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Homeopathic Arnica for Prevention of Pain and Bruising: Randomized Placebo-Controlled Trial in Hand Surgery

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Homeopathic arnica is widely believed to control bruising, reduce swelling and promote recovery after local trauma; many patients therefore take it perioperatively. To determine whether this treatment has any effect, we conducted a double-blind, placebo-controlled, randomized trial with three parallel arms. 64 adults undergoing elective surgery for carpal tunnel syndrome were randomized to take three tablets daily of homeopathic arnica 30C or 6C or placebo for seven days before surgery and fourteen days after surgery. Primary outcome measures were pain (short form McGill Pain Questionnaire) and bruising (colour separation analysis) at four days after surgery. Secondary outcome measures were swelling (wrist circumference) and use of analgesic medication (patient diary). 62 patients could be included in the intention-to-treat analysis. There were no group differences on the primary outcome measures of pain ( P=0.79) and bruising ( P=0.45) at day four. Swelling and use of analgesic medication also did not differ between arnica and placebo groups. Adverse events were reported by 2 patients in the arnica 6C group, 3 in the placebo group and 4 in the arnica 30C group. The results of this trial do not suggest that homeopathic arnica has an advantage over placebo in reducing postoperative pain, bruising and swelling in patients undergoing elective hand surgery.
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Homeopathic arnica for prevention of pain and bruising:
randomized placebo-controlled trial in hand surgery
CStevinson BSc MSc VSDevaraj FRCS FRCS(Plast)1A Fountain-Barber MCSP SRP1SHawkins MCSP SRP1
EErnst MD PhD
J R Soc Med 2003;96:60–65
SUMMARY
Homeopathic arnica is widely believed to control bruising, reduce swelling and promote recovery after local trauma;
many patients therefore take it perioperatively. To determine whether this treatment has any effect, we conducted a
double-blind, placebo-controlled, randomized trial with three parallel arms. 64 adults undergoing elective surgery
for carpal tunnel syndrome were randomized to take three tablets daily of homeopathic arnica 30C or 6C or placebo
for seven days before surgery and fourteen days after surgery. Primary outcome measures were pain (short form
McGill Pain Questionnaire) and bruising (colour separation analysis) at four days after surgery. Secondary outcome
measures were swelling (wrist circumference) and use of analgesic medication (patient diary).
62 patients could be included in the intention-to-treat analysis. There were no group differences on the primary
outcome measures of pain (P=0.79) and bruising (P=0.45) at day four. Swelling and use of analgesic medication also
did not differ between arnica and placebo groups. Adverse events were reported by 2 patients in the arnica 6C
group, 3 in the placebo group and 4 in the arnica 30C group.
The results of this trial do not suggest that homeopathic arnica has an advantage over placebo in reducing
postoperative pain, bruising and swelling in patients undergoing elective hand surgery.
INTRODUCTION
Homeopathy is based on the law of similars (‘like cures
like’) which states that a substance that causes specific
symptoms in a healthy person can be used to treat those
symptoms in a sick person. Remedies undergo a process
called ‘potentization’ which describes stepwise dilution
from the ‘mother tincture’ combined with ‘succession’
(vigorous shaking). The underlying assumption is that the
more dilute a remedy the greater its potency, even though
according to Avogadro’s number, with potencies beyond
12C (12 centesimal dilutions) the chance of a single
molecule remaining in the final solution tends to the
infinitesimal.
The alpine plant Arnica montana is recommended by
homeopathic practitioners for treating injuries on account of
its alleged ability to control bruising, reduce swelling and
promote recovery
1
. Homeopathic arnica is popular with
patients undergoing surgery, who hope it will reduce
postoperative complications. However, despite favourable
anecdotal reports
2
there is little scientific evidence of its
efficacy
3
. A reduction in the pain associated with routine
dental extractions has been reported in placebo-controlled
trials of homeopathic arnica
4–6
, but two double-blind
randomized trials demonstrated no effect on pain, swelling
or bleeding after surgical removal of impacted wisdom
teeth
7,8
. Other trials have shown no beneficial effects on
postoperative haematomas
9
or on recovery from hyster-
ectomy
10
, acute stroke illness
11,12
or childbirth
13
. Tenta-
tively positive results were reported from a small study in
patients with acute trauma
14
. A recent trial of homeopathic
arnica administered in conjunction with herbal arnica
ointment was reported to show no effect on swelling or
grip strength but a reduction in pain following carpal tunnel
release surgery
15
.
