Multi-ingredient herbal topical preparations for the management of pain in osteoarthritis: A perspective from Persian Medicine

Document Type : Review Article

Authors

1 Medicinal Plants Processing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

2 Department of Phytopharmaceuticals (Traditional Pharmacy), School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran

3 Department of Pharmaceutics, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran.

10.30476/tips.2025.107884.1308

Abstract

Osteoarthritis is one of the most common diseases worldwide today. Inflammation and pain caused by osteoarthritis greatly interfere with daily activities for those affected. Although many painkillers and medications are available in the pharmaceutical market for this condition, they often only offer temporary relief from joint pain and inflammation. They can also come with systemic side effects and pose challenges for long-term use in many patients. Accordingly, most patients prefer to use topical treatments that target specific areas of discomfort. In addition to pharmaceutical options, various topical herbal formulations for alleviating osteoarthritis symptoms can be found in traditional pharmacological literature. Persian Medicine, as a school with a thousand years of experience, is a significant source for drug discovery and the extraction of many medicinal formulations. In this regard, the current study aims to compile a collection of topical herbal formulations in the form of multi-ingredient herbal topical preparations from traditional pharmaceutical textbooks, such as Qarābādin Salehi, Azam, and Kabir. The selected preparations can be reformulated for evaluation in the management of osteoarthritis. 

Highlights

Mohammad M. Zarshenas (Google Scholar)

Amir Azadi (Google Scholar)

