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Effectiveness of Infused Herbal oil in enhancing treatment of Non-specific Low Back pain.

Introduction

Low back pain is one of the most common conditions in modern society which is affecting all age groups and major reason for health care usage. Evidence suggests that 80% of adults experience back pain in their lifetime9. Its impact can cause physical, social, psychological and economic distress. Usually low back pain is reported as self-limiting like acute or subacute but, if left untreated it is evident that it turns into a chronic pain in 10% population. Those experiencing chronic pain find it affecting them in their daily activities and disturbed quality of life8. The possible treatment for chronic back pain involves prescribed medications and other adjunctive therapies. Research suggest that widespread and extensive use of prescribed medications for pain relief has developed abuse of these drugs and leads to serious consequences9. In 2016, a study showed that long-term acetaminophen use has led to increased risk of heart attacks, bleeding in digestive system and impaired kidney function.4

Therefore, it is recommended that people with chronic pain must take a holistic approach with incorporation of massage with infused herb oils. Evidences have suggest that certain remedies are helpful and that many people find them useful in daily life.4 A study conducted in 2001 on massage and back pain found that, “Massage decreased lower back pain, depression and anxiety and improved sleep. The massage therapy group also showed improved range of motion.”9 To achieve the best benefits of massage, people are using essential oils, herbs, and other natural pain relievers for hundreds of years. Herbs are useful in relieving the aches and pains due to inflammation. From ancient time, one of the more versatile use of herbs is mixing it to make infused oil. These oils work in two ways – causes emotional and physical response and also penetrates the skin to underlying tissue and distributes their therapeutic properties.1, 4

There are many herbs found locally who has amazing therapeutic properties and are used to make infused oil. Knowing some of the differences can helpful to choose the best herb for the situation.1,4 Few of them which are used for its maximum therapeutic benefits are Garden cress seeds, Oregano, Sesame seeds, Himalayan salt infused in olive oil. These herbs have amazing healing, anti-inflammatory, anti-oxidant and analgesic properties.

Garden cress seeds also known as Lepidium Sativum is an edible fast growing herb which has been used in ancient medicines for a long time. It seeds contains significant amount of plant sterols which are anti-oxidant and anti-inflammatory compounds. It also contains phenolic compounds which fights at molecular level and inhibits the substance involved in inflammation. The seed when infused in the carrier oil and applied to joints or muscle pain helps recover from muscle weakness, reduce muscle tension and promotes pain relief.6

Sesame seeds are used for traditional remedy against various ailments for centuries. It has high antibacterial and anti-oxidant properties. Sesamol, Sesamolin and Sesamin are the anti-oxidant components present in its seeds. Among these, Sesamin is a lignin with anti-inflammatory properties which helps in pain relief, reduce spasm and increase range of motion when applied to the affected area. Many studies have proved its therapeutic and healing properties that sesame seeds when infused in oil, applied to the painful area stimulate the blood flow due to its excellent emollient properties.3, 10

Oregano is the herb found locally and widely used in the culinary arts. Besides from its taste this herb also serves in various ailments due to its anti-inflammatory and anti-oxidant properties. Oregano leaves are high in phenols, which are natural phytochemical compounds with beneficial antioxidant effects. The two most abundant phenols in it are thymol and carvacrol. Among these, Carvacrol — has antimicrobial, antitumor, ant mutagenic, analgesic, anti-inflammatory and antiparasitic properties, making it one of the most active components of oregano when infused in carrier oil.1

Himalayan Salt is the world’s purest and richest, boasting 84 minerals and trace minerals. It’s become increasingly popular nowadays, as many have attributed numerous health benefits to it. The healing properties of pink Himalayan salt are believed to restore restful sleep, relieve muscle aches and increase energy in body. Other than being beneficial for muscle aches and pains, it can also be used to relieve muscle spasms. When infused the salt in carrier oil and applied to the surface, the natural antioxidants present can help to prevent free radical damage and thus reducing the possibility of future muscle pain.5