As well as producing inconsistent results, many of these
trials have methodological limitations that make the findings
unreliable. A rigorous trial on the subject would therefore
be valuable in determining whether homeopathic arnica can
aid recovery from surgery. This study was designed as a
preliminary investigation of the effect of this preparation on
sequelae of hand surgery. If a beneficial effect of arnica (or a
positive trend) was demonstrated, a larger trial would then
be started.
METHODS
All patients between the ages of 18 and 70 years undergoing
elective hand surgery for carpal tunnel syndrome by one
60
JOURNAL OF THE ROYAL SOCIETY OF MEDICINE Volume 96 February 2003
Department of Complementary Medicine, University of Exeter, 25 Victoria Park
Road, Exeter EX2 4NT; 1Department of Plastic & Reconstructive Surgery, Royal
Devon & Exeter Hospital, Barrack Road, Exeter EX2 5DW, UK
Correspondence to: Professor E Ernst
E-mail: Edzard.Ernst@pms.ac.uk
surgeon (VSD) at the Royal Devon & Exeter Hospital or a
private plastic surgery clinic were eligible for the trial.
Patients were excluded if they were currently taking
homeopathic remedies, reported previous hypersensitivity
to homeopathy, were taking aspirin, or were unable to
complete the study diary or attend follow-up appointments.
Patients were not included in the trial a second time if they
subsequently underwent surgery on their other hand.
Patients listed for elective surgery for carpal tunnel
syndrome were sent information and were invited to meet
the investigators to discuss the study; each patient’s general
practitioner was also informed. Patients who wished to
participate and who met the study criteria were allocated
the next available study number.
Patients received a medication bottle, identifiable only
by study number, containing either high (30C) or low (6C)
potency homeopathic arnica tablets or indistinguishable
placebo. Tablets were to be taken three times daily for
seven days preoperatively and fourteen days postopera-
tively. Patients were advised to refrain from handling the
tablets or from eating, drinking, smoking or brushing teeth
within 20 minutes of taking the tablets and were asked to
suck the tablets rather than simply swallow them.
Homeopathic and placebo tablets were supplied by A
Nelson & Co Ltd. Medication bottles were labelled with
study numbers derived from a computer-generated
randomization list in blocks of three by an individual not
involved with running the trial. The randomization list was
kept in a sealed envelope in a locked drawer until the end of
the trial. All patients and investigators, including the
surgeon, physiotherapists and data analysts, remained blind
to treatment allocation until after data analysis.
All patients were admitted as day cases and received
conventional preoperative and postoperative care. The
operations were done under local anaesthesia. Afterwards
the hand was rested on a palmar plaster splint to maintain
the wrist in slight dorsiflexion, allowing the fingers to be
gently mobilized within the dressing and the hand elevated
in a high sling. Oral analgesic medication, either
paracetamol or diclofenac, was routinely prescribed on
the hospital discharge form. All patients were seen by the
physiotherapist at four, nine and fourteen days post-surgery
(or the closest possible day). At day four the splint was
removed and digits and wrists were mobilized. A Futura
aluminium wrist splint was given to the patients to wear for
a further week. Sutures were removed at day fourteen.
