The following is a summary of the authors’ conclusions based on available study data:

Harpagophytum procumbens (devil’s claw)

  • Harpagoside 50mg or 100mg per day, from an aqueous extract of H. procumbens, may be better than placebo for short-term improvements in pain and may reduce rescue medication use (ie, tramadol) in chronic LBP (low quality evidence)
  • Harpagoside 60mg/day, from an aqueous extract of H. procumbens, showed relative equivalence to rofecoxib 12.5mg/day in chronic LBP (very low quality evidence)

Salix alba (white willow bark)


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  • Salicin 120mg or 240mg per day, from an extract of S. alba, is probably better than placebo for short-term improvements in pain and rescue medication use (ie, tramadol) in chronic LBP (moderate quality evidence)
  • Salicin 240mg/day, from an extract of S. alba, showed relative equivalence to rofecoxib 12.5mg/day in chronic LBP (very low quality evidence)
  • S. alba, a platelet inhibitor, minimally affected platelet thrombosis vs. a cardioprotective dose of acetylsalicylate

Capsicum frutescens (cayenne)

  • Capsicum cream reduces pain and improves function compared to placebo in chonic LBP (moderate quality evidence)
  • Capsicum cream may possibly reduce pain more than placebo in acute LBP (very low quality evidence)
  • Capsicum plaster reduces pain and improves function compared to placebo in chronic LBP (moderate quality evidence)
  • Capsici Oleoresin gel showed relative equivalence to Spiroflor SLR homeopathic gel in acute and chronic LBP (very low quality evidence)