title: Harpgophytum procumbens for osteoarthritis and low back pain: a systematic review.
abstract: BACKGROUND
  The objective of this review is to determine the effectiveness of Harpagophytum procumbens preparations in the treatment of various forms of musculoskeletal pain.
  
  
  METHODS
  Several databases and other sources were searched to identify randomized controlled trials, quasi-randomized controlled trials, and controlled clinical trials testing Harpagophytum preparations in adults suffering from pain due to osteoarthritis or low back pain.
  
  
  RESULTS
  Given the clinical heterogeneity and insufficient data for statistical pooling, trials were described in a narrative way, taking into consideration methodological quality scores. Twelve trials were included with six investigating osteoarthritis (two were identical trials), four low back pain, and three mixed-pain conditions.
  
  
  CONCLUSIONS
  There is limited evidence for an ethanolic Harpagophytum extract containing less than <30 mg harpagoside per day in the treatment of knee and hip osteoarthritis. There is moderate evidence of effectiveness for (1) the use of a Harpagophytum powder at 60 mg harpagoside in the treatment of osteoarthritis of the spine, hip and knee; (2) the use of an aqueous Harpagophytum extract at a daily dose of 100 mg harpagoside in the treatment of acute exacerbations of chronic non-specific low back pain; and (3) the use of an aqueous extract of Harpagophytum procumbens at 60 mg harpagoside being non-inferior to 12.5 mg rofecoxib per day for chronic non-specific low-back pain (NSLBP) in the short term. Strong evidence exists for the use of an aqueous Harpagophytum extract at a daily dose equivalent of 50 mg harpagoside in the treatment of acute exacerbations of chronic NSLBP.
authors.affiliation: Department of Health Policy Management and Evaluation, University of Toronto, Faculty of Medicine, Toronto, Canada. j.gagnier@utoronto.ca
authors.forename: Joel J
authors.initials: JJ
authors.lastname: Gagnier
authors.forename: Sigrun
authors.initials: S
authors.lastname: Chrubasik
authors.forename: Eric
authors.initials: E
authors.lastname: Manheimer
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D018771:Arthralgia / Q000628:therapy*; D002908:Chronic Disease; D006027:Glycosides / Q000627:therapeutic use*; D031684:Harpagophytum; D006801:Humans; D017116:Low Back Pain / Q000628:therapy*; D010003:Osteoarthritis / Q000628:therapy*; D010147:Pain Measurement; D008517:Phytotherapy; D010936:Plant Extracts / Q000627:therapeutic use*; D028321:Plant Preparations; D018517:Plant Roots; D011208:Powders; D011714:Pyrans / Q000627:therapeutic use*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D006027:Glycosides; D010936:Plant Extracts; D028321:Plant Preparations; D011208:Powders; D011714:Pyrans; C033249:harpagoside