The primary outcome measures were pain and bruising,
and the secondary measures were swelling and use of
analgesic medication. Pain was assessed with the short-form
McGill Pain Questionnaire (SF-MPQ)
16
completed by the
patient at recruitment (to provide a measure of pain from
carpal tunnel syndrome) and on days four, nine and
fourteen post-surgery. The SF-MPQ includes a visual
analogue scale (VAS)
17
to indicate the intensity of pain and a
list of fifteen descriptive words (e.g. stabbing, gnawing,
shooting). The VAS is sensitive to changes in pain
intensity
18
. The pain descriptors are each rated on a
4-point scale (0
=
none, 1
=
mild, 2
=
moderate, 3
=
severe)
yielding a total score ranging from 0 to 45. Patients kept a
daily pain diary throughout the trial, including VAS scores;
they also recorded use of analgesics and any adverse events.
To quantify bruising, a photograph of the patient’s wrist at
the distal crease was taken by the physiotherapist on days
four, nine and fourteen post-surgery under standard lighting
conditions. Scanned images were analysed with Adobe
Photoshop 4.0 software. For each patient, frames
representative of normal skin (thenar zone) and of the
bruised areas (operative site) were selected. The distribu-
tion of red and blue pixels within each frame was
calculated. This information, displayed as a histogram of
the number of pixels ( y-axis) against an increasing scale of
colour brightness from 0 to 255 (x-axis), enabled an
objective and quantitative comparison of the colour of the
bruised area with the colour of the normal skin. This
method was developed for objective measurement of burn
scar hypertrophy
19
and has been successfully used to assess
healing at skin graft donor sites
20
. For each patient the
extent of bruising was also assessed independently by two
plastic surgeons blind to treatment allocation on a 3-point
scale (0
=
none, 1
=
mild–moderate, 2
=
severe) as a check on
the validity of colour separation analysis in assessing
bruising.
To quantify swelling, wrist circumference was measured
at the distal wrist crease before anaesthetic infiltration and
on days four, nine and fourteen post-surgery. Three
readings were taken of each measurement. Adherence to
the study medication was assessed by tablet counts at the
end of the study. Patients were asked to tick boxes in the
study diary as a further record of tablet taking. The success
of patient blinding was assessed by a question in the study
diary on the last day of the trial, asking patients to indicate
which treatment they believed they had received (arnica,
placebo, don’t know).
Data analysis
The null hypothesis was that there would be no differences
between the arnica and placebo groups on the primary
outcome measures at day four. A search of the published
work yielded no reliable data from carpal tunnel surgery on
which to base a formal sample size calculation
21
. In previous
studies of arnica, statistically significant effects on pain have
been reported with groups of 11–30 patients
4,6,14,15
.
Because of the preliminary nature of the trial and the
number of patients expected to be available, a minimum
sample size of 60 was considered feasible.
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JOURNAL OF THE ROYAL SOCIETY OF MEDICINE Volume 96 February 2003
Since the data were not normally distributed, it was
necessary to employ non-parametric statistical tests. The
Kruskal–Wallis test (two-sided with 5% significance level)
was used to compare the three groups at days four, nine and
fourteen for pain (absolute scores), bruising (difference in
colour values between normal and bruised areas), and
swelling (change from pre-surgery values) and at day four
only for use of analgesic medication (total number of tablets
taken since surgery). Intention-to-treat analyses were
conducted on all randomized patients remaining in the
trial at the time of surgery. Missing data were replaced with
the median value of the total sample. Analyses were
performed in SPSS version 9.0 for Windows.
Ethical approval
The study protocol was approved by the Exeter Research
Ethics Committee. Approval was also obtained from the
Royal Devon and Exeter Healthcare NHS Trust. All
participants gave written informed consent.
