Homeopathic and Herbal Preparations of Arnica montana for Treatment of Musculoskeletal Injuries
April 1998; Volume 1: 42-44
By Vance Dietz, MD, MPH
Body aches and pains, whether from injury or overexertion, are some of the most common human afflictions. For their relief, the pharmaceutical industry produces vast numbers of ointments, sprays, and tablets. Whether motivated by concerns about drug side effects or simply a desire for something more "natural," many people are turning to numerous alternative medicines. One of the most common of these is derived from the herb Arnica montana.
History of Arnica
Arnica montana, also called Leopard's bane, fall-kraut, mountain tobacco, and sneezewort, is an herb that grows on mountain slopes in Europe, northern Asia, and Siberia as well as in the Americas. A perennial, the arnica plant has a bright yellow, daisy-like flower that blooms around July and has a slightly hairy stem. Arnica grows to about two feet in height.
The arnica plant is protected in parts of Europe. It is used in herbal ointments and oils as well as homeopathic preparations. Homeopathic arnica is a preparation that is widely used and recommended for the treatment of injuries. It is felt to be particularly useful for bruised tissues, as it is believed to alleviate pain and promote resorption of extravasated blood. It is also recommended prior to surgery to control blood loss.
Arnica has been widely used throughout Europe since the 16th century as a remedy for bruising and soft-tissue injury and as a general aid to recovery after shock. Goethe claimed that arnica saved his life after a serious fever. He described it as "a plant of rapid healing . . . If you suffer violence and injury, from fist, cudgel, or blade, wondrous healing is high in this herb . . . if the blood has lost its way in a bruise or an effusion, arnica will remind it of its proper courses."1 Swiss mountain climbers reportedly seek it out and chew it to relieve sore, tired muscles.
Mechanism of Action: Arnica
Arnica's mechanism of action is not completely understood. The herb arnica contains sesquiterpene lactones, flavonoids, and mucilage. Herbal arnica preparations are said to promote healing, resorption of blood, and to aid in blood coagulation. Although data on the sales of different preparations are not available, arnica is often prepared and used as a homeopathic preparation. Proponents state that it improves platelet function and decreases bleeding following injuries.
Theory and Mechanism: Homeopathy
Homeopathy is a self-healing method for treating the sick based on the "principle of similars" developed in the late 18th century. This principle ("let likes be cured by likes") states that the clinical signs and symptoms a substance causes in healthy volunteers can be cured by the same substance when those signs and symptoms arise spontaneously in sick persons.
Central to homeopathy is the use of Ultra High Succussed Dilutions (UHSDs). The manufacture of homeopathic medicines involves consecutive dilutions of substances in a water-and-alcohol mixture in repeated doses of 1:10 or 1:100, coupled with vigorous shaking to produce highly diluted preparations. For example, a substance from a plant is diluted in distilled water at one part to nine parts of water and then vigorously shaken. This process is repeated, each time diluting the original mixture. When the process is completed three times, the solution is said to have a potency of 3X. When the substance is diluted 1 to 99 and then repeated three times, the potency is said to be 3C. Homeopathic medication is prescribed in an individual manner (i.e., based upon the unique symptoms and signs of the individual).
The mechanism of action for homeopathic preparations has not been clearly established. Conflicting scientific studies have been published concerning the biologic activity of UHSDs. Clinical trials suggesting the efficacy of homeopathic treatment for several common illnesses have been published, as have trials suggesting its lack of effect.
Clinical Studies
Several references to double-blind, randomized, controlled trials were found in a literature search on the effectiveness of arnica in the treatment of bruising and acute injuries.
In a meta-analysis of homeopathic studies published in 1991 in the British Medical Journal, at least four studies were found that evaluated homeopathic arnica for the treatment of trauma or pain,2 but none were felt by the authors to represent a "good study" methodologically. A more recent meta-analysis, published in 1997 in The Lancet, reported that, of 89 articles that could be critically reviewed, 10 examined the effect of homeopathic arnica in the treatment of sprains (2), bruises (1), pain (3), hematomas (2), hemarthrosis (1), or preventing complications after surgery (1).3 Six suggested a positive clinical outcome with the use of arnica, one was neutral, and three showed a negative clinical outcome. Of the six studies that reportedly demonstrated a positive outcome, three were judged of good quality. Two of these evaluated the use of arnica cream in the treatment of sprains using patient self-assessment of improved joint movement.4,5 The third study evaluated the impact of arnica on hematomas using a pain scale.6
One study on subjective physical stiffness encountered during a marathon showed no difference between arnica and placebo in the blood parameters monitored (e.g., LD, CK) but found that the "feeling of stiffness" was more pronounced in the placebo group than the arnica group.7 Improvement over placebo was also noted when different preparations containing combinations of homeopathic medicines, some of which included arnica, were prescribed on an individual basis in a blinded, controlled study of the treatment of the pain associated with rheumatoid arthritis.8
However, other studies evaluating pain and blood loss in conditions not associated with musculoskeletal injuries have reported no improvement with arnica. Although said to increase absorption of extravasated blood, no benefit was observed when arnica was given to 40 patients within 24 hours of an acute cerebrovascular accident or a perfusion failure following a myocardial infarction.9 Another study concluded that arnica did not have any significant effect on bleeding time in healthy volunteers.10 Arnica was not shown to be better than placebo in relieving pain and swelling following dental surgery when compared with metronidazole and placebo11 or to placebo alone.12
Adverse Effects
In contrast to herbal preparations of arnica, no adverse effects to homeopathic preparations of arnica have been reported. No studies were found directly addressing administration with convention medication.
