Zingiberaceae extracts for pain: a systematic review and meta-analysis - PubMed (original) (raw)

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Zingiberaceae extracts for pain: a systematic review and meta-analysis

Shaheen E Lakhan et al. Nutr J. 2015.

Abstract

Background: Members of the family Zingiberaceae including turmeric, ginger, Javanese ginger, and galangal have been used for centuries in traditional medicine. Preclinical studies of Zingiberaceae extracts have shown analgesic properties. This study aims to systematically review and meta-analyze whether extracts from Zingiberaceae are clinically effective hypoalgesic agents.

Methods: Literature was screened from electronic databases using the key words Zingiberaceae AND pain OR visual analogue score (VAS) to identify randomized trials. From this search, 18 studies were identified, and of these, 8 randomized, double-blinded, placebo-controlled trials were found that measured pain by VAS for inclusion in the meta-analysis.

Results: Findings indicated significant efficacy of Zingiberaceae extracts in reducing subjective chronic pain (SMD - 0.67; 95 % CI - 1.13 to - 0.21; P = 0.004). A linear dose-effect relationship was apparent between studies (R(2) = 0.71). All studies included in the systematic review reported a good safety profile for extracts, without the renal risks associated with non-steroidal anti-inflammatory drugs, and with similar effectiveness.

Conclusion: Our findings indicated that Zingiberaceae extracts are clinically effective hypoalgesic agents and the available data show a better safety profile than non-steroidal anti-inflammatory drugs. However, both non-steroidal anti-inflammatory drugs and Zingiberaceae have been associated with a heightened bleeding risk, and there have been no comparator trials of this risk. Further clinical studies are recommended to identify the most effective type of Zingiberaceae extract and rigorously compare safety, including bleeding risk.

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Figures

Fig. 1

Fig. 1

PRISMA flow chart showing the numbers of identified, screened, included, and excluded studies for the systematic review (qualitative synthesis) and meta-analysis (quantitative analysis)

Fig. 2

Fig. 2

A funnel plot for pain, showing standard error plotted against effect size (SMD). Each data point represents one RCT included in the meta-analysis. The plot was not completely symmetrical, indicating potential bias, but bias could not be concluded due to a lack of statistical significance (Egger’s test, P = 0.10). A high degree of inconsistency between studies (I2 = 87.5) may contribute to the asymmetry of the funnel plot

Fig. 3

Fig. 3

Random-effects meta-analysis Forest plot showing standardized mean differences (SMDs) for each study of Zingiberaceae extracts included in the quantitative analysis, sorted by date of publication. The meta-analysis findings indicated that Zingiberaceae extracts significantly reduced subjective pain (P = 0.004; SMD -0.67; 95 % CI -1.13 to -0.21). Earlier studies tended to use lower doses, which may explain the tendency for more recent studies to have larger effect sizes. Each study is represented by a square, with the area of the square corresponding to the weight given to that study in the meta analysis (weighting based on the number of subjects in each trial). The estimated overall effect size is displayed as a diamond. Horizontal lines show 95 % confidence intervals

Fig. 4

Fig. 4

A scatter plot showing the effect size (standardized mean difference (SMD), y-axis) for each study included in the meta-analysis, plotted against the dose of Zingiberaceae extract that was used in that study (x-axis). The results show that studies using larger doses of Zingiberaceae extracts tended to report more effective hypoalgesia (R2 = 0.71). Different markers represent the extract type: Triangle = Javanese ginger; Circle = Ginger; Square = Mixed ginger and galangal; Diamond = Curcuminoids/curcumin

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References

    1. Gupta SC, Sung B, Kim JH, Prasad S, Li S, Aggarwal BB. Multitargeting by turmeric, the golden spice: From kitchen to clinic. Mol Nutr Food Res. 2013;57:1510–28. doi: 10.1002/mnfr.201100741. - DOI - PubMed
    1. Prasad S, Aggarwal B. Turmeric, the golden spice: From traditional medicine to modern medicine. In: Benzie I, Wachtel-Galor S, editors. Herbal Medicine. 2. Boca Raton: FL, USA, CRC Press; 2011. - PubMed
    1. Lantz RC, Chen GJ, Sarihan M, Solyom AM, Jolad SD, Timmermann BN. The effect of extracts from ginger rhizome on inflammatory mediator production. Phytomedicine. 2007;14:123–8. doi: 10.1016/j.phymed.2006.03.003. - DOI - PubMed
    1. Prasad S, Gupta SC, Tyagi AK, Aggarwal BB. Curcumin, a component of golden spice: From bedside to bench and back. Biotech Advances. 2014;32(6):1053–64. doi: 10.1016/j.biotechadv.2014.04.004. - DOI - PubMed
    1. Chandran B, Goel A. A randomized, pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis. Phytother Res. 2012;26:1719–25. doi: 10.1002/ptr.4639. - DOI - PubMed

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