Фитотерапия боль в нижней части спины




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Introduction


Osteoarthritis (OA) is one of the most prevalent and disabling chronic diseases affecting older people. A high prevalence of OA among older people and women and the moderate to severe impact on daily life pose a significant public health problem [Malemud et al. 2003; Yelin, 2003]. OA involves the erosion of articular cartilage, inflammation of synovial membrane, and resorption of the underlying subchondral bone [van der Kraan and van den Berg, 2000]. These pathological changes are associated with an excessive production of proinflammatory molecules such as interleukin 1β (IL-1β) and tumor necrosis factor α (TNFα), which shift the balance between the synthesis and degradation of matrix components resulting in progressive destruction of the joint tissue [van der Kraan and van den Berg, 2000]. Today, a cure for OA remains elusive. Nonpharmacological management includes physical therapy, aerobic exercises, muscle strengthening, weight reduction, walking aids, knee braces, footwear and insoles, electromagnets, thermal modalities and acupuncture. For OA treatment and prevention, glucosamine and chondroitin sulfate, two of the molecular building blocks found in articular cartilage, are the most commonly used dietary supplements. In randomized trials of variable quality, these compounds show efficacy in reducing symptoms, but neither has been shown to arrest progression of the disease or regenerate damaged cartilage [reviewed in Häuselmann, 2001; Morelli et al. 2003; McAlindon, 2006; Gregory et al. 2008]. Pharmacological management of OA has targeted symptoms of the disease rather than the underlying cause; analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs) represent the mainstay of treatment [Altman, 2009]. These drugs generally decrease pain and stiffness and improve function. Although, any beneficial effects to the underlying cartilage and bone associated with the use of these drugs have not been demonstrated, they remain among the most widely prescribed drugs for OA therapy [Abramson, 2003]. Other treatment options are selective cyclooxygenase 2 (COX-2) inhibitors (rofecoxib) for pain management but these drugs are reported to be associated with gastrointestinal [Chan et al. 2010] and cardiovascular [Hsiao et al. 2009] adverse events. Matrix metalloproteinase (MMP) inhibitors have been studied for prevention of cartilage degradation but their clinical use has been limited by severe side effects [Nuti et al. 2009]. Intra-articular therapies like glucocorticoid and hyaluronan injections have been used for pain relief but recent observations suggest that they may accelerate cartilage breakdown [Gonzalez-Fuentes et al. 2010]. Basically, long-term use of available pharmacological agents to relieve OA symptoms is associated with serious adverse events and highlights the importance of developing safer alternative and prevention strategies. Such prevention and alternative/adjunct therapies could come from nutraceuticals. The term ‘nutraceutical’ was coined from ‘nutrition’ and ‘pharmaceutical’ in 1989 by DeFelice and was originally defined as ‘a food (or part of the food) that provides medical or health benefits, including the prevention and/or treatment of a disease’ [Kalra, 2003]. Zeisel distinguished whole foods from the bioactive chemical compounds derived from them and available in a nonfood matrix by using the terms ‘functional foods’ and ‘nutraceuticals’ respectively [Zeisel, 1999]. However, the term nutraceuticals has no regulatory definition and is not recognized by the US Food and Drug Administration (FDA), which uses the term ‘dietary supplements’ instead [Halsted, 2003]. OA as a chronic disease is a perfect paradigm of pathology of treatment, which could be addressed by nutraceuticals and dietary supplements. First, because nutraceuticals only have limited effects on their biological target and significant differences can be reached over time through a buildup effect in which daily benefits add up and the time window for intervention is longer in chronic diseases. Second, nutraceuticals could provide a safer alternative because generally their use is devoid of adverse effects, although this is not universal. Public interest in the benefits provided by nutraceuticals such as medicinal herbs for OA is high and 47% of older adults use nonprescribed alternative medications (dietary supplements) for OA management [Ramsey et al. 2001]. The objective of this review is to discuss the scientific evidence supporting the efficacy of Punica granatum (pomegranate fruit), Camellia sinensis (green tea), Uncaria tomentosa/Uncaria guianensis (cat’s claw), Harpagophytum procumbens (devil’s claw), Zingiber officinale (ginger), Boswellia serrata, Curcuma longa (turmeric) and Ananas comosus in an attempt to understand the pivotal molecular targets involved in inflammation and the joint destruction process and to summarize their toxicities and efficacies for OA management. We have purposely not considered use of glucosamine sulphate and chondroitin sulphate because these compounds have been the main topic of numerous recent reviews [e.g. Häuselmann, 2001; Morelli et al. 2003; McAlindon 2006; Gregory et al. 2008]. For this review a literature search was performed of the Pubmed database and the scientific data with a direct link to OA were selected. We tried to include all the relevant references but the list may not be complete. If some published work is not included, the omission is unintentional.
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