Herbal remedies for neuropathic pain in Traditional Persian Medicine

Nerve-originated Pain was a known concept in traditional Persian medicine (TPM) [1]. Different therapeutic strategies were used for management of nerve-originated pain in TPM. The goal of this study was to review the herbal remedies used for nerve originated pain in TPM as potential options for current researchs on new drugs for neuropathic pain.

In this study, we reviewed TPM literature including Avicenna's Canon of Medicine regarding this topic, to find herbs suggested for theraputic use in nerve originated pain.

Topical oil-based ointments' of herbs with hot temperaments such as pepper, chamomile, lavender, thyme, bitter apple and flax were used for nerve-originated pain. Among these herbs Capsicum annuum and Citrullus colocynthis have been investigated in clinical studies with promising results [2 – 3]. Others are only investigated in pre-clinical studies. Herbal remedies used in the treatment of nerve-originated pain and potential mechanisms for their effects in-light-of current medical literature are summarized in Table 1.

These herbs can be more investigated as potential agents in the field of drug discovery in neuropathic pain.

Tab. 1: Medicinal plants mentioned in the traditional Persian medical books for managing the nerve originated pain.

Common name	Traditional name	Scientific name	Route of administration	Pharmacologic effect
Pepper	Felfel	Capsicum annuum L.	Oral, Topical (Oil based formulation)	Antinociceptive, Antiinflammatory, Antioxidant, Neuroprotective
Colocynth	Hernial	Citrullus colocynthus (L.) Schrad.	Topical (Oil based formulation)	Analgesic, Antiinflammatory, Antioxidant
Olive	Zeyton	Olea europaea L.	Topical (Olive oil)	Anti-inflammatory, Antioxidant, Neuroprotective
Castor	Karchak	Ricinus communis L.	Topical (Castor oil)	Anti-inflammatory, Antioxidant
Flax	Katan	Linum usitatissimum L.	Topical (Flax oil)	Analgesic, Antioxidant, Neuroprotective
Lavender	Iranian Ostokhudus	Nepeta menthoides Boiss. & Buhse	Oral (Syrup)	Neuroprotective
Shirazi Thyme	Sa'atar	Zataria multiflora Boiss.	Oral (decoction)	Analgesic, Antiinflammatory
Garlic	Sir	Allium sativum L.	Oral, Topical (Oil based formulation)	Analgesic, Antioxidant
Citron	Balang	Citrus medica L.	Topical (Oil based formulation)	Analgesic, Antiinflammatory
Saffron	Zaferan	Crocus sativus L.	Topical (Oil based formulation)	Antinociceptive, Antiinflammatory

References:

[1] Heydari M, Shams M, Hashempur MH, Zargaran A, Dalfardi B, Brhan-Haghighi A. The origin of the concept of neuropathic pain in early medieval Persia (9th-12th century CE). Acta Med Hist Adriat (In-press)

[2] Ellison N, Loprinzi CL, Kugler J, Hatfield AK, Miser A, et al. Phase III placebo-controlled trial of capsaicin cream in the management of surgical neuropathic pain in cancer patients. J Clin Oncol 1997; 15: 2974 – 80

[3] Heydari M, Homayouni K, Hashempur MH, Shams M. Topical Citrullus colocynthis in painful diabetic neuropathy: a double-blind randomized placebo-controlled clinical trial. J Diabetes 2015; doi: 10.1111/1753 – 0407.12287 [in press]