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Phytodolor for musculoskeletal pain

Clinical bottom line: Phytodolor provides significant pain and/or symptom relief in arthritic and rheumatic diseases at standard doses of 90 to 120 drops/day. This was no better than that associated with low doses of diclofenac or indomethacin. More information is required on adverse effects.

Phytodolor is a standardised herbal preparation of Populus tremula, Fraxinus excelsior and Solidago virgaurea (ratio 3:1:1) used for the treatment of musculoskeletal pain. It may have anti-inflammatory properties, and it is thought to inhibit arachidonic acid metabolism via the cyclooxygenase and lipoxygenase pathways, leading to suppression of inflammation.

Systematic review

Ernst E. the efficacy of Phytodolor for the treatment of musculoskeletal pain - a systematic review of randomized clinical trials. Natural Medicine Journal, 1999; 2(5):14-17.

Date review completed: October 1997

Number of trials included: 10

Number of patients: 1135

Control group: placebo and/or active

Main outcomes: pain, functional assessment, rescue medication

Inclusion criteria were randomised, placebo-controlled, double-blind trials of herbal remedies for musculoskeletal pain; published and unpublished reports.

Reviewers provided as descriptive summary of included trials, including main outcome and main result.


Trials were carried out in a number of conditions - predominantly osteo- and rheumatoid arthritis, rheumatic diseases and epicondylitis. Most trials examined standard doses (3 x 30 or 3 x 40 drops/day) for two to four weeks. Reviewers did not supply information to enable assessment of the reliability of data collection methods and pain assessment.

Six trials in 315 compared phytodolor with placebo over three to four weeks. Six of six trials showed significant benefit of phytodolor compared with placebo on main outcomes (pain, morning stiffness, physical impairment, grip strength and rescue medication use). One of these trials found significant benefit with half strength phytodolor (3 x 15 drops/day) and with double strength (3 x 60 drops/day) for pain on movement, and significant reduction in chronic pain with double strength only.

Four trials of 820 patients reported on double-blind comparisons of phytodolor with an active treatment over two to four weeks. In four of four trials there was no significant difference between treatments (diclofenac 3 x 25 mg/day or indomethacin 2 x 50 mg/day) assessed using similar outcomes to placebo trials. One of these trials was at a high dose equivalent to 2 x 100 drops/day. However, none of these trials were designed to demonstrate internal sensitivity, and may be lacking in statistical power

Adverse effects

No adverse effects were reported in any placebo-controlled trial. Four of four active controlled trials reported adverse effects. Two of four trials reported similar rates per group, and two reported higher rates with diclofenac (14.2% versus 7.4% and 'tolerance better with Phytodolor'). Reviewers did not describe these effects or whether they resulted in study withdrawal.

Further reading

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