Keywords

References

1.    Sarzi-Puttini P, Cimmino MA, Scarpa R, Caporali R, Parazzini F, Zaninelli A, Atzeni F, Canesi B. Osteoarthritis: an overview of the disease and its treatment strategies. Semin Arthritis Rheum. 2005 Aug;35(1 Suppl 1):1-10. doi: 10.1016/j.semarthrit.2005.01.013. PMID: 16084227. 
2.    Miller RE, Miller RJ, Malfait AM. Osteoarthritis joint pain: the cytokine connection. Cytokine. 2014 Dec;70(2):185-93. doi: 10.1016/j.cyto.2014.06.019. Epub 2014 Jul 24. PMID: 25066335; PMCID: PMC4254338. 
3.    Wood MJ, Miller RE, Malfait AM. The Genesis of Pain in Osteoarthritis: Inflammation as a Mediator of Osteoarthritis Pain. Clin Geriatr Med. 2022 May;38(2):221-238. doi: 10.1016/j.cger.2021.11.013. PMID: 35410677; PMCID: PMC9053380.
4.    Hawker GA. Osteoarthritis is a serious disease. Clin Exp Rheumatol. 2019 Sep-Oct;37 Suppl 120(5):3-6. Epub 2019 Oct 14. PMID: 31621562.
5.    Tang S, Zhang C, Oo WM, Fu K, Risberg MA, Bierma-Zeinstra SM, et al. Osteoarthritis. Nat Rev Dis Primers. 2025 Feb 13;11(1):10. doi: 10.1038/s41572-025-00594-6. PMID: 39948092.
6.    Lohmander LS, Roos EM. Clinical update: treating osteoarthritis. Lancet. 2007 Dec 22;370(9605):2082-4. doi: 10.1016/S0140-6736(07)61879-0. PMID: 18156017.
7.    Sohail R, Mathew M, Patel KK, Reddy SA, Haider Z, Naria M, et al. Effects of Non-steroidal Anti-inflammatory Drugs (NSAIDs) and Gastroprotective NSAIDs on the Gastrointestinal Tract: A Narrative Review. Cureus. 2023 Apr 3;15(4):e37080. doi: 10.7759/cureus.37080. PMID: 37153279; PMCID: PMC10156439. 
8.    Simon LS, Hatoum HT, Bittman RM, Archambault WT, Polisson RP. Risk factors for serious nonsteroidal-induced gastrointestinal complications: regression analysis of the MUCOSA trial. Fam Med. 1996 Mar;28(3):204-10. PMID: 8900554.
9.    Hawkey CJ. COX-2 inhibitors. Lancet. 1999 Jan 23;353(9149):307-14. doi: 10.1016/s0140-6736(98)12154-2. PMID: 9929039.
10.    FitzGerald GA, Patrono C. The coxibs, selective inhibitors of cyclooxygenase-2. N Engl J Med. 2001 Aug 9;345(6):433-42. doi: 10.1056/NEJM200108093450607. PMID: 11496855.
11.    Richard MJ, Driban JB, McAlindon TE. Pharmaceutical treatment of osteoarthritis. Osteoarthritis Cartilage. 2023 Apr;31(4):458-466. doi: 10.1016/j.joca.2022.11.005. Epub 2022 Nov 19. PMID: 36414224. 
12.    Fuggle N, Curtis E, Shaw S, Spooner L, Bruyère O, Ntani G, et al. Safety of Opioids in Osteoarthritis: Outcomes of a Systematic Review and Meta-Analysis. Drugs Aging. 2019 Apr;36(Suppl 1):129-143. doi: 10.1007/s40266-019-00666-9. PMID: 31073926; PMCID: PMC6509215.
13.    Yip K, Oettinger J. Why are we still using opioids for osteoarthritis? Int J Clin Pract. 2020 Jan;74(1):e13416. doi: 10.1111/ijcp.13416. Epub 2019 Oct 23. PMID: 31508873.
14.    Sinusas K. Osteoarthritis: diagnosis and treatment. Am Fam Physician. 2012 Jan 1;85(1):49-56. Erratum in: Am Fam Physician. 2012 Nov 15;86(10):893. PMID: 22230308.
15.    Shavlovskaya O. DMOADs and DMARDs in the treatment of patients with joint and spine diseases. Farmakoekonomika Modern Pharmacoeconomics and Pharmacoepidemiology. 2023;16(4):700-7. doi: 10.17749/2070-4909/farmakoekonomika.2023.226.
16.    Oo WM, Little C, Duong V, Hunter DJ. The Development of Disease-Modifying Therapies for Osteoarthritis (DMOADs): The Evidence to Date. Drug Des Devel Ther. 2021 Jul 6;15:2921-2945. doi: 10.2147/DDDT.S295224. PMID: 34262259; PMCID: PMC8273751.
17.    Jiang P, Hu K, Jin L, Luo Z. A brief review of current treatment options for osteoarthritis including disease-modifying osteoarthritis drugs (DMOADs) and novel therapeutics. Ann Med Surg (Lond). 2024 Jun 4;86(7):4042-4048. doi: 10.1097/MS9.0000000000002214. PMID: 38989236; PMCID: PMC11230824.
18.    Mancarella C, Morrione A, Scotlandi K. PROTAC-Based Protein Degradation as a Promising Strategy for Targeted Therapy in Sarcomas. Int J Mol Sci. 2023 Nov 15;24(22):16346. doi: 10.3390/ijms242216346. PMID: 38003535; PMCID: PMC10671294.
19.    Gaffari F, Naseri M, Khodadoost M. Traditional Iranian medicine and the need for its revival and development. Journal: Medicine and Spiritual Cultivation. 2010;19: 63-71
20.    Aghebati A, Safdari R, Dargahi H, Gushehgir S, Saharkhiz P. Evaluation of information Traditional medicine. JIITM 2014; 5 (3) :263-269.
21.    Khosravi A, Changizi-Ashtiyani S, Amini S. The Interaction between Hellenic and Persian Pharmacology: What's the output? Open Public Health J. 2022, e187494452208190.
