This herb’s name definitely stimulates the imagination, but imagination may not be far from reality: devil’s claw produces a hard fruit with large claw like appendages that lie waiting for a passerby on which to grip and hitch a ride for dispersal, only to eventually work its way into or tear out of the skin of its host. It is native to South Africa {though unrelated “devil’s claws” are found in Noith America) and traditional healers have used it to reduce pain and inflammation. Today, its anti-inflammatory attributes are being confirmed by science, and it is primarily used as an herb for the pain and inflammation of arthritis and back pain. The German Commission E has approved its claims for “degenerative disorders of the locomotor system” (Bltimenthal et al., 11J98).

Preclinical and clinical studies showed mixed results, indicating that perhaps only certain types of inflammatory disease benefit from devil’s claw (Chrubasik el al., 2003). More recent clinical data, however, have indicated a benefit for back pain and osteoarthritis of die knee and hip (Chantre el al., 2000).

In a randomized, double-blind, double-placebo clinical study involving patients with low back pain, Chrubasik et al. (2003) compared a devil’s claw extract (Dolotcffin) totheCOX-2 inhibitor rofecoxib. Fifty eight patients were split into two groups and given either devil’s claw extract (60 mg/day) or rofecoxib (12.5 mg/day) for 6 weeks. Rescue medication of’100 mg/day of tramadol was allowed all participants. No significant differences between outcome measures were observed, but there was a trend toward greater pain reduction and fewer side effects from the devil’s claw group.

A postmarketing survey was performed to assess die safety and efficacy of a proprietary devil’s claw extract (Doloteffin) in 227 people suffering from back pain or osteoarthritis pain of the knee or hip. The parameters measured were several validated and unvalidated measures of pain and for joint, low back, and arthritis pain.

Symptoms. The authors concluded that 50-70% of the participants benefited from the treatment with Doloteffin, and that both the generic and disease-specific outcomes improved in all groups. Few adverse effects were reported, with 10% found to be possibly caused by Doloteffin (Ghrubasik et al., 2002a, 2000b).

Gobel et a!. (2001) examined the effect of devil’s claw extract (480 mg of Rivoltan 2 times a day or placebo for 4 weeks) in a randomized, double-blind, placebo-controlled study on people with slight to moderate muscular tension or slight muscular pain of the back, shoulder, and neck. The treatment group showed clear improvement in clinical global scores and in patient and physician subjective ratings. Highly significant results were found in the test measures of the visual analogue scale, pressure algometry test, muscle stiffness test, and muscular ischemia test. The mechanism of action of the extract was reported to have an influence on sensor)’ and vascular muscular response and to reduce muscle stiffness without affecting the central nervous system. No serious adverse effects were noted, and tolerability was good.

Patients suffering from nonradicular back pain were studied in an open, multicenter study of devil’s claw extract (480 mg of Rivoltan 2 times a day for S weeks). Significant improvement of pain symptoms and mobility were found (using die multidimensional pain scale, Arhus back pain index, finger-floor distance, and Schober’s sign). No serious side effects were found, and the authors reported that iL appeared to be an excellent herbal alternative for chronic back pain, though further studies were needed (Laudahn and Walper, 2001).

A double-blind, randomized, multicenter, comparison study was performed on a 4-month treatment of Harpadol (six 435-mg capsules per day) versus diacerhein (100 mg/day) in 122 patients with knee and hip osteoarthritis. Although there were no significant differences between the two groups in efficacy, by the end of the study, patients in the devil’s claw treatment group were using significantly less of other pain medications and had fewer reported adverse effects. The authors concluded that Harpadol is safer than and equally as effective as diacerhein (Chantre et al., 2000; Ghrubasik et al., 2002a, 2002b). A similar study vas performed to compare the efficacy of devil’s claw extract versus diacerhein, and after 4 months of treatment, the same overall results vere found. The devil’s claw extract showed similar efficacy for knee and hip osteo arthritis and fewer side effects than diacerhein, and the need for other pain medications was reduced in the devil’s claw group (Leblanetal., 2000).

In a randomized, double-blind study involving 197 patients with chronic back pain, two doses of devil’s claw extract (1531, 600 and 1,200 mg containing 50 and 100 mg of the marker compound larpagoside, respectively) were compared with a placebo over 4 weeks of treatment. Using the principal outcome measure of die number of patients free from pain without using the rescue medication (tramadol), the results were 3 for the placebo group, 6 for the 600-mg group, and 10 for the 1,200-mg group. Using analysis based on the Arhus back pain index, however, the 600-mg group showed more benefits. The only minor reported side effects were mild and infrequent gastrointestinal upset (Chrubasik et al, 1999).

The typical dosage of devil’s claw extract is between 600 and 6,000 mg/day (standardized between 1% and 3% of iridoid glycosides, often calculated as harpagosidc), taken in divided doses. Only mild side effects of transitory gastrointestinal upset have been reported, if any. Because devil’s claw extract is able to stimulate gastric acid secretion, it is not recommended for people with ulcers.

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