Olive oil is valued not only for its flavor, but also for its range of wellness benefits. Olive oil is rich in oleic acid, a type of monounsaturated fat. Studies have shown that oleic acid is linked to reduced biomarkers of inflammation17 such as C-reactive protein. This oil when infused with herbs, doubles the benefits with its rich properties and gives the best results. Extra virgin olive oil is considered the highest-quality olive oil to be used as carrier oil with herbs. It is unrefined and contains more nutrients compared to other processed varieties.2

Objective

The objective of this randomized controlled trial is to determine whether a course of massage combined with herbal infused oil confers greater improvement on pain due to nonspecific low back pain in general population. Despite of the popularity and over hauling properties of the above mentioned herbs individually, there continues a need to determine the effectiveness of these herbs when mixed together in treatment of non-specific back pain. There are large number of primary research which evidence that use of different herbs as an infused oil in treatment of joint and muscle pain is effective. But, the efficacy of Garden cress seed, Oregano, Sesame seeds, Himalayan salt and olive oil when mixed together is still to be identified which will be done in these study. It will provide a conservative approach in treatment of non-specific low back pain and enhancing quality of life.

Hypothesis

Infused herb oil will be effective in treatment of Non-specific low back pain

Or

Infused herb oil will not be effective in treatment of Non-specific low back pain.

Inclusion/Exclusion Criteria

· People who are suffering with non-specific low back pain

· Participants who are willing to participate in the study

· Those participants who were allergic to herbs were excluded from the study

· Severe disk lesions or osteoporotic conditions were excluded

· Any mental or cognitive dysfunction where the participants cannot give consent

Method and Material

The purpose and procedure was explained to the participants followed by taking their consent and getting enroll in this study. A self-screening questionnaire was filled up by the participants on the first day for determining the difficulty in functions due non-specific low back pain. The Questionnaire included personal details, Area/Intensity of pain and their functional abilities. The functional activities were graded from 0 to 5, 0 – No pain, 1 and 2 – mild pain, 3 and 4 – moderate pain and 5 – severe pain. The participants who qualified were provided the bottle of infused oil with herbs. The herb infused oil was prepared with mixture of all the 5 herbs, coarsely grinded in equal amount and then mixing it with olive oil to increase its effectiveness.

The application of oil was explained to the participants which included first cleaning of the area with Luke warm water and applying the oil directly (3 times a day and keep it on for 5 minutes) with firm pressure. The participants were asked to continue the application regularly with other back pain preventive measures to be taken. After 1 week, the participants were assessed again by filling the same back pain questionnaire and results were compared. None of the participants received any kind of treatment during the 1 week time period which could affect the effectiveness of oil.

Results

Data analysis was conducted by qualitative analysis in Ms. Excel. There were total 42 participants who demonstrated non-specific low back pain. No drop-out was seen during the course of study. Among 42 participants, 29 were females and 13 were males.




The average age of participants included in study was 49 years with a maximum age of 76 years and minimum age of 21 years.



Maximum participants (33) didn’t have any medical conditions like arthritis, diabetes or any skin allergies. Only 7 participants had history with arthritis, 1 with cardiac arrest and 1 with diabetes.



The application of herb infused oil for 1 week showed significant changes in overall pain of the participants. 81% of them experienced severe pain initially which reduced to only 5% after 1 week. This also led to 67% participants experiencing only mild pain symptoms. The details are mentioned in chart below;




There were significant differences noted in functional activities with decrease in intensity of pain. For each activity, drastic change were notes in participants having severe pain and moderate pain.



As shown in the chart above, there were no participants experiencing severe pain after 1 week of oil application except for sleeping activity still 2% experienced severe pain. Also there were significant changes in moderate pain level in all the activity which is mentioned in chart below. However, no specific changes were noted in sleep pre and post values.





