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Musculoskeletal disorders (MSDs) are medical condition mostly caused by work related occupations and working environment, affecting patients’ muscles, joints, tendons, ligaments and nerves and developing over time. A community sample of 73 females and 32 males aged 85 and over underwent a standardised examination at home. Musculoskeletal pain was reported by 57% of those interviewed. A major restriction of joint movement range was frequent in the shoulder but uncommon in other joints(1).
Types of Musculo-Skeletal disorders in elder(2)
3. Rheumatoid Arthritis
4. Polymalagia Arthritis
5. Cervical myleopathy and spinal canal stenosis
7. Low back pain
Osteoarthritis (OA), a form of arthritis, is defined as a condition of as a result of aging causes of wear and tear on a joint, affecting over 25 million people in the United States in alone. University of Porto Medical School indicated that one must understand the differences in prevalence and incidence estimates of osteoarthritis (OA), according to case definition, in knee, hip and hand joints(3).
The characteristics of osteoarthritis are aching pain(5), stiffness(6), or difficulty of moving the joint or joints(7). The pain usually gets worse in change of weather, at night and in the advanced diseases, the pain can occur even at rest(8). Today management of osteoarthritis (OA) focuses on pain relief and improved physical function through pharmacological, non pharmacological, and surgical treatments(4).
B.2.2. Herbal and traditional Chinese medicine formulas
Phytodolor, a fixed herbal formulation containing alcoholic extracts of aspen leaves and bark (Populus tremula), common ash bark (Fraxinus excelsior), and golden rod herb (Solidago virgaurea), has been used for treatment in painful inflammatory or degenerative rheumatic diseases(483), probably due to its antiinflammatory, antioedematous, antioxidative and analgesic properties(483).
According to the University Hospital Zurich, in the review of the data base of randomized controlled trials (RCTs), STW1 can be used as non-steroidal anti-inflammatory drugs (NSAIDs) in relieving pain in patient with musculoskeletal disorders, including osteoarthritis(484). DR. Gundermann KJ and Dr., Müller J. in the study of painful inflammatory or degenerative rheumatic diseases, said" Phytodolor (STW 1) is a reasonable alternative to NSAIDs and to cyclooxygenase(COX)-2-inhibitors such as rofecoxib"(483) and "STW 1 has a high drug safety"(483) with little side effects(486).
Reumalex, is a herbal medicine formula containing 100 mg White Willow bark, 40 mg, Guaiacum Resin BHP, 35 mg Black Cohosh, 25 mg Extract of Sarsparilla and 17 mg Extract of Poplar Bark. In a 2 months without cross-over study, in 82 subjects with chronic arthritic pain, Dr. Mills SY and the research team at the University of Exeter showed that Reumalex, the herbal medicine improved the pain symptoms through its mild analgesic effect(487).
Gitadyl is another herbal medicine formula containing 110 mg feverfew, 90 mg American aspen and 60 mg milfoil(488). According to a double-blind, randomized, cross-over study conducted by Hvidovre Hospital, in comparison of the effectiveness of herbal formula Gitadyl and conventional medicine ibuprofen(490) in patients with osteoarthritis, researchers found that Gitadyl can be used for treatment of such as reduced pain(488) and working ability(488) of patient with osteoarthritis who are prone to bleeding or who develop gastrointestinal (GI) symptoms from NSAIDs(489),
Duhuo Jisheng Wan (DJW)or Duhuo Jisheng Tang (DJT) is a Chinese herbal formula containing over 18 individual herbs(501) has been used for treatment of knee osteoarthritis with limit scientific evidence(502), according to the Nestlé Research Center(503), but in a randomized, double-blind, double-dummy, controlled trial of a total of 200 patients suffering from OA of the knee, researcher at the Chiang Mai University, showed to improve walking pain, standing pain and stiffness, with approximately 30% of patients in both groups experienced mild adverse events(504).
The Taipei City Hospital study of Duhuo Jisheng Wan(DJW) also supported the effectiveness of the herbal formula in reduced pain, stiffness and improved physical functioning as well as other symptoms of degenerative osteoarthritis of the knee(502).
6. Huo-Luo-Xiao-Ling (HLXL) Dan
Huo-Luo-Xiao-Ling (HLXL) Dan is a Chinese herbal formula containing Ru Xiang (Boswellia carterii Birdw.), Mo Yao (Commiphora myrrha Engl.), Dang Gui (Angelica sinensis (Oliv.) Diels) and Dan Shen (Salvia miltiorrhiza Bge), used over thousands of year in Chinese history for treatment in alleviating pain caused rheumatoid arthritis (RA) and other inflammatory disorders(505)(508). On a Phase II clinical trial at Kernan Hospital of the University of Maryland School of Medicine, the herbal formula moderately inhibited hyperanalgesic (severe pain killing)(508) with no side effect in comparison to placebo(506) in patient with osteoarthritis OA. The phase II clinical trials also showed treatment of HLXL-Dan was not superior to placebo in pain relief or functional improvement in patients with knee OA if use only in 8 weeks(507).
