Bach Flower Remedies for psychological problems and pain: a systematic review.
BACKGROUND
Bach Flower Remedies are thought to help balance emotional state and are commonly recommended by practitioners for psychological problems and pain. We assessed whether Bach Flower Remedies (BFRs) are safe and efficacious for these indications by performing a systematic review of the literature.


METHODS
We searched MEDLINE, Embase, AMED, and the Cochrane Library from inception until June 2008 and performed a hand-search of references from relevant key articles. For efficacy, we included all prospective studies with a control group. For safety, we also included retrospective, observational studies with more than 30 subjects. Two authors abstracted data and determined risk of bias using a recognised rating system of trial quality.


RESULTS
Four randomised controlled trials (RCTs) and two additional retrospective, observational studies were identified and included in the review. Three RCTs of BFRs for students with examination anxiety, and one RCT of BFRs for children with attention-deficit hyperactivity disorder (ADHD) showed no overall benefit in comparison to placebo. Due to the number and quality of the studies the strength of the evidence is low or very low. We did not find any controlled prospective studies regarding the efficacy of BFRs for pain. Only four of the six studies included for safety explicitly reported adverse events.


CONCLUSIONS
Most of the available evidence regarding the efficacy and safety of BFRs has a high risk of bias. We conclude that, based on the reported adverse events in these six trials, BFRs are probably safe. Few controlled prospective trials of BFRs for psychological problems and pain exist. Our analysis of the four controlled trials of BFRs for examination anxiety and ADHD indicates that there is no evidence of benefit compared with a placebo intervention.
Thaler
Kylie
K
Department for Evidence-based Medicine and Clinical Epidemiology, Danube University, Krems, A-3500, Austria. kylie.thaler@donau-uni.ac.at
Kaminski
Angela
A
Chapman
Andrea
A
Langley
Tessa
T
Gartlehner
Gerald
G
D001007:Anxiety / Q000628:therapy*; D001289:Attention Deficit Disorder with Hyperactivity / Q000628:therapy; D000529:Complementary Therapies / Q000009:adverse effects; D035264:Flowers; D006801:Humans; D001523:Mental Disorders / Q000628:therapy*; D059408:Pain Management; D028321:Plant Preparations / Q000627:therapeutic use*; D010944:Plants; D016032:Randomized Controlled Trials as Topic
D028321:Plant Preparations