Also, number of participants experiencing mild pain increased after 1 week which signifies that there were no participants left with severe pain symptoms during these activities. The comparison is seen in the chart below.



Remarkable increase in number participants was seen with no symptoms of pain in these activities after 1 week. Though there were less change noted for sleeping activity. The details in relation with all the activities are mentioned in chart below.



Discussion

The herb infused oil prepared included oregano, sesame, garden cress seeds, Himalayan pink salt and olive oil. All the herbs has their own significant value and possess overhauling anti-inflammatory, anti-oxidant, analgesic properties individually which were proven effective in treatment of various painful conditions. Since, these herbs were effective in reducing pain and inflammation in various conditions, we tested whether a combination of these herbs will be effective in with back pain.

To assess and compare the pain score we used a questionnaire which showed decrease in NPRS score and pain in other functional activity. Herb infused oil when applied to skin for 1 week help reduce inflammation and decrease pain by penetrating through the skin, working on muscular level. The participants also experienced reduced stiffness and increase in mobility which led to decrease in pain. When kept on surface for few minutes, these herbs penetrates the micro level in skin and helps blocking the pain receptors which results in decrease pain symptoms.


Conclusion

Herb infused oil showed effectiveness in enhancing treatment in participants with non-specific low back pain.



References

1. Ali, B., Al-Wabel, N. A., Shams, S., Ahamad, A., Khan, S. A., & Anwar, F. (2015). Essential oils used in aromatherapy: A systemic review. Asian Pacific Journal of Tropical Biomedicine, 5(8), 601-611. doi:10.1016/j.apjtb.2015.05.007


2. Benefits of Olive Oil and its properties. (n.d.). Retrieved March 11, 2021, from https://articles.mercola.com/herbal-oils/olive-oil.aspx

3. Bhat, K., Kumari, R., Pathak, N., & Rai, A. (2014). Value addition in sesame: A perspective on bioactive components for enhancing utility and profitability. Pharmacognosy Reviews, 8(16), 147. doi:10.4103/0973-7847.134249


4. Chrubasik, J. E., Roufogalis, B. D., & Chrubasik, S. (2007). Evidence of effectiveness of herbal antiinflammatory drugs in the treatment of painful osteoarthritis and chronic low back pain. Phytotherapy Research, 21(7), 675-683. doi:10.1002/ptr.2142



6. Garden cress seeds: Benefits, uses and side effects. (n.d.). Retrieved March 11, 2021, from https://www.alwosta.tn/en/blog/75_garden-cress-seeds-benefits-uses-and-side-effects.html#:~:text=Benefits%20of%20garden%20cress%20for%20skin.%20Garden%20cress,calcium%2C%20vitamin%20C%2C%20vitamin%20E%20and%20vitamin%20A.


7. Kanodia, A. K., Legedza, A. T., Davis, R. B., Eisenberg, D. M., & Phillips, R. S. (2010). Perceived benefit of complementary and alternative Medicine (CAM) for back PAIN: A national survey. The Journal of the American Board of Family Medicine, 23(3), 354-362. doi:10.3122/jabfm.2010.03.080252


8. Kong, L. J., Fang, M., Zhan, H. S., Yuan, W. A., Tao, J. M., Qi, G. W., & Cheng, Y. W. (2012). Chinese massage combined with Herbal ointment for athletes WITH Nonspecific low back PAIN: A randomized controlled trial. Evidence-Based Complementary and Alternative Medicine, 2012, 1-

8. doi:10.1155/2012/695726


9. PMC, E. (n.d.). A Comparison of the Effects of 2 Types of Massage and Usual Care on Chronic Low Back Pain: A Randomized, Controlled Trial. Retrieved March 11, 2021, from http://europepmc.org/articles/PMC3570565


10. Sesame oil benefits and uses. (n.d.). Retrieved March 11, 2021, from https://articles.mercola.com/herbal-oils/sesame-oil.aspx

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