Chronic pain is a signal of some underlying problem, like a injury that has failed to heal, autoimmune condition, vitamin deficiency, gut dysbiosis, mechanical wear and tear, nerve damage, there are so many possible reasons. When using herbs to go after chronic pain, which can be due to many possible causes, it can be helpful sometimes to focus less on the specific diagnosis, and more the type of pain. Is it in the muscles, the nerves, or inflammatory? Then matching with these types of pain are herbal actions; antispasmodic, nervine, and anti-inflammatory/ alterative. This is a simple way to approach the situation. It is also important to learn the specific indications of each herb (their specialities) and also their energetics (warming, cooling, moistening, drying). Each herb often has certain affinities for particular tissues or organs in terms of its medicinal effect.
There are many causes of chronic pain, but generally, it is appropriate to make sure the diet is well balanced, without processed foods, refined sugar, and contains plenty of vegetables and fruits, whole grains, or if you eat meat, wild or grass-fed animal derived meats. The Paleolithic and ketogenic diets are worth considering. Yoga, Qi-gong, or other physical exercises should be used in any holistic strategy. However, there are a wide variety of chronic pain conditions that are not well understood and don’t yield to changing the diet, conventional medicine, acupuncture, chiropractor, or physiotherapy.
Traditionally, herbal therapies have been used for chronic pain and there are a wide variety of herbs to consider. However, they are suited for different kinds of chronic pain, so it is instructive to further break them down by action, affinity for body systems, energetics, and for treating certain diseases.
Anti-inflammatory and immune balancing
These herbs can oftentimes help reduce inflammation without overly suppressing the immune system. A few of these herbs are adaptogens from TCM and Ayurveda, they are known as Qi or rasayana tonic herbs in these systems of medicine and have a range of uses beyond reducing inflammation. They often help calm the nervous system as well, for example, and can reduce fatigue as they help boost energy reserves. They may have a balancing role to play on the immune system. Another herbal derivative we might put here is CBD, but I have included cannabis in the anodyne section.
Turmeric: General widely used Ayurvedic anti-inflammatory, appropriate for different types of inflammation. Applied especially in musculoskeletal conditions.
Boswellia: Another popular option from the Ayurvedic system of medicine. Often applied alongside turmeric for musculoskeletal conditions, but also has an affinity for the bowel and may help with disorders like Crohn’s disease and ulcerative colitis.
Chinese skullcap: A TCM herb that is often used in musculoskeletal conditions, but also in allergies. The Chinese skullcap, Scutellaria baicalensis, is often confused with its American relative, Scutellaria lateriflora, which is more of a sedative to help sleep and can help with conditions such as epilepsy. Chinese skullcap is more of an anti-inflammatory, but also seems to have some sedative properties.
Reishi: Increasingly used adaptogenic medicinal mushroom from TCM that contains triterpenes that are anti-inflammatory, but also contains polysaccharides that stimulate the immune system. Used in inflammation of the bowel, but also more generally in fighting chronic infections and inflammation. Reishi is also a relaxing adaptogen and may help improve sleep, anxiety, and reduce fatigue.
Slippery elm: A medicine from traditional Western herbalism that is very specific to the GI tract and reducing inflammation here. It comes from a bark of a tree and contains mucilage and tannins which are thought to form a soothing coating in the digestive tract. Slippery elm may interfere with the absorption of pharmaceutical drugs taken at the same time. WebMD recommends taking it at least one hour before or after taking other medication.
Ashwagandha: A widely appropriate Ayurvedic adaptogenic herb, that is often used in treating musculoskeletal pain related conditions, including fibromyalgia, rheumatoid arthritis, and osteoarthritis. Is also is applied in many disorders that effect the nervous system such as insomnia, anxiety, neuralgia, and multiple sclerosis. May help relax tense muscles. I have found the KSM-66 extract effective.