SI Miao Fang is a herbal formula comprised of Phellodendri Chines Cortex, Atractylodis rhizoma, Coicis Semen, and Achyranthis bidentatae Radix used in traditional Chinese medicine for pain relief, due to inflammation and and analgesics(509) in patient with gouty arthritis(510) and rheumatoid arthritis(511). In osteoarthritic rat model, according to the China Academy of Chinese Medical Sciences, herbal formula inhibited expression of matrix metalloproteinases (MMPs) -3 and -13 and aggrecanases (ADAMTS) -4 and -5, induced OA causes of cartilage matrix degradation, by increasing proteoglycan and collagen content(512) through its interferes with secretion of pro-inflammatory cytokines and inflammatory mediators(512).
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(1) Prevalence of rheumatic symptoms, rheumatoid arthritis, ankylosing spondylitis, and gout in Shanghai, China: a COPCORD study by Dai SM1, Han XH, Zhao DB, Shi YQ, Liu Y, Meng JM.(PubMed)
(2) Musculoskeletal Disorders in the Elderly by Ramon Gheno, Juan M. Cepparo, Cristina E. Rosca,1 and Anne Cotten(PMC)
(3) The effect of osteoarthritis definition on prevalence and incidence estimates: a systematic review by Pereira D1, Peleteiro B, Araújo J, Branco J, Santos RA, Ramos E.(PubMed)
(4) Effect of therapeutic aquatic exercise on symptoms and function associated with lower limb osteoarthritis: systematic review with meta-analysis by Waller B1, Ogonowska-Slodownik A2, Vitor M3, Lambeck J4, Daly D5, Kujala UM6, Heinonen A7.(PubMed)
(5) Effects of therapeutic ultrasound on pain, physical functions and safety outcomes in patients with kneeosteoarthritis: A systematic review and meta-analysis by Zhang C1, Xie Y2, Luo X3, Ji Q3, Lu C3, He C4, Wang P3.(PubMed)
(6) Oral intake of purple passion fruit peel extract reduces pain and stiffness and improves physical function in adult patients with knee osteoarthritis by Farid R1, Rezaieyazdi Z, Mirfeizi Z, Hatef MR, Mirheidari M, Mansouri H, Esmaelli H, Bentley G, Lu Y, Foo Y, Watson RR.(PubMed)
(7) Functional ability, mobility, and pain before and after knee replacement in patients aged 75 and older: a cross-sectional study by Limnell K1, Jämsen E, Huhtala H, Jäntti P, Puolakka T, Jylhä M.(PubMed)
(8) The symptoms of OA and the genesis of pain by David J. Hunter, MBBS PhD,1,2 Jason J. McDougall, BSc PhD,3 and Francis J. Keefe4(PubMed)
(484) Phytodolor® in musculoskeletal disorders: re-analysis and meta-analysis by Uehleke B1, Brignoli R, Rostock M, Saller R, Melzer J.(PubMed)
(485) Selected CAM therapies for arthritis-related pain: the evidence from systematic reviews.
(487) Effect of a proprietary herbal medicine on the relief of chronic arthritic pain: a double-blind study by Mills SY1, Jacoby RK, Chacksfield M, Willoughby M.(PubMed)
(488) [Gitadyl versus ibuprofen in patients with osteoarthrosis. The result of a double-blind, randomized cross-over study].[Article in Danish]by Ryttig K1, Schlamowitz PV, Warnøe O, Wilstrup F.(PubMed)
(489) Gitadyl versus ibuprofen in patients with osteoarthritis: a double-blind, randomized, cross-over study of clinical efficacy and effects on platelets and PMNs by Mieszczak CI1, Kharazmi A, Rein J, Winther K.(PubMed)
(490) [Gitadyl versus ibuprofen].[Article in Danish] by [No authors listed](PubMed)
(494) [Comparative analysis on composition principles of traditional Chinese medicine prescriptions for osteoporosis and osteoarthritis].[Article in Chinese] by Zheng ZR, Tang SH.(PubMed)
(495) Complementary and Alternative Medicine Use Among Adults and Children: United States, 2007 by Patricia M. Barnes, M.A., and Barbara Bloom, M.P.A., Division of Health Interview Statistics, National Center for Health Statistics; and Richard L. Nahin, Ph.D., M.P.H., National Center for Complementary and Alternative Medicine, National Institutes of Health
(496) Chinese Herbal Bath Therapy for the Treatment of Knee Osteoarthritis: Meta-Analysis of Randomized Controlled Trials by Chen B1, Zhan H1, Chung M2, Lin X1, Zhang M1, Pang J1, Wang C3.(PubMed)