Clinical effectiveness of Sahasthara remedy for relief of musculoskeletal pain: a systematic review and meta-analysis of randomized controlled trials

Main Article Content

Sontaya Sookying
Mutita Piromyapron
Panupong Puttarak
Sornkanok Vimolmangkang
Surasak Saokaew

Abstract

Sahasthara (SHT) has been used for more than thirty years for reducing pain. The remedy has been listed in the Thailand national list of essential medicines. Evidence on the clinical benefits of SHT has never been summarized and documented. Its effectiveness is still limited and unclear. This study aims to systematically review and meta-analyze the clinical effects of SHT for pain reduction. Studies were eligible if they measured pain intensity. Ninety-nine identified studies were systematically searched and two of those were included into the synthesis and analysis. Quality of articles was assessed using the Jadad scale and risk of bias tool. This study was performed and reported in line with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. Two publications included in this meta-analysis were randomized control trials that compared the efficacy of SHT to diclofenac, a standard drug used for pain. SHT shows significant differences in pain reduction compared to diclofenac. Our findings indicated the potential of SHT as a pain reliever that is superior to diclofenac. Safety data, however, were not reported systematically, although the studies provided safety information compared to NSAIDs. Longitudinal studies on the efficacy and safety of SHT are needed.

Downloads

Download data is not yet available.

Article Details

How to Cite
Sookying, S. ., Piromyapron, M. ., Puttarak, P., Vimolmangkang, S., & Saokaew, S. (2021). Clinical effectiveness of Sahasthara remedy for relief of musculoskeletal pain: a systematic review and meta-analysis of randomized controlled trials. Science, Engineering and Health Studies, 15, 21050007. https://doi.org/10.14456/10.14456/sehs.2021.22
Section
Health sciences

References

Abd El-Razek, M. H. (2007). A new ester isolated from Ferula assa-foetida L. Bioscience, Biotechnology, and Biochemistry, 71(9), 2300-2303.

Ackerman, I. (2009). Western Ontario and McMaster universities osteoarthritis index (WOMAC). Australian Journal of Physiotherapy, 55, 212-213.

Al-Ghamdi, M. S. (2001). The anti-inflammatory, analgesic and antipyretic activity of Nigella sativa. Journal of Ethnopharmacology, 76(1), 45-48.

Bang, J. S., Oh, D. H., Choi, H. M., Sur, B., Lim, S., Kim, J. Y., Yang H., Yoo M. C., Hahm D. H., and Kim K. S. (2009). Anti-inflammatory and antiarthritic effects of piperine in human interleukin 1beta-stimulated fibroblast-like synoviocytes and in rat arthritis models. Arthritis Research and Therapy, 11(2), R49.

Booranasubkajorn, S., Huabprasert, S., Wattanarangsan, J., Chotitham, P., Jutasompakorn, P., Laohapand, T., Akarasereenont, P., and Tripatara, P. (2017). Vasculoprotective and vasodilatation effects of herbal formula (Sahatsatara) and piperine in spontaneously hypertensive rats. Phytomedicine, 24, 148-156.

Boros, L. (2017). GSK Global Pain Index 2017 Global Research Report. GSK. [Online URL: https://www.gsk.com/media/3814/global-pain-index-2017-report.pdf] accessed on May 1, 2020.

Burits, M., and Bucar, F. (2000). Antioxidant activity of Nigella sativa essential oil. Phytotherapy Research, 14(5), 323-328.

Cai, Y., Luo, Q., Sun, M., and Corke, H. (2004). Antioxidant activity and phenolic compounds of 112 traditional Chinese medicinal plants associated with anticancer. Life Science, 74(17), 2157-2184.

Chan, B. C. L., Hon, K. L. E., Leung, P. C., Sam, S. W., Fung, K. P., Lee, M. Y. H., and Lau H. Y. A. (2008). Traditional Chinese medicine for atopic eczema: PentaHerbs formula suppresses inflammatory mediators release from mast cells. Journal of Ethnopharmacology, 120(1), 85-91.

Chanwitheesuk, A., Teerawutgulrag, A., and Rakariyatham, N. (2005). Screening of antioxidant activity and antioxidant compounds of some edible plants of Thailand. Food Chemistry, 92(3), 491-497.

Checker, R., Sharma, D., Sandur, S. K., Khanam, S. K., and Poduval, T. B. (2009). Anti-inflammatory effects of plumbagin are mediated by inhibition of NF- kappaB activation in lymphocytes. International Immunopharmacology, 9(7-8), 949-958.

