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Homoeopathic Arnica for the Treatment of Soft Tissue Injury


Complementary and Alternative Therapies Evidence-based Summary


Date of review: November 2004

Injuries from bumps, falls and other accidents can cause bruising and swelling to skin and muscles. A number of treatments are available to help reduce swelling and bruising, including icing of injured areas of skin and applying creams. Homoeopathic preparations, particularly flowers from the herb arnica montana (arnica), are also used by some for the treatment for bruises, sprains and sore muscles. This evidence summary identified one systematic review and 14 clinical trials (involving 1,275 people) that examined the effectiveness of homoeopathic arnica for the easing of pain, swelling and bruising caused by a variety of accidents.

View also in PDF format - Homeopathic arnica for the treatment of soft tissue injury (PDF, 65 KB)

Results summary


Overall, the results from the trials indicate that homoeopathic arnica has no clear effect on bruising, swelling, or pain after soft tissue injury. Side effects related to the use of homoeopathic arnica for the treatment of soft tissue injury tend to mild and reversible, and include stomach irritation, tiredness (lethargy), dry mouth, and headache. However, there is no clear difference in the proportion of people experiencing side effects who took homoeopathic arnica compared to those who took a placebo. Side effects related to the use of homoeopathic arnica in general tend to be mild and reversible, and include headaches, tiredness, skin eruptions, dizziness, diarrhoea, and/or the temporary worsening of symptoms (often referred to as “homoeopathic aggravation”). Severe and potentially lethal side effects are associated with the ingestion of the essential oil or the herb itself, and only the homoeopathic preparation of arnica is safe for oral use.

Background


Soft tissue injury


Falls, sudden forceful contact with a blunt instrument, and surgery often result in bleeding and inflammation deep in the muscle fibres. Symptoms of acute inflammation include pain, heat, redness, and swelling. Some bruising may also accompany this process. Although the inflammatory process is vital to the process of muscle regeneration and healing, it can cause further swelling, which can be detrimental to the healing process. The goal of treatment for such injuries is to minimize bleeding and control pain.

Arnica


Arnica (Arnica montana) is an alpine herb native to the mountains of Siberia and central Europe.1 Arnica grows from a cylindrical hairy bulb with a creeping underground stem.2 The flowers are scented and daisy-like, and have 10-14 bright rays each with three notches at the end.2 Arnica is also known as leopardsbane, wolfsbane, and Mountain tobacco.2 The flower head of arnica is the main part used in herbal medicine.2 Traditionally, arnica has been used as a herbal medicine throughout North America, Germany and Russia, since the 16th century.

Sesquiterpene lactones are considered the active constituents of arnica and are thought to help reduce inflammation (anti-inflammatory) and reduce pain (analgesic).2 Through this action, arnica helps improves the blood flow to areas of tissue damage, thereby assisting in the healing process.3 Arnica is also said to have some antibiotic activity. Arnica also contains two toxins, namely lobeline and myristic acid (found in the essential oil of arnica).2,3

Homoeopathy


Homoeopathy aims to stimulate the body’s own healing responses and is based upon three main principles, namely the principle of “similars”, the use of dilutions called “potencies”, and the totality of symptoms or “holism”.4,5 The principle of “similars” is the theory of treating like with like, in that people with particular signs and symptoms can be cured if given a drug that produces the same signs and symptoms in a healthy individual. The principle of “potencies” is the idea that remedies retain biological activity if they are repeatedly diluted and shaken.4 The principle of “holism” is that preparations are most effective when all symptoms are considered. For example, two people presenting with a cold but different symptoms would receive a different homoeopathic treatment. Preparation of homoeopathic products involves a method called “potentisation” (stepwise dilution), combined with “succussion” (vigorous shaking).6 In assessing the patient, homeopaths often take into account a range of physical, emotional and lifestyle factors in order to identify the best homoeopathic preparation (or “simile’). Many homeopaths also recommend changes to diet and lifestyle.7 The practice of homoeopathy is not currently regulated by legislation in New Zealand. Many homeopaths are affiliated with a selfregulating professional body (such as the New Zealand Council of Homeopaths).

