Low Back Pain and Sciatica and White Willow

Willow bark has been used as a treatment for pain and fever in China since 500 BC. It contains the substance salicin, which is chemically related to aspirin. Another ingredient of white willow, tremulacin, may also be important

Extract of the herb white willow appears to be helpful for acute and chronic back pain and sciatica, presumably because of its similarity to aspirin. White willow helps to inhibit pain and, to a lesser extent, also has anti-inflammatory properties.

Note: White willow should not be combined with standard anti-inflammatory drugs, such as ibuprofen. For more information, including dosage and safety issues, see the full White Willow article.

Read more details about White Willow.

In a 4-week, double-blind, placebo-controlled study of 210 individuals with chronic back pain, two different doses of willow bark extract were compared against placebo.⁵ The higher-dose group received extract supplying 240 mg of salicin daily; in this group, 39% were pain-free for at least the last 5 days of the study. In the lower-dose group (120 mg of salicin daily), 21% became pain-free. In contrast, only 6% of those given placebo became pain-free. Stomach distress did not occur in this study. The only significant side effect seen was an allergic reaction in one participant given willow.

Safety Issues

Evidence suggests that willow, taken at standard doses, is the equivalent of 50 mg of aspirin, a very small dose. ¹ Willow doesn't impair blood coagulation to the same extent as aspirin, ² and also doesn't appear to significantly irritate the stomach. ³ Nonetheless, it seems reasonable to suppose that, if it is used over the long term or in high doses, willow could still cause the side effects associated with aspirin. All the risks of aspirin therapy potentially apply.

For this reason, white willow should not be given to children, due to the risk of Reye's syndrome. It should also not be used by people with aspirin allergies, bleeding disorders, or kidney disease. In addition, it may interact adversely with "blood thinners," other anti-inflammatory drugs, methotrexate, metoclopramide, phenytoin, probenecid, spironolactone, and valproate.

Safety in pregnant or nursing women, or those with severe liver or kidney disease, has not been established.

Interactions You Should Know About

Avoid combining white willow with the following medications:

Blood-thinning medications, such as:

• Warfarin (Coumadin)
• Heparin
• Clopidogrel (Plavix)
• Ticlopidine (Ticlid)
• Pentoxifylline (Trental)
• Aspirin
• Methotrexate
• Metoclopramide
• Phenytoin (Dilantin)
• Sulfonamide drugs
• Spironolactone and other potassium-sparing diuretics
• Valproic acid

Note: White willow should not be combined with standard anti-inflammatory drugs, such as ibuprofen. For more information, including dosage and safety issues, see the full White Willow article.