RESULTS
The flow of patients through the trial is displayed in Figure
1. Of the 64 patients recruited to the trial, 62 were
included in the analysis. One patient in the arnica 6C group
did not undergo the scheduled surgery so was no longer
eligible for the trial and one patient from the arnica 30C
group withdrew from the study before undergoing surgery
because she believed that the tablets were causing her to
feel ‘unhappy or low’. 8 other patients reported adverse
events—3 in the placebo group (heartburn; sore throat and
flu-like symptoms; faintness and headache); 3 in the arnica
30C group (dry mouth; headache; feeling ‘throbby’ in
head/neck); 2 in the arnica 6C group (drowsiness; sore
tongue). Adherence was incomplete in all three groups. As
judged by tablet counts at the end of the trial, the number
of patients who had taken less than 90% of their tablets was
9/20 for the arnica 6C group, 7/22 for the placebo group
and 6/20 for the arnica 30C group. Self-reported adherence
was much higher, with only 2 patients indicating that they
had taken less than 90% of the tablets. In total there were
data missing at one or more timepoints on at least one
outcome for 10 patients—3 of these were from the arnica
6C group, 5 from the placebo group and 2 from the arnica
30C group. Patient blinding seemed to remain intact
throughout the study. 7/20 patients in the arnica 6C group,
3/22 in the placebo group and 7/20 in the arnica 30C
group correctly identified their treatment allocation at the
end of the trial. The randomization procedure resulted in
similar patient characteristics in each group for most
variables (Table 1). However, the arnica 6C group
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JOURNAL OF THE ROYAL SOCIETY OF MEDICINE Volume 96 February 2003
Figure 1 Trial flow
Table 1 Patient characteristics
Arnica 6C (n=20) Placebo (n=22) Arnica 30C (n=20)
M/F 8/12 2/20 3/17
Age [years] 51.0 (30–68) 51.0 (33–57) 47.5 (30–68)
Left/right wrist 8/12 6/16 6/14
NHS/private 19/1 21/1 19/1
Wrist circumference [mm] 162.0 (140–202) 160.0 (140–190)* 163.0 (144–190)
Carpal tunnel syndrome pain
SF-MPQ VAS [0–100] 3.0 (0–71) 20.0 (0–69)* 27.5 (0–68)
SF-MPQ descriptors [0–45] 2.0 (0–18){3.5 (0–24)* 6.5 (0–19)
Values are median (range) unless specified
*data missing from one patient (n=21)
{data missing from one patient (n=19)
SF-MPQ=short form McGill Pain Questionnaire; VAS=visual analogue scale; C=centesimal dilution
contained more male patients and had lower VAS scores
for carpal tunnel syndrome pain than the other two
groups.
Results of the primary outcome measures of pain and
bruising are presented in Tables 2 and 3. Postoperative pain
did not differ between the groups at day 4 according to VAS
scores (w
2
=
4.81, d.f.
=
2, P
=
0.79) or MPQ descriptor scores
(w
2
=
2.48, d.f.
=
2, P
=
0.29). Similarly, bruising did not differ
between the groups at day 4 in terms of blue (w
2
=
1.61,
d.f.
=
2, P
=
0.45) or red (w
2
=
3.89, d.f.
=
2, P
=
0.14) channel
brightness. The null hypothesis was therefore accepted.
There was support from the results of the secondary
outcome measures of swelling and use of analgesic
medication, which are presented in Tables 4 and 5 and
Figure 2. Neither swelling (w
2
=
1.25, d.f.
=
2, P
=
0.54) nor
number of tablets (w
2
=
1.63, d.f.
=
2, P
=
0.44) differed
between the groups at day four. The only group difference
that approached statistical significance was on the MPQ
descriptors total score (w
2
=
6.72, d.f.
=
2, P
=
0.04) where the
placebo group had lower scores than the arnica 30C group
at day nine (U
=
122.0, P
=
0.01, Mann–Whitney U test).
Figure 3 displays the daily pain VAS scores from the study
diary.