Gotu kola: Another Ayurvedic herb, often used alongside ashwagandha. Specific for conditions involving hot inflamed joints or skin, such as rheumatoid arthritis or psoriasis. It is applied by herbalists alongside ashwagandha and sarsaparilla in treating arthritis. Also used to treat nerve pain. Best used in a fresh tincture.
Holy basil: An Ayurvedic herb, used with reishi in treating allergies, but also useful for chronic inflammation and infections. Similar to ashwagandha and gotu kola in terms of medicinal potential and can be applied to help nervous system problems such insomnia, anxiety, depression, and neuralgia.
Sarsaparilla: Originally brought to Europe from Mexico by the Spanish. Sarsaparilla has a specificity towards chronic inflammation, and has been used to treat rheumatoid arthritis and psoriasis. It may be combined with gotu kola for a stronger anti-inflammatory action.
These herbs can reduce muscle tension that may be helpful in conditions such as fibromyalgia and sciatica. Many of these also may help sleep as they have a hypnotic or sedative action, hypnotics are stronger than sedatives, which are in turn stronger than relaxants. Magnesium should also be considered as a cheap and safe muscle relaxant, sometimes a nutritional deficiency may be underlying or contributing to a pain disorder, herbs cannot correct that.
Valerian: One of the great European nervines. Commonly known for its ability to help insomnia as it is a hypnotic, but this herb is an effective anti-spasmodic (calms muscles) and carminative (reduces excess digestive gas). May have a role to play in reducing pain where there are tense muscles. Can be used to help disrupted sleep related to chronic pain in a synergistic manner alongside other sedative herbs like American skullcap and lemon balm.
Black cohosh: A potent Native American remedy, traditionally used for rheumatic conditions such as arthritis and fibromyalgia. It also appears to be quite a strong anti-depressant and can help insomnia as it is a nervine relaxant. Only small doses of tincture are required (5-30 drops).
Blue vervain: Bred in North America from European vervain. A small amount of blue vervain goes a long way (1-10 drops). However, it is very bitter, cooling, and drying, therefore can be used alongside warming and moistening herbs. Traditionally applied especially against epilepsy, but also has a role in reducing anxiety. Reduces tension all over the body, particularly noticeable in the neck and shoulders.
Crampbark: Is commonly combined with valerian in treating muscle cramps.
Lobelia: Another herb used in dropwise doses (1-10 drops), effective at relaxing muscles, may also help anxiety and sleep.
American skullcap: A nervine tonic and sedative, good for helping restore normal sleep and may help nerve pain. Best used in a fresh tincture. Should notice a gentle relaxing sensation in the top of the head, if the quality is good, when taking 10-15 drops or so of the tincture. Although it is fine to take more, 30-60 drops for example. It is thought by herbalists to have a gentle restorative effect on the nervous system over time. It does not tend to over sedate. Good for nerve pain with St. John’s wort, this is a simple nerve pain pair.
Kava: A traditional remedy from the South Pacific, it is a strong hypnotic so may help sleep. Often taken for fibromyalgia and is an effective antispasmodic for muscle spasms. May have a role to play in reducing neuralgia. Is not considered suitable for those with a history of liver problems and there is potential for addiction at higher doses.
These are herbs that reduce pain. Jamaican dogwood, Californian poppy, kratom, and cannabis are more like conventional painkillers. As well as being anodyne, St. John’s wort is thought by herbalists to have a more restorative role on the nervous system.
Jamaican dogwood: From the bark of the tree and one of the stronger anodyne herbs in traditional Western herbalism. Good for pain, but also improving sleep where disrupted due to chronic pain. It also is antispasmodic and hypnotic. Has a strong taste. I think kratom or CBD is better.
Californian poppy: Grows brilliant bright orange flowers. A gentler nervine than Jamaican dogwood, we might call it a sedative, suitable for reducing pain and improving sleep.
Cannabis: Legal hemp extracts that contain phytocannabinoids are often used to treat chronic pain and CBD is one of those compounds that has gained huge popularity. It is suitable for treating both inflammatory and neuropathic pain.
