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Medicinal Herbs in the Treatment of Neuropathic Pain

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Medicinal Herbs in the Treatment of Neuropathic Pain Iranian Journal of Basic Medical Sciences ijbms.mums.ac.ir Medicinal herbs in the treatment of neuropathic pain: a review Fatemeh Forouzanfar 1, Hossein Hosseinzadeh 2, 3* 1 Department of Neuroscience, Mashhad University of Medical Sciences, Mashhad, Iran 2 Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran 3 Department of Pharmacodynamy and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran A R T I C L E I N F O A B S T R A C T Article type: Review article challenge to health-care. Despite the large number of available drugs, there are no curative conventional treatmentsChronic neuropathic for neuropathic pain ispain. a commonNowadays, significant more attention and debilitating has been focused problem on thatthe herbalpresents formulation a major Article history: Received: Jun 2, 2017 Accepted: Jan 7, 2018 in thedifferent field ofneuropathic drug discovery. pain Therefore,model, either we inperformed animals oran inextensive patients review are reported. about herbal Moreover, drugs the and possible plants Keywords: involvedthat exhibited mechanisms protective for effectsthe protective on neuropathic effects are pain. discussed. In this review,The more the commonbeneficial plants effects which of each are plantused Analgesic for the treatment of neuropathic pain are included as: Acorus calamus, Artemisia dracunculus, Butea Antinociceptive monosperma, Citrullus colocynthis, Curcuma longa, Crocus sativus, Elaeagnus angustifolia, Ginkgo biloba, Chronic pain Mitragyna speciosa, Momordica charantia, Nigella sativa, Ocimum sanctum, Phyllanthus amarus, Pterodon Herbal medicine Neuropathic pain apoptotic,pubescens neuroprotective Benth, Rubia cordifolia and calcium and Salvia inhibitory officinalis. actions. Furthermore, the most pathways which are known Into beconclusion, involved thisin pain review relief suggests by means that of some herbal herbal remedies plants are can anti-oxidant be suitable activity, candidates anti-inflammatory, for the treatment anti- of neuropathic pain. ►Please cite this article as: Forouzanfar F, Hosseinzadeh H. Medicinal herbs in the treatment of neuropathic pain: a review. Iran J Basic Med Sci 2018; 21:347-358. doi: 10.22038/ IJBMS.2018.24026.6021 Introduction Pain, an unpleasant sensation and emotional experience that in our daily life, is an alert of tissue thisdisease state lead resolves to persist as healing nociception, occurs then and the inflammation changes in subsides.primary afferentBut, stimulation neurons may from continue ongoing (11). injury Central or (1). Acute pain is a useful biologic purpose and self- changes can result from peripheral nerve lesions, which injury to prevent further or impending tissue damage have been investigated in animals mainly at the spinal cord or sometimes at supraspinal levels (12, 13). limitingas a disease in nature state. that It may arises outlast in response the usual to aduration specific Several types of alterations can induce pathologic injury. Chronic pain, in contrast, may be considered activation of central nociceptive neurons: such as neuroplasticity, microglial activation and hyper- ofthat recovery, comes iffrom accompanied direct consequence with a disease of ora lesioninjury (1,or excitability (central sensitization) of nociceptive 2).disease The definitionwhich affect of thechronic somatosensory neuropathic system” pain is (3).“pain It neurons. Central sensitization possibly depends critically on intracellular changing that induced by on the site of the lesion. The most causes of chronic the activation of N-methyl-D-aspartate (NMDA) and mayneuropathic be classified pain areas centralmetabolic or peripheral,disease, viral, depending trauma, glutamate metabotropic receptors (12, 13). The severe ischemic insults, and autoimmune diseases (4-6). stimulation of non-neuronal cells, microglia in central Neuropathic pain usually does not have effective and macrophages in periphery, leads to production of a treatment, because of heterogeneous etiology and complex underlying pathophysiology, moreover, the play critical roles in neuropathic pain condition (14, 15). variety inflammatory cytokines and chemokines which drugs (7-9). Neuropathic pain and herbal medicinal products unwanted side effect profiles limit the use of available The usage of natural products, principally herbal Neuropathic pain and underlying mechanisms medicines is one of the ancient therapies used by Neuropathic pain humanity (16). During the recent years, people are in response to physical stimuli, that may manifest as eager to use herbal medicines due to their lower increased sensitivity mayto pain be spontaneous(hyperalgesia) or orevoked as a complications and fewer side effects than synthetic drugs (17). Regarding to the increasing demand 10). for medicinal plants and related compounds the pain evoked by a nonpainful stimuli (allodynia) (5, phytopharmaceutical studies and the use of these as peripheralOnce injury sensitization. occurs, inflammation Many types and of reparatoryperipheral remedies for the management of painful neuropathy processesmechanisms ensue, have leads been to described,a hyperexcitable in most state patients, known have been growing throughout the world (18). *Corresponding author: Hossein Hosseinzadeh. Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran. Tel: +98-51-38819042; Fax: +98-51-38823251; Email: [email protected] Forouzanfar and Hosseinzadeh Neuropathic pain and herbal medicine thalidomide. These drugs exert direct and indirect Animal models and/or pharmacological mechanisms effects on sensory nerves to diminish the amplitude of neuropathic pain of action potential, slow conduction velocity and Animal models of neuropathic pain have been induce pain in patients, mainly those who experience essential in the exploration of molecular mechanisms nociceptive sensory loss through their cancer treatment of pain also for the analysis of novel analgesics in the (28, 29). treatment of chronic pain (19). The animal models for studying neuropathic pain and a brief description of Research methodology each model are as follows: The current search was done in databases of Google Scholar, Medline and Scopus, using the following The streptozotocin (STZ)-induced diabetes The STZ-induced diabetic neuropathic pain model phytotherapy and natural products. The search included mimics the diabetic neuropathy. This neuropathy is keywords:literatures publishedneuropathic as late aspain, 31 Aprilmedicinal 2017. plants, one of the most frequent peripheral neuropathies In the present review, plants and some constituents associated with hyperalgesia, cold or hot allodynia of herbal medicine which have the potential to cure and hyperesthesia, the high blood glucose level neuropathic pain have been discussed alphabetically. induced oxidative and nitrosative stress which have For a summary of the selected experimental and been proposed to be an essential mechanism of human studies see Table 1 and Table 2. Reactive oxygen species (ROS) enhanced nociceptors Acorus calamus neuronalsensitization injury so related that theyto diabetic not onlyneuropathy respond (20-22). more A. calamus, belongs to Araceae family, it has been used vigorously towards noxious stimuli, but also start to respond towards normally subthreshold stimuli. This in Indian traditional medicine (30). The hydroalcoholic peripheral sensitization not only induces pain directly forextract the managementof A. calamus of several(HAE-AC) inflammatory has been showndisorders to but furthermore induces central sensitization in the spinal cord, which also indirectly contributes to pain (7, allodynia and mechanical hyperalgesia on neuropathic 23). In high concentrations superoxide combine with significantlypain induced byattenuate tibial and thermal sural nerve hyperalgesia, transection thermal(TST) in nitric oxide to form peroxynitrite, which is implicated in diabetes accompanied by motor and sensory nerve anion, total calcium levels and myeloperoxidase (MPO) rats.activity Moreover, were also a significant observed decrement (31). Furthermore, in the superoxide HAE-AC decreased superoxide anion, total calcium levels and conduction deficits, in addition to peripheral nerve energyHigh-fat deficiency diet (7, 24). (CCI). It also attenuated CCI induced development of MPOpainful activity behavioral in sciatic changes nerve including: chronic constriction thermal, radiant, injury mechanical hyperalgesia and thermal, chemical, tactile neuropathyHigh-fat withdiet isalimentary an important obesity, risk hyperinsulinemia, factor for nerve allodynia in rats (32). In other study, HAE-AC attenuated conductionand impaired velocity glucose tolerancedeficit and develops small neuronal sensory damage fiber the development of painful behavioral (thermal and resulting from oxidative stress of lipid metabolism and mechanical hyperalgesia and mechanical allodynia), indicate increased sorbitol pathway activity, oxidative- biochemical (rises in the levels of superoxide anion, total calcium and myeloperoxidase activity) and peripheral nervous system (PNS) (25, 26). This model histological changes in vincristine-induced neuropathy nitrosativehas been used stress, in studies and onpro-inflammatory pathophysiology changesof impaired in in rats (33). In a further study saponin rich extract of A. glucose tolerance (IGT) and type 2 diabetes and for calamus improved
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