Chung, J. H., Kang, D. H., Jo, J. K., and Lee, S. W. (2012). Assessing the quality of randomized controlled trials published in the Journal of Korean Medical Science from 1986 to 2011. Journal of Korean Medical Science, 27(9), 973-980.

DerSimonian, R., and Laird, N. (1986). Meta-analysis in clinical trials. Controlled Clinical Trials, 7, 177-188.

Desai, P. V., Wadekar, R. R., Kedar, G. H., and Patil, K. S. (2008). Free radical scavenging activity of aqueous extract of roots of Baliospermum montanum Muell-Arg. International Journal of Green Pharmacy, 2, 31-33.

Drug and Medical Supply Information Center (DMSIC). (2019). The national lists of essential medicines 2019. Drug and Medical Supply Information Center, Ministry of Public Health. [Online URL: http://dmsic.moph.go.th/index/dataservice/97/0] accessed on May 4, 2020. [in Thai]

Engels, F., Renirie, B. F., Hart, B. A., Labadie, R. P., and Nijkamp, F. P. (1992). Effects of apocynin, a drug isolated from the roots of Picrorhiza kurroa, on arachidonic acid metabolism. FEBS letters, 305(3), 254-256.

Fan, J., Liu, K., Zhang, Z., Luo, T., Xi, Z., Song, J., and Liu, B. (2010). Modified Si-Miao-San extract inhibits the release of inflammatory mediators from lipopolysaccharide-stimulated mouse macrophages. Journal of Ethnopharmacology, 129(1), 5-9.

Goldberg, D. S., and McGee, S. J. (2011). Pain as a global public health priority. BMC Public Health, 11, 770.

Gould, D. (2001). Visual analogue scale (VAS). Journal of Clinical Nursing, 10, 697-706.

Gülçın, I., Oktay, M., Kıreçcı, E., and Küfrevıoǧlu, O. I. (2003). Screening of antioxidant and antimicrobial activities of anise (Pimpinella anisum L.) seed extracts. Food Chemistry, 83(3), 371-382.

Hazra, B., Sarkar, R., Biswas, S., and Mandal, N. (2010). Comparative study of the antioxidant and reactive oxygen species scavenging properties in the extracts of the fruits of Terminalia chebula, Terminalia belerica and Emblica officinalis. BMC Complementary and Alternative Medicine, 10, 20.

Health Care Association of New Jersey (HCANJ). (2017). Best practice committee of the health care association of New Jersey. HCANJ. [Online URL: https://www.hcanj.org/files/2013/09/Pain-Management-Guidelines-_HCANJ-May-12-final.pdf.] accessed on May 4, 2020.

Higgins, J. P., Altman, D. G., Gotzsche, P. C., Juni, P., Moher, D., Oxman, A. D., Savović, J, Schulz, K. F., Weeks, L., and Sterne, J. A. (2011). The Cochrane collaboration's tool for assessing risk of bias in randomised trials. British Medical Journal, 343, d5928.

Jadad, A. R., Moore, A., Carroll, D., Jenkinson, C, Reynolds, J. M., Gavaghan, D. J., and McQuay, H. J. (1996). Assessing the quality of reports of randomized clinical trials: is blinding necessary?. Controlled Clinical Trials, 17(1), 1-12.

Jaiaree, N., and Itharat, N. (2012). Anti-inflammatory effect of a Thai traditional drug for muscle pain treatment via nitric oxide and COX-II inhibitor. Planta Medica, 78(11), PF23.

Jin, D. Q., Lim, C. S., Hwang, J. K., Ha, I., and Han, J. S. (2005). Anti-oxidant and anti-inflammatory activities of macelignan in murine hippocampal cell line and primary culture of rat microglial cells. Biochemical and Biophysical Research Communications, 331(4), 1264-1269.

Kakatum, N. (2011). Anti-inflammatory activity of Thai traditional remedy extract for muscle pain treatment called Sahastara and its plant ingredients. Master’s thesis. Thammasat University, Thailand.

Kakatum, N., Jaiaree, N., Makchucit, S., and Itharat, A. (2012). Antioxidant and anti-inflammatory activities of Thai medicinal plants in Sahasthara remedy for muscle pain treatment. Journal of the Medical Association of Thailand, 95(Suppl1), S120-126.

Kapoor, I. P. S., Singh, B., Singh, G., Heluani, C. S., Lampasona, M. P., and Catalan, C. A. (2009). Chemistry and in vitro antioxidant activity of volatile oil and oleoresins of black pepper (Piper nigrum). Journal of Agricultural and Food Chemistry, 57(12), 5358-5364.