Kratom: A strong, versatile pain-killing herb from Asia, that may produce some similar effects to opioid drugs (at 4-8 gram doses). Contains mitragynine and 7-hydroxymitragynine that can bind to the body’s opioid receptors and provide pain relief. It also has anti-inflammatory properties. It is suitable in treating inflammatory and neuropathic pain. Has some potential for withdrawal symptoms if taking long-term high doses, to avoid this strains can be rotated, doses maintained quite low (e.g. 3g), or taper when coming off it. Perhaps the most important herbal ‘painkiller’ we have.
St. John’s wort: A European nervine tonic, anodyne, relaxant, and anti-depressant. Specific for nerve pain, but also may improve sleep alongside other nervines, anxiety, and mood. Best used in a fresh tincture. The best option for nerve pain I think, alongside ashwagandha.
Certain herbs are thought to herb boost circulation and the supply of oxygen and nutrients to damaged tissues.
Prickly ash: A native American remedy from the bark of a North American tree, it is said to be a specific for nerve pain, like St. John’s wort. They are often used together for this reason. Prickly ash is also anodyne. Traditionally, prickly ash was used for rheumatism.
Ginkgo: The leaf extract comes from the ginkgo tree which is the oldest surviving species of tree in the world. However, traditional indications for ginkgo are less clear than other herbs, mainly because the leaf extract only became popular last century and has been used mainly as a nootropic. It has been found useful for various cognitive and circulatory problems.
These herbs are quite specific for reducing chronic inflammation and are thought to work by stimulating the excretory organs and altering metabolism in the body in poorly understood ways. They could also be classed as anti-inflammatory, as sarsaparilla is another alterative mentioned earlier, however, they are thought by herbalists, in some cases, to have a more curative role.
Nettles: Traditional Western herbalism speaks very highly of nettles and its chronic pain indications include arthritis and gout. Nettles is high in protein, vitamins, and minerals, so makes an excellent all round nutritive tonic. May be used alongside dandelion and burdock as a long-term traditional Western herbalism style treatment for arthritis.
Constructing a formula
Here is a basic formula for reducing nerve pain, and may have a renewing effect on the nervous system as a whole. It has an anti-inflammatory property due to the ashwagandha, for the nervous and musculoskeletal systems.
For more details on constructing herbal formula that are more specific to certain conditions, I would recommend Matthew Wood’s the Earthwise Herbal (2009) books, of which there are two, and particularly Maria Groves Body into Balance (2016).
American skullcap (fresh tincture) (1 part)
St. John’s wort (fresh tincture) (1 part)
Ashwagandha KSM-66, 2-4 capsules per day (400mg)
Dose: 20-90 drops 2-3 times daily.
Contraindications: Do not use when pregnant or breastfeeding. Be careful if combining with sedative drugs regarding dose. St. John’s wort may not be appropriate alongside drugs as it may reduce their effect, best to consult a doctor if you are in this situation.
Note: See the text books in the references section to learn more about how to use these herbs in more detail. It is good to develop an understanding of herbal energetics before using medicinal herbs, incase problems related to dryness are encountered, for example. This is an ancient system of dividing herbs into warming, cooling, drying, and moistening. For researching drug-herb interactions and contra indications, Examine and WebMD are helpful. Many of the above herbs are not at all safe during pregnancy or breast feeding.
Groves, Maria. Body into Balance. Storey Publishing, 2016.
Hoffman, David. Holistic herbal. Element Books, 1988.
Panossian, Alexander. “Understanding adaptogenic activity: specificity of the pharmacological action of adaptogens and other phytochemicals.” Annals of the New York Academy of Sciences (2017).
Winston, David, and Steven Maimes. Adaptogens: herbs for strength, stamina, and stress relief. Inner Traditions/Bear & Co, 2007.
Wood, Matthew. The Earthwise Herbal: A Complete Guide to New World Medicinal Plants. North Atlantic Books, 2009.