil), with its high gamma linoleic acid content, may preferentially promote the synthesis of anti-inflammatory prostaglandin series over inflammatory prostaglandins. One critical review of the effects of evening primrose oil for the treatment of PMS concluded that there was no benefit. However, in a study of women (n = 40) who experienced symptoms of irritable bowel syndrome (IBS) just prior to and at the onset of menstruation, 53% reported an improvement in symptoms, whereas no improvement was seen in the placebo group. Improvement generally took 2 to 3 months to become apparent. Blood analysis at the beginning and end of treatment revealed significant improvement in fatty acid imbalances in the evening primrose oil-treated group.

Feverfew

Feverfew has exhibited inhibition of prostaglandin syn-thetase preventing the conversion of arachidonic acid to prostaglandins, inhibits mast cell degranulation and subsequent histamine and serotonin release, and has shown inhibition of other inflammatory cytokines such as TNF-a, IL-1, NFkB, and IFN-y, as well as inhibiting peritoneal cyclooxygenase in animal models. These effects suggest possible application of this herb to treat pain related to inflammation inchronic pelvic pain.

Ginger

Herbalists commonly use ginger root as an anti-inflammatory and antispasmodic herb for the treatment of pelvic pain and congestion, as an infusion, and also in hip baths and hot compresses over the affected area. No studies have been identified for its use for gynecologic complaints. Ginger remains popular among Western and traditional Chinese medicine herbalists as an antispasmodic treatment for dysmenorrhea; however, no clinical trials have been done to evaluate its efficacy. Ginger’s historical use for treatment of digestive disorders may be applicable for women with concurrent abdominal discomfort resulting from digestive complaints.

Licorice

Licorice root is commonly included in formulae when an anti-inflammatory herb is indicated. It may be considered an effective anti-inflammatory activity without many of the most troubling side effects seen for drugs used as COX-2 and 5-LO inhibitors. However, high doses of licorice may exacerbate hypertension (see Plant Profiles).

Peony and Rehmannia

Two herbs commonly used in traditional Chinese medicine formulae, peony and rehmannia, have demonstrated significant anti-inflammatory and antispasmodic activity. Studies using a traditional formula containing both herbs have demonstrated prostaglandin production inhibition in the uterine myometrium via phospholipase A2 inhibition, whereas other studies have demonstrated arachidonic acid inhibition, PAF inhibition, reduction in free radical formation, and smooth muscle relaxation. Note that nearly all of the studies use these herbs in traditional formulae rather than in isolation, and that studies are conducted in animal models, and have focused on arthritis, ulcers, and other chronic inflammatory conditions. Licorice is frequently included in traditional Chinese medicine formulae that also contain peony and Rehmannia, as is dong quai when these herbs are used for gynecologic conditions.