There have been rare reports in the literature of contact dermatitis in individuals who have handled the arnica plant or who have used the herbal preparations in the form of an ointment. The extent or risk of allergic dermatitis is not known. Arnica herbal preparations should not be taken internally because of the potential for gastrointestinal upset.
Drug Interaction
No drug interactions with homeopathic arnica have been reported.
Formulation
Arnica is generally prepared as an herbal tincture or cream from the roots or flower or as a homeopathic remedy. Many companies promote herbal arnica preparations. As a homeopathic medicine, it is often combined with other homeopathic medicines and sold as a remedy for injuries, muscle soreness, and shock.
Homeopathic arnica may not be self-administered.
Dosage
Herbal arnica ointments are often used 3-4 times a day.
Various homeopathic arnica preparations can be obtained in different potencies. Different doses and potencies of homeopathic arnica are recommended for different conditions, although lower potencies (i.e., less than 10 potency) are prescribed for injuries. For example, in an acute injury in an adult, four tablets or pillules (i.e, small tablet-like homeopathic preparations) of the 4-6 potency could be prescribed every four hours.
Conclusion
Medicinal preparations of Arnica montana have been used for centuries. When questioned by their patients about the use of arnica, clinicians could advise that accounts of clinical improvement with the use of arnica have been reported through the years (e.g., after dental surgery). Specifically, data suggest that homeopathic arnica preparations may be effective in the particular treatment of sprains, and, therefore, clinicians could recommend its use as an adjunctive therapy.
References
1. Pelikan W. Healing Plants: Insights through Spiritual Science. Spring Valley, NY: Mercury Press. 1997:258.
2. Kleijnen J, Knipschild P, ter Riet Gerben. Clinical trials of homeopathy. BMJ 1991;302:316-23.
3. Linde K, Clausius N, Ramirez G, et al. Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trials. Lancet 1997;350:834-843.
4. Bohmer D, Ambrus P. Behandlung von Sportverletzungen mit Traumeel-Salbe-Kontrollierte Doppelblindstudie. Bio Med 1992;21:260-68.
5. Zell J, Connert WD, Mau J, et al. Behandlung von akuten Sprunggelenksdistorsionen. Fortschr Med 1988;106:96-100.
6. Bourgois JC. Protection de capital veineux chez les perfusées au long cours dans la cancer du sein: Essai clinique en double aveugle. Université Paris Nord (thesis); 1984.
7. Tweiten D, Bruseth S, Borchgrevink CF, et al. Effect of arnica D30 during hard physical exertion. A double-blind randomized trial during the Oslo Marathon in 1990. Tidsske Nor Laegeforen 1991;111:3630-3631.
8. Gibson RG, Gibson SLM, MacNeill AD, et al.. Homeopathic therapy in rheumatoid arthritis: Evaluation by double-blind clinical therapeutic trial. Br J Clin Pharmac 1980;9:453-459.
9. Savage RH, Roe PF. A double blind trial to assess the benefit of Arnica montana in acute stroke illness. Br Hom J 1977;66:207-20.
10. Baillargeon L, Drouin J, Desjardins L, et al. The effects of Arnica montana on blood coagulation. Randomized controlled trial. Can Fam Physician 1994;40:225.
11. Caesar GS. Metronidazole and Arnica montana in the prevention of post-surgical complications, a comparative placebo controlled clinical trial. B J Oral Maxillofacial Surg 1984;22(1):42-49.
12. Lokken P, Straumsheim PA, Tveiten D, et al. Effect of homeopathy on pain and other events after acute trauma: Placebo controlled trial with bilateral oral surgery. BMJ 1995;310:1439-1442.
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