Keeratitanont, K., Jensen, M. P., Chatchawan, U., and Auvichayapat, P. (2015). The efficacy of traditional Thai massage for the treatment of chronic pain: a systematic review. Complementary Therapies in Clinical Practice, 21(1), 26-32.

Kim, H., Han, T. H., and Lee, S. G. (2009). Anti-inflammatory activity of a water extract of Acorus calamus L. leaves on keratinocyte HaCaT cells. Journal of Ethnopharmacology, 122(1), 149-156.

Kusirisin, W., Srichairatanakool, S., Lerttrakarnnon, P., Lailerd, N., Suttajit, M., Jaikang, C., and Chaiyasut, C. (2009). Antioxidative activity, polyphenolic content and anti-glycation effect of some Thai medicinal plants traditionally used in diabetic patients. Medical Chemistry, 5(2), 139-147.

Lee, H. J, Hyun, E. A., Yoon, W. J., Kim, B. H., Rhee, M. H., Kang, H. K., Cho, J. Y., and Yoo, E. S. (2006). In vitro anti-inflammatory and anti-oxidative effects of Cinnamomum camphora extracts. Journal of Ethnopharmacology, 103(2), 208-216.

Lin, C. T., Chu, F. H, Tseng, Y. H., Tsai, J. B., Chang, S. T., and Wang, S. Y. (2007). Bioactivity investigation of Lauraceae trees grown in Taiwan. Pharmaceutical Biology, 45(8), 638-644.

Manosroi, A., Jantrawut, P., Akazawa, H., Akihisa, T., and Manosroi, J. (2010a). Biological activities of phenolic compounds isolated from galls of Terminalia chebula Retz. (Combretaceae). Natural Product Research, 24(20), 1915-1926.

Manosroi, A., Jantrawut, P., Akihisa, T., Manosroi, W., and Manosroi, J. (2010b). In vitro anti-aging activities of Terminalia chebula gall extract. Pharmaceutical Biology, 48(4), 469-481.

Mehrotra, S., Mishra, K. P., Maurya, R., Srimal, R. C., Yadav, V. S., Pandey, R., and Singh, V. K. (2003). Anticellular and immunosuppressive properties of ethanolic extract of Acorus calamus rhizome. International Immunopharmacology, 3(1), 53-61.

Mukherjee, P. K., Kumar, V., Mal, M., and Houghton, P. J. (2007). Acorus calamus: scientific validation of ayurvedic tradition from natural resources. Pharmaceutical Biology, 45(8), 651-666.

Nootim, P., Bunchuailua, W., and Kapol, N. (2013). Comparative efficacy of sahasthara capsule vs diclofenac tablet for the relief of muscle pain. Journal of Thai Traditional & Alternative Medicine, 11(1), 54-65. [in Thai]

Nuengchamnong, N., and Ingkaninan, I. (2017). An on-line LC-MS/DPPH approach towards the quality control of antioxidantive ingredient in Sahastara. Songklanakarin Journal of Science and Technology, 39(1), 123-129.

Pearson, N. (2012). Acute versus Chronic Pain: Understanding the difference and choosing appropriate treatment. OrionHealth. [Online URL:https://www.orionhealth.net/news/-/asset_publisher/Xvx6HtHyOTwg/content/acute-versus-chronic-pain-understanding-the-difference-and-choosing-appropriate-treatment?inheritRedirect=false.] accessed on May 5, 2020.

Pfundstein, B., Desouky, S. K., Hull, W. E., Haubner, R., Erben, G., and Owen, R. W. (2010). Polyphenolic compounds in the fruits of Egyptian medicinal plants (Terminalia bellerica, Terminalia chebula and Terminalia horrida): characterization, quantitation and determination of antioxidant capacities. Phytochemistry, 71(10), 1132-1148.

Pinsornsak, P., Kanokkangsadal, P., and Itharat, A. (2015). The clinical efficacy and safety of the Sahastara remedy versus diclofenac in the treatment of osteoarthritis of the knee: a double-blind, randomized, and controlled trial. Evidence-Based Complementary and Alternative Medicine, 2015, 103046.

Rababah, T. M., Ereifej, K. I., Esoh, R. B., Al-u'datt, M. H., Alrababah, M. A., and Yang, W. (2011). Antioxidant activities, total phenolics and HPLC analyses of the phenolic compounds of extracts from common Mediterranean plants. Natural Product Research, 25(6), 596-605.