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JOURNAL OF THE ROYAL SOCIETY OF MEDICINE Volume 96 February 2003
Table 2 Postoperative pain
Arnica 6C (n=20) Placebo (n=22) Arnica 30C (n=20)
MPQ-SF VAS score [0–100]
Day 4 10.5 (0–76) 16.0 (0–69) 15.0 (0–82)
Day 9 6.0 (0–31) 3.5 (0–35) 8.0 (0–49)
Day 14 0.0 (0–28) 2.0 (0–41) 8.5 (0–45)
MPQ-SF descriptors [0–45]
Day 4 2.0 (1–16) 3.0 (0–10) 5.0 (0–24)
Day 9 2.0 (0–8) 1.0 (0–10) 3.0 (0–20)
Day 14 0.5 (0–7) 1.0 (0–6) 3.0 (0–13)
All values are median (range)
See Table 1 for key to abbreviations
Table 3 Postoperative bruising
Arnica 6C (n=20) Placebo (n=22) Arnica 30C (n=20)
Change in blue channel brightness [0–255]*
Day 4 26.0 (740–59) 28.5 (71–75) 22.0 (714–92)
Day 9 15.5 (733–61) 15.5 (718–62) 11.25 (730–81)
Day 14 11.5 (721–69) 12.0 (721–61) 12.5 (732–49)
Change in red channel brightness [0–255]*
Day 4 12.5 (712–39) 12.5 (2–57) 20.0 (78–60)
Day 9 13.0 (717–69) 13.0 (77–50) 13.5 (722–52)
Day 14 14.5 (717–50) 18.0 (77–55) 17.5 (716–42)
Clinician rating (none; mild–moderate; severe) [n]{
Day 4 5;12;3 3;13;6 5;12;3
Day 9 3;14;3 4;13;5 5;14;1
Day 14 4;16;0 6;15;1 6;13;1
*Values are median (range) change from normal skin
{Ratings from two clinicians with highest value used if d iscrepant
C=centesimal dilution
Figure 2 Postoperative use of analgesic medication. Arnica 6C;
placebo; &arnica 30C
DISCUSSION
Despite its reputation as a useful intervention for preventing
the effects of anticipated trauma (e.g. surgery) or for
treating unexpected trauma (e.g. accidental injury),
homeopathic arnica was no better than placebo in reducing
postoperative complications. These results are compatible
with the negative findings from other studies
7–10,11–13,15
.
This trial was designed to be a methodologically
rigorous investigation of the specific effects of two potencies
of homeopathic arnica. Attempts were made to select
outcome measures that were objective and/or adequately
validated. In particular, by employing colour separation
analysis it was intended to assess bruising in a more
objective quantitative manner than previous studies that
have relied only on crude and subjective ratings
9,22
.
These results do not support the routine use of
homeopathic arnica for preventing or reducing post-
operative complications such as bruising, swelling and pain.
However, they do not rule out the possibility that individual
patients could benefit. Homeopathic practitioners identify
specific patient characteristics (e.g. fear of being touched,
denial of illness, difficulty sleeping due to a hard bed,
anxious dreams
2
) that help predict who will respond to
arnica. This trial did not apply traditional homeopathic
principles in this way. However, in one trial of surgical
patients where the homeopathic remedy was chosen to
match the patient’s constitution, arnica was selected in 21
of 24 cases and no differences from placebo were
demonstrated
8
.
The use of non-parametric tests reduces the likelihood
of detecting statistical differences since they are less
powerful than parametric tests particularly with smaller
samples. However, a type II error does not appear to
account for the results of this trial, where differences
between groups are so small that they would have no
clinical relevance even if statistically significant. Further-
more, there is no clear trend or consistent pattern that
favours any of the interventions, indicating that measure-
ment and random error can explain any perceived
differences.
