Willow bark is the original source of aspirin, but when used as the entire herb it has been found to be much safer than aspirin and quite effective. The active ingredient is salicin, and willow bark has been shown to be effective in both osteoarthritis and back pain. People who are severely allergic to aspirin (e.g. those with aspirin-induced asthma or anaphylaxes, which is very unusual) should not use willow bark. Like aspirin and Celebrex®, it acts as a COX (Cyclooxygenase enzyme) inhibitor, decreasing inflammation. There is clearly a combination of other elements in willow bark that markedly enhance its effectiveness and safety — which can be a major benefit over aspirin and NSAIDs (e.g. Motrin®). Unfortunately aspirin and NSAIDs cause an enormous amount of gastritis and ulcer bleeding to the extent of killing 15,000 to 20,000 Americans yearly! To make matters worse, most of these medications increase heart attack and stroke risk by about 50 to 300%. The studies on willow bark are quite consistent in showing its effectiveness in reducing pain. Let’s look at some of the research.
In one study, 210 patients with severe chronic low back pain were randomly assigned to receive an oral willow bark extract, with either 120 mg (low-dose) or 240 mg (high-dose) of salicin, or placebo, in a 4-week blinded trial. In the last week of treatment, 39 percent of the group receiving high-dose extract were pain free; 21 percent of the group receiving low-dose extract were pain free; and only 6 percent of the placebo group were pain free. The response in the high-dose group was evident after only 1 week of treatment.2 Researchers then studied 451 patients who came in with low back pain in an open study, using salicin 240 mg, 120 mg, or standard orthopedic/NSAID care for 4 weeks. Forty percent of the patients in the 240 mg group and 19 percent in the 120 mg group were pain free after four weeks. In the standard treatment group, using standard medications, only 18 percent were pain free. The study showed that willow bark was not only far more effective and safer than standard prescription therapies, it also decreased the cost of care by approximately 40 percent!3
Another review found that willow bark extract has comparable anti-inflammatory activities as higher doses of acetylsalicylic acid/aspirin (ASS) and it reduces pain and fever as well. In pharmacologically active doses, no adverse effects on the stomach lining (e.g. indigestion, ulcers, etc) were observed, in contrast to aspirin.
A daily dose of willow bark extract standardized to 240 mg salicin per day was also significantly superior to placebo in patients with osteoarthritis of the hip and the knee. In two open studies against standard active treatments as controls, willow bark extract exhibited advantages compared to NSAIDs and was about as effective as Vioxx4 (but much safer). Another study found that willow bark (salicin 240 mg/day) was much more effective than placebo in treating arthritis (the normal wear and tear type called osteoarthritis) after only 2 weeks of therapy.5 Other references are also available for those of you who would like more information on willow bark.6-9
All of this makes willow bark a wonderful natural pain medicine. It is safe and effective for arthritis, back pain, and likely many other types of pain. I recommend beginning with enough to get 240 mg of Salicin a day until maximum benefit is seen. At that point, you may be able to lower the dose to 120 mg, or less, a day, or take it as needed.
2Chrubasik, S., et al. “Treatment of low back pain exacerbations with willow bark extract: a randomized double-blind study.” American Journal of Medicine, 2000 Jul; 109 (1): 9 – 14.
3Chrubasik, S., Kunzel, O., et al. “Potential economic impact of using a proprietary willow bark extract in outpatient treatment of low back pain: an open non-randomized study.” Phytomedicine, 2001 Jul;8(4): 241 – 51.
4Marz, R.W., Kemper, F. “Willow bark extract—effects and effectiveness. Status of current knowledge regarding pharmacology, toxicology and clinical aspects>” [Article in German] Wien Med Wochenschr, 2002;152(15-16): 354 – 9.
5Schmid, B., et al. “Efficacy and tolerability of a standardized willow bark extract in patients with osteoarthritis: randomized placebo-controlled, double blind clinical trial.” Phytother Res, 2001 Jun;15(4): 344 – 50.
6Highfield, E.S., Kemper, K.J. “White willow monograph.” Longwood Herbal Task Force. Accessed on June 7, 2004.
7Hedner, T., Everts, B. “The early clinical history of salicylates in rheumatology and pain.” Clinical Rheumatology, 1998; 17: 17 – 25.
8Chrubasik, S., Eisenberg, E. “Treatment of rheumatic pain with herbal medicine in Europe.” Pain Digest, 1998; 8: 231 – 6.
9Meier, B., Sticher, O., Julkunen-Tiitto, R. “Pharmaceutical aspects of the use of willows in herbal remedies.” Planta Medica 1988: 559 – 60.