Homoeopathic arnica


Homoeopathic practitioners often recommend the use of homoeopathic arnica to help improve the healing of tissues after falls, surgery and other injuries that result in bruising and bleeding.2 In addition, homoeopathic arnica is sometimes given before surgery, (including dental surgery) and childbirth to help reduce the severity of any expected soft tissue injury. The extremely dilute homoeopathic preparation of arnica is considered safe for internal use, but only in appropriate therapeutic dosages.

Evidence reviewed in this summary


Efficacy information


  • Systematic reviews: One systematic review on this topic was identified for this evidence summary.8 One other review was identified but this considered a variety of homoeopathic preparations for a number of disorders, and was therefore not included in this summary.4
  • Clinical trials: The above systematic review8 identified eight randomised, placebo-controlled trials in which 338 people were enrolled.9-16 Since this review was undertaken, six additional randomised placebo-controlled trials (involving 937 people) on this topic have been published17-22. No clinical trials of homoeopathic arnica for soft tissue injury are known to be currently underway (see www.controlled-trials.com).
  • Case-control studies/Cohort studies/Case studies: Given the extensive coverage of the above systematic review, no case-control, cohort or case series studies were assessed for this evidence summary.

Safety information


  • Systematic reviews: The systematic review identified above did not examine side effects related to the use of homoeopathic arnica, and no other systematic reviews were identified that specifically addressed this topic.8 However, two systematic reviews on the safety of homoeopathic medicines in general were identified.23,24One review focused on homoeopathy aggravations (the temporary worsening of symptoms), and identified 25 relevant randomized placebo-controlled trials, involving 3,437 people.23 The second review summarised all adverse effects related to homoeopathy published in English from 1970 to 1995, and identified 53 relevant studies.24
  • Clinical trials: Three of the 14 trials identified in the efficacy section above reported on side effects related to the use of homoeopathic arnica.18, 20, 21
  • Other studies: No further studies were identified that reported on side effects associated with the use of homoeopathic arnica for soft tissue injury. However, a general survey involving 1,025 users of homoeopathy across six European countries was identified that provided details on side effects of homoeopathy in general.25 Given the comprehensive information provided by the above studies, no further information on side effects was sought.

Evidence on efficacy


Evidence on the use of homoeopathic arnica for the treatment of soft tissue injury is available from one systematic review8, that included eight placebo-controlled trials (involving a total of 338 people.9-16 The subjects in the trials were being treated for soft tissue injury from a variety of causes including delayed onset of muscle soreness (DOMS)13,15 and the prevention of postsurgical complications9, 11, 14, 16. Two trials examined the effect of arnica on healthy volunteers after "experimentally inflicted mechanical bruising".10, 12 Arnica was administered orally in various potencies ranging from D2 (mother tincture diluted 1 in 10, twice) to M10 (diluted 1 in 1000, 10 times). The dose schedule also varied between the studies. The results from the systematic review8 indicate that:

There are few well-conducted clinical trials that examine the efficacy of arnica compared with placebo or any other treatment for soft tissue injuries (such as bruising and exercise-induced muscle soreness). Consequently, results found may be biased in some way.

Small numbers of patients were enrolled in the included trials (only one trial had more than 100 participants14), which makes it difficult to know if there are any important differences between homoeopathic arnica and placebo treatments for the treatment of pain and inflammation.

In general the well conducted studies yielded negative findings, either of no difference in effect between arnica and placebo or a difference favouring the placebo treatment.

There is little evidence that homoeopathic arnica is more effective than a placebo in relieving the pain associated with bruising and swelling.

There is no evidence to suggest that a particular potency of arnica or dose regimen is superior to another potency or dose regimen.

