Fibromyalgia (FM) is a clinical syndrome characterised primarily by chronic widespread pain and fatigue as well as a cluster of other symptoms including sleep disorders, cognitive dysfunction, irritable bowel and bladder, headaches and a variety of somatic complaints. Although its pathogenesis has yet to be fully clarified, most of the evidence points to a disorder of central pain modulation, impairments of the descending inhibitory system (serotoninergic, noradrenergic and opioid) and/or hypersensitivity or excitatory neurotransmitters such as substance P).
Treatment of fibromyalgia includes both non-pharmacological therapies and pharmacological interventions. Many patients respond well to exercise, and up to 50 percent of cases respond adequately to treatment with low dose amitriptyline. Various other medications used in controlled studies have been found to relieve symptoms of fibromyalgia including fluoxetine, gabapentin and tramadol. Patients are, however, extremely interested in alternative and complementary medicine for the treatment of this disease.
Panax ginseng is an herb that has been used for hundreds of years in Eastern Medicine. The principal active components of P. ginseng are the ginsenosides or triterpenoid saponins of ginseng. Some experimental studies have suggested that ginsenosides act on the central nervous system, particularly in neurodegenerative disorders. Recently, research from the University of Brasilia, Brazil, evaluated the efficacy of an extract of P. ginseng in patients with fibromyalgia (Women, aged 27-58) (2013). A randomised, double blind, controlled clinical trial was carried out over 12 weeks to compare the effects of p. ginseng (100 mg/day - 27 percent ginsenosides) with amitriptyline (25 mg/day) and placebo in 38 patients with fibromyalgia (13 participants in group I (amitriptyline; 13 in group II placebo; 12 in group III P. ginseng). Participants in the foregoing study completed a Visual Analog Scale (VAS) before and after the intervention, as a way to evaluate pain, fatigue, sleep quality and anxiety.
The results of the aforementioned study demonstrated that reductions in pain scores were found in the group using P. ginseng, from week 6 onwards when compared to pre-treatment scores. At week 6 there were reductions of 31.7 percent in mean pain scores, 35.6 percent at week 9 and 40 percent at week 12. When compared to amitriptyline, P. ginseng proved similar in effect, with mean pain scores for amitriptyline at week 6, 9 and 12 presenting as 25.4, 37.2, and 44.6 percent respectively. Moreover, there were statistically significant reductions in the mean scores for fatigue in the group that received P. ginseng, with a 25.9 percent improvement at week 3, a 39.3 percent improvement at week 9, and 46.5 percent by week 12. Interestingly, improvements in mean fatigue scores for the amitriptyline group at week 12 stood at 38.7 percent.
It is important to acknowledge that the foregoing study represents the first step in the evaluation of the effect P. ginseng can have in patients diagnosed with fibromyalgia. However, further studies are needed with larger sample sizes, that include both male and female participants. Following further evaluation, P. ginseng may represent an option for the treatment of acute/chronic pain and may constitute a future therapeutic option for patients with fibromyalgia.
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Mark Hinchey Naturopathy, 601 Glebe Road Adamstown, NSW, Australia.
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