22.    Aghili SM. Qarabadeen-e-Kabir: Vol. I (Urdu Translation by Hadi Husain Khan). Matba munshi nawal kishore, Lucknow, India. 1897;561.
23.    Zarshenas MM, Zargaran A, Müller J, Mohagheghzadeh A. Nasal drug delivery in traditional persian medicine. Jundishapur J Nat Pharm Prod. 2013 Aug;8(3):144-8. doi: 10.17795/jjnpp-9990. Epub 2013 Jul 16. PMID: 24624204; PMCID: PMC3941896.
24.    Khan M. Qarabadeen azam. Central Council for Research in Unani Medicine, Department of AYUSH, Government of India, New Delhi. 2009.
25.    Ghaeni Heravi M. Qarabadin Salehi. Tehran, Iran: Chogan. 2013:252.
26.    Baranifard M, Khazaei MM, Jamshidi S, Zarshenas MM, Zargaran A. A critical comparison between dosage forms in traditional Persian pharmacy and those reported in current pharmaceutical sciences. Res j pharmacogn. 2017;4(3):67-74..
27.    Hailu T, Sharma R, Mann S, Gupta P, Gupta RK, Rani A. Determination of bioactive phytochemicals, antioxidant and anti-inflammatory activity of Colchicum autumnale L.(Suranjanshireen). Indian J Nat Prod Resour. 2021; 12(1):52-60. 
28.    Chung JM. The role of reactive oxygen species (ROS) in persistent pain. Mol Interv. 2004 Oct;4(5):248-50. doi: 10.1124/mi.4.5.3. PMID: 15471906.
29.    Vallejo R, Tilley DM, Vogel L, Benyamin R. The role of glia and the immune system in the development and maintenance of neuropathic pain. Pain Pract. 2010 May-Jun;10(3):167-84. doi: 10.1111/j.1533-2500.2010.00367.x. Epub 2010 Apr 5. PMID: 20384965.
30.    Comelli F, Giagnoni G, Bettoni I, Colleoni M, Costa B. Antihyperalgesic effect of a Cannabis sativa extract in a rat model of neuropathic pain: mechanisms involved. Phytother Res. 2008 Aug;22(8):1017-24. doi: 10.1002/ptr.2401. PMID: 18618522.
31.    Kandhare AD, Raygude KS, Ghosh P, Ghule AE, Bodhankar SL. Neuroprotective effect of naringin by modulation of endogenous biomarkers in streptozotocin induced painful diabetic neuropathy. Fitoterapia. 2012 Jun;83(4):650-9. doi: 10.1016/j.fitote.2012.01.010. Epub 2012 Feb 9. PMID: 22343014.
32.    Assimopoulou AN, Sinakos Z, Papageorgiou VP. Radical scavenging activity of Crocus sativus L. extract and its bioactive constituents. Phytother Res. 2005 Nov;19(11):997-1000. doi: 10.1002/ptr.1749. PMID: 16317646.
33.    Rezaee R, Hosseinzadeh H. Safranal: from an aromatic natural product to a rewarding pharmacological agent. Iran J Basic Med Sci. 2013 Jan;16(1):12-26. PMID: 23638289; PMCID: PMC3637901.
34.    Zeinali M, Zirak MR, Rezaee SA, Karimi G, Hosseinzadeh H. Immunoregulatory and anti-inflammatory properties of Crocus sativus (Saffron) and its main active constituents: A review. Iran J Basic Med Sci. 2019;22(4):334–344.
35.    Manouze H, Bouchatta O, Gadhi AC, Bennis M, Sokar Z, Ba-M'hamed S. Anti-inflammatory, Antinociceptive, and Antioxidant Activities of Methanol and Aqueous Extracts of Anacyclus pyrethrum Roots. Front Pharmacol. 2017 Sep 5;8:598. doi: 10.3389/fphar.2017.00598. PMID: 28928658; PMCID: PMC5591861.
36.    Bharti P, Singh M, Singh AK. Role of Ahiphena (Papaver sominiferum) in modern and ancient treatment. J Ayurveda Integr Med Sci 2023;8(10):164-6.
37.    Calixto JB, Scheidt C, Otuki M, Santos AR. Biological activity of plant extracts: novel analgesic drugs. Expert Opin Emerg Drugs. 2001 Oct;6(2):261-79. doi: 10.1517/14728214.6.2.261. PMID: 15989526.
38.    Butnariu M, Quispe C, Herrera-Bravo J, Pentea M, Sarac I, Küşümler AS, et al. Papaver Plants: Current Insights on Phytochemical and Nutritional Composition Along with Biotechnological Applications. Oxid Med Cell Longev. 2022 Feb 3;2022:2041769. doi: 10.1155/2022/2041769. PMID: 36824615; PMCID: PMC9943628.
39.    Ali BH, Bashir AK, Tanira MO. Anti-inflammatory, antipyretic, and analgesic effects of Lawsonia inermis L. (henna) in rats. Pharmacology. 1995 Dec;51(6):356-63. doi: 10.1159/000139347. PMID: 8966192.
40.    Alvi M, Saleem MN. A Systematic Review of Barley (Hordeum vulgare Linn.) in Unani Medicine with Recent Advances. J Drug Deliv Ther. 2024;14(9):201-14. https://doi.org/10.22270/jddt.v14i9.6793.
41.    Shoara R, Hashempur MH, Ashraf A, Salehi A, Dehshahri S, Habibagahi Z. Efficacy and safety of topical Matricaria chamomilla L. (chamomile) oil for knee osteoarthritis: A randomized controlled clinical trial. Complement Ther Clin Pract. 2015 Aug;21(3):181-7. doi: 10.1016/j.ctcp.2015.06.003. Epub 2015 Jun 9. PMID: 26256137.
Trends in Pharmaceutical Sciences and Technologies
Volume 11, Issue 3
September 2025
Pages 187-196

Files

Share

How to cite

Statistics