Poor adherence to the trial regimen was seen in over
one-third of the sample. However, it seems unlikely that
this explains the lack of difference between arnica and
placebo since homeopathic practitioners often recommend
64
JOURNAL OF THE ROYAL SOCIETY OF MEDICINE Volume 96 February 2003
Table 4 Postoperative swelling
Arnica 6C (n=20) Placebo (n=22) Arnica 30C (n=20)
Change in wrist circumference [mm]
Day 4 6.0 (72–12) 4.0 (74–14) 5.0 (72–14)
Day 9 4.0 (74–12) 4.0 (76–16) 6.0 (0–11)
Day 14 4.0 (76–8) 4.0 (74–14) 5.0 (72–10)
All values are median (range) change from preoperative measurement
C=centesimal dilution
Table 5 Postoperative use of analgesic medication
Arnica 6C (n=20) Placebo (n=22) Arnica 30C (n=20)
Day 0 (surgery) 3.5 (2–8) 4.0 (2–10) 3.5 (0–10)
Day 1 2.5 (0–12) 6.0 (0–18) 6.0 (0–14)
Day 2 1.1 (0–10) 1.5 (0–10) 4.0 (0–12)
Day 3 0.0 (0–8) 0.0 (0–6) 2.0 (0–12)
Day 4 0.0 (0–10) 0.0 (0–6) 0.0 (0–8)
Total 10.0 (2–46) 14.5 (2–44) 16.0 (2–50)
All values are median (range) number of tablets
C=centesimal dilution
Figure 3 Postoperative pain. Arnica 6C; placebo;
arnica 30C
that a single dose of arnica before and after surgery is
sufficient to hasten recovery
2
. From the study diaries it
seems that more tablets were missed in the latter days of the
trial when patients are likely to have fully recovered.
A final point to consider in attempting to explain the
lack of difference between arnica and placebo groups is the
surgical model used in this trial. There was little bruising,
pain and swelling in any of the groups, so perhaps the skill
of the surgeon offered little scope for arnica. However,
arnica is reputed to be effective in every case of trauma,
however slight
2
; some of the rigorous trials cited above
have tested arnica in bigger operations without significant
effects
7–13
. Conversely, it might also be argued that major
tissue injury is too severe to benefit from the subtle effects
of homeopathy; the present choice of surgical model
represented a compromise between minor and major
trauma.
In view of the ineffectiveness of homeopathic arnica
observed in this and other trials, how can we account for its
remarkable reputation for healing injury? The probable
explanation is positive selection bias. Some patients recover
very quickly from surgery. If those taking arnica attribute
their good recovery to the homeopathic remedy and this
apparent association is widely reported, it is easy to see how
the reputation can build. Since the experiences of patients
who recover well without taking arnica and those who
receive no benefit from arnica are less likely to be reported,
the myth becomes reinforced.
Acknowledgments
We thank Joanne Barnes for her
assistance in designing this trial, Chris Stone for his help
with the colour separation analysis and Theresa Sheldon
who collected data for this trial. Funding was provided by
the Dr Susil Kumar and Jamila Mitra Charitable Trust
(UK); homeopathic and placebo tablets were supplied by A
Nelson & Co Ltd.
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JOURNAL OF THE ROYAL SOCIETY OF MEDICINE Volume 96 February 2003
... They found that patients who received the Arnica treatment suffered greater pain compared to patients treated with a placebo [23]. Several other trials reported that therapy with Arnica had no evidence of effects on pain relief after surgical procedures, even though it showed improvement on other symptoms related to the operation [16,[24][25][26]. Patients undergoing elective surgery for carpal tunnel syndrome were treated with Arnica or a placebo for seven days before surgery and fourteen days after surgery [24]. ...
... Several other trials reported that therapy with Arnica had no evidence of effects on pain relief after surgical procedures, even though it showed improvement on other symptoms related to the operation [16,[24][25][26]. Patients undergoing elective surgery for carpal tunnel syndrome were treated with Arnica or a placebo for seven days before surgery and fourteen days after surgery [24]. Compared to the placebo group, the results showed no improvement for Arnica in reducing patients' post-operative pain [24,27]. ...
... Patients undergoing elective surgery for carpal tunnel syndrome were treated with Arnica or a placebo for seven days before surgery and fourteen days after surgery [24]. Compared to the placebo group, the results showed no improvement for Arnica in reducing patients' post-operative pain [24,27]. Cornu et al. also found that Arnica combined with Bryonia did not relieve pain after the cardiac surgery [25]. ...
