A.Vogel Joint Pain Relief treats: Joint pain and inflammation Osteo-arthritic pain Gluten- and sugar-free Devils claw gets its name from the hooks that cover the fruits skin and that hang on animals hoofs, thus allowing the species to spread. Traditional African and European medicines use devils claw for its anti-inflammatory and analgesic properties as well as its tonic activity on liver and stomach. Traditionally, it is used for arthritis, gout, muscle pain of all types (myalgia), lumbago, etc. as well as for loss of appetite, liver disorders and dyspepsia. In African pharmacopoeia, devils claw is used for urinary and menstrual problems. Composition Each tablet contains: Medicinal ingredient: Devil’s Claw dry extract (Harpagophytum procumbens) Root (1.5–3.0:1) …480 mg, equivalent to 720–1440 mg root Non-medicinal ingredients: Lactose, corn starch, microcrystalline cellulose, hypromellose, silica, magnesium stearate, talc, titanium dioxide, Macrogol 6000. Dosage Adults: Take 1 tablet twice daily with water, before meals. Duration of use: Minimum 2 to 3 months. Actions and pharmacology Devils claw active principles are iridoids in the form of glycosides (harpagoside, harpagide, procumbine) or aglycone (harpagegine), as well as flavonoids (kaempferol, apigenine). A recent study evaluating the production of eicosanoids (inflammation mediators such as prostaglandins) found a very clear anti-inflammatory effect. It has been demonstrated that devils claw extract (particularly harpagosides) inhibits the synthesis of tromboxanes and leukotrienes.(1) It seems that devils claw extract also may have cardiac effects, which could limit its use in patients on heart medications. This effect has only been demonstrated in vitro and its actual relevance in humans has never been demonstrated.(2) Some authors also mention a hypoglycemic effect but no clinical data supports this affirmation. The German Commission E acknowledges the following uses: loss of appetite, dyspepsia, and supportive therapy of degenerative disorders of the locomotor system. The specific extract used in Atrosan demonstrated a potent anti-inflammatory effect in an in vitro study. In addition, the partial inhibition of the COX enzyme caused by this extract seems to have a beneficial effect on the kidney, contrary to non-specific synthetic anti-inflammatory medications.(3) Scientific studies Several well-designed clinical studies demonstrated the efficacy of devils claw in inflammatory disorders. A French double-blind randomized study compared a devils claw preparation and an anti-inflammatory agent (diacerhein) in 122 patients with hip and knee osteoarthritis over a period of 4 months. The devils claw extract proved as effective as the anti-inflammatory agent but had a much better tolerance and was safer.(4) A German 4-week study conducted on 197 patients with chronic back pain demonstrated that devils claw extract relieves and reduces exacerbation. Only few minor and transient gastro-intestinal side effects were reported.(5) Many clinical trials have confirmed the efficacy of tablets of harpagophytum dry extracts. For instance, researchers compared an extract of devils claw to a new generation anti-inflammatory medication, Vioxx®, at 12,5 mg daily. The extract was as effective as the medication to relieve low back pain.(6) In another study, the same researchers evaluated the efficacy of the extract not only for non-specific low back pain but also for osteo-arthritis of the knee and hip. Of the 227 patients following the protocol 70% reported a significant relief.(7) Two more trials used a devils claw extract similar to Atrosan. At the same dosage (480 mg twice daily) the harpagophytum extract proved effective for muscle pain: on the perception of pain as well as on inflammation. In addition no serious side effects were reported in either double blind randomized clinical trials.(8,9) Precautions, contraindications and interactions Consult a healthcare practitioner prior to use if you are pregnant or breastfeeding. Avoid taking in case of known allergy to any of the ingredients in the product. Consult a healthcare practitioner if symptoms persist or worsen. Do not use if safety seal is broken. Keep out of reach of children. References 1- Loew D, Mollerfeld J, Schrodter A et al. Investigations on the pharmacokinetic properties of Harpagophytum extracts and their effects on eicosanoid biosynthesis in vitro and ex vivo. Clin Pharmacol Ther 2001 May;69(5):356-64 2- Occhiuto F et al. A drug used in traditional medicine: Harpagophytum procumbens DC. IV. Effects on some isolated muscle preparations. J Ethnopharmacol 1985;13:201-8. 3- Kaszkin M, Degenring FH, Suter A et al. Anti-inflammatory Activity of The Newly Developed Harpagophytum procumbens Extracts. Poster presentation 6th ESCOP Symposium, Bonn 2001 4- Chantre P, Cappelaere A, Leblan D et al. Efficacy and tolerance of Harpagophytum procumbens versus diacerhein in treatment of osteoarthritis. Phytomedicine 2000 Jun;7(3):177-83 5- Chrubasik S, Junck H, Breitschwerdt H et al. Effectiveness of Harpagophytum extract WS 1531 in the treatment of exacerbation of low back pain: a randomized, placebo-controlled, double-blind study. Eur J Anaesthesiol 1999 Feb;16(2):118-29 6- Chrubasik S, Model A, Black A, Pollak S. A randomized double-blind pilot study comparing Doloteffin((R)) and Vioxx((R)) in the treatment of low back pain. Rheumatology (Oxford) 2003 Jan;42(1):141-8 7- Chrubasik S, Thanner J, Kunzel O et al. Comparison of outcome measures during treatment with the proprietary Harpagophytum extract doloteffin in patients with pain in the lower back, knee or hip. Phytomedicine 2000 Apr;9(3):181-94 8. Gobel H, Heinze A, Ingwersen M et al. [Effects of Harpagophytum procumbens LI 174 (devil's claw) on sensory, motor und vascular muscle reagibility in the treatment of unspecific back pain] [Article in German] Schmerz 2001 Feb;15(1):10-8 9- Laudahn D, Walper A. Efficacy and tolerance of Harpagophytum extract LI 174 in patients with chronic non-radicular back pain. Phytother Res 2001 Nov;15(7):621-4 10- Shaw D, et al. Traditional remedies and food supplements: a 5-year toxicological study (1991-1995). Drug Safety 1997;17:342-56. 11- The Complete German Commission E Monographs, Therapeutic Guide to Herbal Medicines. Blumenthal M et al. 1998. American Botanical Council, 6200 Manor Rd, Austin, Texas, 78723