Rajkumar, V., Guha, G., and Kumar, R. A. (2011). Antioxidant and anti-neoplastic activities of Picrorhiza kurroa extracts. Food and Chemical Toxicology, 49(2), 363-369.

Ramos, A., Visozo, A., Piloto, J., Garcia, A., Rodriguez, C. A, and Rivero, R. (2003). Screening of antimutagenicity via antioxidant activity in Cuban medicinal plants. Journal of Ethnopharmacology, 87(2-3), 241-246.

Reddy, D. B., and Reddanna, P. (2009). Chebulagic acid (CA) attenuates LPS-induced inflammation by suppressing NF-kappaB and MAPK activation in RAW 264.7 macrophages. ‎ Biochemical and Biophysical Research Communications, 381(1), 112-117.

Reddy, D. B., Reddy, T. C. M., Jyotsna, G., Sharan, S., Priya, N., Lakshmipathi, V., and Reddanna, P. (2009). Chebulagic acid, a COX-LOX dual inhibitor isolated from the fruits of Terminalia chebula Retz., induces apoptosis in COLO-205 cell line. Journal of Ethnopharmacology, 124(3), 506-512.

Resch, M., Steigel, A., Chen, Z. L., and Bauer, R. (1998). 5-Lipoxygenase and cyclooxygenase-1 inhibitory active compounds from Atractylodes lancea. Journal of Natural Products, 61(3), 347-350.

Satyanarayana, S., Sushruta, K., Sarma, G. S., Srinivas, N., and Subba Raju, G. V. (2004). Antioxidant activity of the aqueous extracts of spicy food additives-evaluation and comparison with ascorbic acid in in-vitro systems. Journal of Herbal Pharmacotherapy, 4(2), 1-10.

Shyu, Y. S., Lin, J. T., Chang, Y. T., Chiang, C. J., and Yang, D. J. (2009). Evaluation of antioxidant ability of ethanolic extract from dill (Anethum graveolens L.) flower. Food Chemistry, 15, 515-521.

Singh, G., Marimuthu, P., Heluani, C. S., and Catalan, C. (2005). Antimicrobial and antioxidant potentials of essential oil and acetone extract of Myristica fragrans Houtt. Journal of Food Science, 70(2), M141-148.

Singtong, P., Soonyarach, W., and Phaikhomnam, P. (2016). Effectiveness of traditional Thai massage with Sahasthara drug used for treatment of shoulder muscle pain. Journal of Traditional Thai Medicinal Research, 2(2), 13-24. [in Thai]

Sripanidkulchai B, Fangkratok, N., Saralamp, P., and Soonthornchoreonnon, N. (2007). Mutagenicity and antimutaginicity tests of extracts from Thai traditional medicines. KKU Research Journal, 12(4), 492-498. [in Thai]

Sterne, J. A., Sutton, A. J., Ioannidis, J. P., Terrin, N., Jones, D. R., Lau, J., Carpenter, J., Rücker, G., Harbord, R. M., Schmid, C. H., Tetzlaff, J., Deeks, J. J., Peters, J, Macaskil, P., Schwarzer, G., Duval, S., Altman, D. G., Moher, D., and Higgins, J. P. (2011). Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials. BMJ, 343, d4002.

Surveswaran, S., Cai, Y. Z., Corke, H., and Sun, M. (2007). Systematic evaluation of natural phenolic antioxidants from 133 Indian medicinal plants. Food Chemistry, 102(3), 938-953.

Tabanca, N., Ma, G., Pasco, D. S., Bedir, E., Kirimer, N., Baser, K. H., Khan, I. A., and Khan S. I. (2007). Effect of essential oils and isolated compounds from Pimpinella species on NF-B: a target for antiinflammatory therapy. Phytotherapy Research, 21(8), 741-745.

Thamsermsang, O., Akarasereenont, P., Laohapand, T., and Panich, U. (2017). IL-1β-induced modulation of gene expression profile in human dermal fibroblasts: the effects of Thai herbal Sahatsatara formula, piperine and gallic acid possessing antioxidant properties. BMC Complement and Alternative Medicine, 17(1), 32.

Thippeswamy, N. B., and Naidu, K. A. (2005). Antioxidant potency of cumin varieties —cumin, black cumin and bitter cumin—on antioxidant systems. European Food Research and Technology, 220, 472-476.

Zhang, Y., DeWitt, D. L., Murugesan, S., and Nair, M. G. (2004). Novel lipid-peroxidation- and cyclooxygenase-inhibitory tannins from Picrorhiza kurroa seeds. Chemistry & Biodiversity, 1(3), 426-441.