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An epididymal cyst is a scrotal complaint that is usually resolved by surgery. However, multiple post-surgical complications are common, including recurrence, hematoma, abscess, and chronic scrotal swelling. This case study presents homeopathic medicine managing a fairly large-sized epididymal cyst which might encourage physicians to rethink surgical options. A 24 years male presented with pain in the lower pelvic region and swelling in the scrotum; an ultra-sonogram of the scrotum diagnosed a 2.8 cm × 1.9 cm sized epididymal cyst, and Fine Needle Aspiration Cytology (FNAC) confirmed that it was a spermatocele. He was prescribed homeopathic medicine, i.e., Arnica montana, Calcarea fluorica, and Calcarea phosphorica, for his spermatocele. After seven weeks of homeopathic treatment, the cyst size was reduced to 4.8mm×2.2mm. This case study concludes that homeopathic medication resulted in a significant outcome. It also encourages the consideration of homeopathic remedies as an alternative to surgery in treating epididymal cysts.
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Background: Cellulite 80%-98% of post-pubertal women and results in cutaneous dimples in the affected area. Aims: Therapies that target collagenous fibrous septae often provide successful outcomes. Materials & methods: Collagenase clostridium histolyticum-aaes (CCH) for injection consists of two collagenases which, under physiologic conditions, disrupt collagen structures by hydrolyzing Type I and III collagen. Results: Subcutaneous CCH was approved in the United States in 2020 for the treatment of moderate-to-severe cellulite in the buttocks of adult women. Although bruising is primarily an aesthetic concern, a conspicuous procedure-induced bruise may limit a patient's social activities and result in hesitation to undergo a similar cosmetic procedure in the future. Conclusion: The purpose of this review is to describe the available techniques for hastening bruise resolution and how they apply to resolving bruises associated with a CCH injectable.
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This commentary examines the utility of arnica in cosmetic dermatology. For many years, arnica has been used to reduce the morbidity associated with various procedures, including surgeries and treatments with laser and other energy-based devices. Arnica is a traditional homeopathic remedy that can reduce post-procedural edema and bruising. Although it has been used clinically by many physicians and is widely and readily available to patients, the available data is limited and often conflicting. We reviewed the relevant information on arnica and offer our own insights into its use in order to shed more light on its peri-procedural utility.
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Background Arnica montana containing helenalin as its principal active constituent, is the most widely used plant to treat various ailments. Recent studies indicate that Arnica and helenalin provides significant health benefits, including anti-inflammatory, neuroprotective, antioxidant, cholesterol-lowering, immunomodulatory and most important, anticancer properties. Objective The objective of the present revie w is to overview the recent patents of Arnica and its principal constituent helenalin, including new methods of isolation, and their use in the prevention of cancer and other ailments. Methods Current prose and patents emphasizing the anticancer potential of helenalin and Arnica, incorporated as anti-inflammary agent in anticancer preparations have been identified and reviewed with particular emphasis on their scientific impact and novelty. Results Helenalin has shown its anticancer potential to treat multiple types of tumors, both in vitro and in vivo. It has also portrayed synergistic effects when given in combination with other anticancer drugs or natural compounds. New purification/isolation techniques are also developing with novel helenalin formulations and its synthetic derivatives have been developed to increase its solubility and bioavailability. Conclusion The promising anticancer potential of helenalin in various preclinical studies may open new avenues for therapeutic interventions in different tumors. Thus clinical trials validating its tumor suppressing and chemopreventive activities particularly in conjunction with standard therapies, are immediately required.
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Introduction. Тhe search for drugs that accelerate the process of resolving post-traumatic reactive changes, which have both sufficient anti-edema and anti-inflammatory effects, and reparative properties, is relevant. Goal of reserch. The purpose of this review is to find a means to speed wound healing after nasal traumas. Materials and methods. The researchers conducted an analysis of scientific research data to evaluate the efficacy of naturopathic mountain arnica-based remedies for the treatment of patients with an external nose trauma accompanied by the formation of edema, hematoma of lateral nasal wall and/or skin abrasions of external nose. Results. This work shows that topical plant remedies based on Аrnicamontana has a pronounced anti-inflammatory and antiedema effect, comparable to the traditionally used for this purpose heparin-containing ointments and gels. However, unlike the latter, products based on Arnica montana have a pronounced wound- healing effect, which allows to significantly reduce the time to resolve traumatic injuries of the skin of the external nose. The analysis of the work also demonstrates the absence of adverse reactions when using this drug. Conclusion. The obtained data allow us to recommend topical naturpathic remedies based on Arnicamontana for use as a firstchoice drug for wound healing after nasal traumas. In addition, the drug is effective in the complex treatment of patients with nasal trauma requiring surgical intervention: at the preoperative stage - to reduce post-traumatic reactions and prepare for surgery, and at the postoperative stage - for the early recovery, reducing edema and inflammation.