There is no evidence that homoeopathic arnica is more likely to benefit a particular patient group (e.g. those with bruises or injury to the limbs) over another (e.g. patients with bruising inflicted through abdominal or facial surgery).8

Six placebo-controlled clinical trials published after the systematic review was published, were also identified.17-22 These trials varied in the populations studied, and included long distance runners21 and patients undergoing surgery for carpal tunnel surgery18, 20, wisdom teeth removal19, abdominal hysterectomy17, and varicose veins.22 In addition, there were a variety of potencies (either the D6 or D30 preparations were used) and schedules of doses of arnica administered in the trials. The results from these five trials were consistent with the findings of the systematic review. Specifically, no significant difference between homoeopathic arnica and placebo was found for:

  • infection after abdominal hysterectomy17
  • grip strength and wrist circumference (a measure of swelling)18,20
  • pain after wisdom tooth removal19
  • swelling, and use of pain killers (analgesics) after surgery for carpal tunnel syndrome20
  • pain two days after endurance running21
  • bruising and pain after surgery on varicose veins.22

Evidence on safety


Findings from the three clinical trials reviewed for this summary18,20,21 indicate that:

Side effects associated with the use of homoeopathic arnica tend to be mild and reversible.

Two of the trials found no statistically significant difference between groups in the reporting of adverse events.
  • The largest trial, which enrolled 519 long distance runners, found 4.5% of runners who took homoeopathic arnica experienced side effects, compared to 6% of the patients who received the placebo21. The events reported included stomach irritation, tiredness (lethargy), headache and some musculoskeletal symptoms, some of which may also have been caused by the running itself.
  • In the second trial, eight (12.5%) of the 64 patients enrolled in the trial experienced side effects.20 Three patients who received arnica D30 reported dry mouth, throbbing in the head and neck, and headache, and two patients in the placebo group reported drowsiness and sore tongue.
The third trial found no adverse events in the study participants.18 No serious adverse events were reported by any of identified trials. In terms of side effects associated with the use of homoeopathy in general, a systematic review identified 12 relevant placebo-controlled clinical trials.24 Results from these trials showed that three in every 100 people taking a homoeopathic medication experienced at least one side effect. Side effects were minor and short-lived, and included headaches, tiredness, skin eruptions, dizziness, diarrhoea, and/or the temporary worsening of symptoms (often referred to as “homoeopathic aggravation”).24 A survey of 1,025 people receiving homoeopathy (of any type) found that 7.8% reported a “significant aggravation” and 25.4% reported a “slight aggravation” of their symptoms (which homeopaths believe is a positive sign that the correct remedy has been given – referred to as “proving”).25 However, results from a systematic review that specifically looked at homoeopathic aggravations found no difference in the proportion of aggravations reported by people taking placebo compared to those taking a homoeopathic treatment.23

It is important to note that the arnica herb and the essential oil made from the herb should not be eaten as an overdose of arnica extract can result in vomiting, diarrhoea, and excessive bleeding (haemorrhage).2 A number of publications state that deaths have occurred in people who have eaten the flowers or the arnica herb, although no documented evidence of these deaths could be located for this review.

Cited references


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  21. Vickers AJ, Fisher P, Smith C, Wyllie SE, Rees R. Homeopathic Arnica 30x is ineffective for muscle soreness after long-distance running: a randomized, double-blind, placebocontrolled trial. Clinical Journal of Pain 1998;14(3):227-31
  22. Wolf M, Tamaschke C, Mayer W, Heger M. Efficacy of Arnica in varicose vein surgery: results of a randomized, double-blind, placebo-controlled pilot study. Forschende Komplementarmedizin und Klassische Naturheilkunde 2003;10(5):242-7
  23. Grabia S, Ernst E. Homeopathic aggravations: a systematic review of randomised, placebocontrolled clinical trials. Homeopathy: the Journal of the Faculty of Homeopathy. 2003;92(2):92-8
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DISCLAIMER: This summary does not provide specific medical advice and the information provided should not be used as a substitute for seeking medical advice from a registered health practitioner.
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