The Pharmaceutical Journal
Vol 270 No 7235 p180
8 February 2003

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Placebo effect for homoeopathic arnica

New research showing homoeopathic arnica has no effect on pain or bruising after hand surgery will "help people save money" by not buying this remedy, according to a professor of complementary medicine.

Researchers from Exeter University and the Royal Devon and Exeter Hospital carried out a "rigorous randomised" trial of homoeopathic arnica, published earlier this week in the Journal of the Royal Society of Medicine (2003;96:60). The study involved 64 adults about to have wrist surgery for carpal tunnel syndrome. They were given three tablets daily of either arnica 30C, 60C or placebo for one week before, and two weeks after surgery.

There were no advantages for arnica in relieving pain, as measured by a pain questionnaire, or bruising, as assessed by computer imaging. Other outcomes (swelling and use of analgesic medication) also showed no differences between the homoeopathic remedy and placebo.

The authors say that arnica has a reputation as a useful intervention for preventing the effects of anticipated trauma such as surgery. Previous studies on arnica had contradictory results and many had "methodological limitations that made the findings unreliable". Although the authors say that the results do not support the routine use of homoeopathic arnica for preventing or reducing postoperative bruising, swelling or pain, they do not rule out the possibility that individual patients could benefit.

One of the study's authors, Professor Edzard Ernst, department of complementary medicine, University of Exeter, explains arnica's previous repute in healing as "positive selection bias". Patients taking arnica, and subsequently healing well after surgery could attribute their recovery to the remedy. Those recovering well without a remedy or healing slowly after taking arnica, are less likely to report their experiences.

Professor Ernst hopes this research will encourage people to look for more effective treatments and help them "to save money by not buying homoeopathic arnica".

However, Dr Steven Kayne, a Glasgow community pharmacist with an interest in complementary medicine, told The Journal that, although he believes the trial to be of good quality, in his view, sweeping comments have been made. Although arnica appears not to work at the doses and in the context studied, it may have effects at other doses, in other forms and in different applications, he said.

Dr Kayne pointed out that arnica is not indicated in pain control, although it is used for bruising. He acknowledged that the doses studied were those most commonly sold over the counter for minor bruising, but questioned whether these would have been used preoperatively.

However, Dr Kayne praised the study for showing that homoeopathic remedies could be subject to a randomised trial and he called for further research in this area.