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To examine whether homoeopathy has any effect on pain and other inflammatory events after surgery. Randomised double blind, placebo controlled crossover trial with "identical" oral surgical procedures performed on two separate occasions in 24 patients. Treatment started 3 hours after surgery with either homoeopathy or placebo. Postoperative pain and preference for postoperative course assessed by patients on visual analogue scales. Measurements of postoperative swelling and reduction in ability to open mouth. Assessment of bleeding after surgery. Pain after surgery was essentially the same whether treated with homoeopathy or placebo. Postoperative swelling was not significantly affected by homoeopathy, but treatment tended to give less reduction in ability to open mouth. No noticeable difference was seen in postoperative bleeding, side effects, or complaints. Thirteen of the 24 patients preferred the postoperative course with placebo. No positive evidence was found for efficacy of homoeopathic treatment on pain and other inflammatory events after an acute soft tissue and bone injury inflicted by a surgical intervention. Differences in the order of 30% to 40% would have been needed to show significant effects.
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Background The efficacy of homeopathic remedies has remained controversial. The homeopathic remedy most frequently studied in placebo-controlled clinical trials is Arnica montana. Objective To systematically review the clinical efficacy of homeopathic arnica. Materials and Methods Computerized literature searches were performed to retrieve all placebo-controlled studies on the subject. The following databases were searched: MEDLINE, EMBASE, CISCOM, and the Cochrane Library. Data were extracted in a predefined, standardized fashion independently by both authors. There were no restrictions on the language of publications. Results Eight trials fulfilled all inclusion criteria. Most related to conditions associated with tissue trauma. Most of these studies were burdened with severe methodological flaws. On balance, they do not suggest that homeopathic arnica is more efficacious than placebo. Conclusion The claim that homeopathic arnica is efficacious beyond a placebo effect is not supported by rigorous clinical trials.
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A short form of the McGill Pain Questionnaire (SF-MPQ) has been developed. The main component of the SF-MPQ consists of 15 descriptors (11 sensory; 4 affective) which are rated on an intensity scale as 0 = none, 1 = mild, 2 = moderate or 3 = severe. Three pain scores are derived from the sum of the intensity rank values of the words chosen for sensory, affective and total descriptors. The SF-MPQ also includes the Present Pain Intensity (PPI) index of the standard MPQ and a visual analogue scale (VAS). The SF-MPQ scores obtained from patients in post-surgical and obstetrical wards and physiotherapy and dental departments were compared to the scores obtained with the standard MPQ. The correlations were consistently high and significant. The SF-MPQ was also shown to be sufficiently sensitive to demonstrate differences due to treatment at statistical levels comparable to those obtained with the standard form. The SF-MPQ shows promise as a useful tool in situations in which the standard MPQ takes too long to administer, yet qualitative information is desired and the PPI and VAS are inadequate.
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A double blind trial, was designed, in which 118 patients undergoing the removal of impacted wisdom teeth were randomly divided into the following groups; 41 patients received Metronidazole, 39 patients received Arnica Montana, 38 patients received the placebo. Metronidazole was more effective in pain control than Arnica (p less than 0.001) and placebo (p less than 0.01). It prevented swelling better than Arnica (p less than 0.01) and placebo (p less than 0.05) and was more effective in promoting healing than Arnica (p less than 0.01) and placebo (p greater than 0.02). Arnica Montana appeared to give rise to greater pain than placebo (p less than 0.05) and caused more swelling than the placebo (p less than 0.01).