Traumeel: An Natural Alternative to Anti-Inflammatory Drugs

The Basics

Traumeel is a solution of 14 active ingredients (12 of which are naturally occurring compounds) which can be used as an alternative for pain and inflammation relief from musculoskeletal injuries. Traumeel can be used in the form of tablets, drops, injection solution, ointment and gel (1).

Background

Musculoskeletal injuries are very common injuries and are on the rise (3). In fact they are the most common cause of disability and the leading reason for a visit to a primary care physician (3).  It is important to understand that the general population is starting to realize the effects of living a sedentary life and are starting to exercise, however participation in activity also leads to increase risk of injury.  Chiropractic studies show that only 10% of the population currently seeks a Chiropractor for musculoskeletal pain. On the other hand, the majority of musculoskeletal problems present to the Medical Doctor’s office, clog up emergency rooms or result in the patient self-treating. Generally these alternatives have little to offer in terms of treating the source of pain and inflammation other than RICE, NSAIDs, other pain medication or surgery. The Rice debate will be left for a different discussion.

The dangers of NSAIDS

There is no doubt that taking a non-inflammatory is very convenient and cheap in reducing pain and inflammation in the short term.  However, Medical Doctors fail to educate their patients that anti-inflammatories should not be used for extended amounts of time. Long term use of anti-inflammatory medication degrades cartilage (in joints) and inhibits the healing processes of connective tissue (tendons and ligaments) thus causing more harm than good (4,5).  It is also important to understand and appreciate that many musculoskeletal injuries resolve over time without intervention. The body is amazing! Typically, bone injuries take 4-6 weeks to heal, muscle injuries take 2-4 weeks to heal, and ligament structures take the longest at 6-8 weeks (source). The metaphor of NSAIDs being band-aids should be considered for musculoskeletal injuries because they just prevent you from feeling pain, but do not address the source of the injury.

Table 1 from Schneider 2011 (1)

Typical adverse events of nonsteroidal anti-inflammatory drugs

 

System/organ	Adverse event
Cardiovascular system	Thrombotic vascular incidents, including myocardial infarction
Gastrointestinal tract	Nausea, vomiting, dyspepsia, gastritis, bleeding, ulceration
Hematopoiesis	Thrombocytopenia, hypoprothrombinemia, anemia, granulocytopenia
Hypersensitivity reactions	Rashes, erythema, drug-induced eruptions, urticaria, angioedema, broncospasm, aspirin-induced asthma, Stevens–Johnson syndrome (very rarely)
Kidneys	Renal failure, hematuria, proteinuria, sodium and water imbalance (fluid retention), interstitial nephritis, nephrotic syndrome, papillary necrosis
Liver	Hepatic damage, abnormalities on liver function tests (eg, increased aminotransferase activity)
Nervous system	Headache, dizziness, nervousness, depression, drowsiness, insomnia
Sense organs	Hearing disturbances, vertigo, photosensitivity, eye changes

 

A Natural alternative

Traumeel was invented in 1930 by a German physician, Hans-Heinrich Reckeweg. Traumeel has been available in Germany for 60 years and Austria for 40 years and is currently available in 50 countries, including the United States (1). Dr. Reckeweg developed this formula of ingredients based on observations of the ingredients being used the treatment of pain and inflammation for many years. Traumeel contains 14 ingredients, 12 of which are naturally occurring herbs and minerals. The 12 natural compounds found in Traumeel are as follows (2):

• Aconitum Napellus
• Arnica Montana
• Belladonna
• Bellis Perennis
• Calendula Officinalis
• Chamomilla
• Echinacea
• Echinacea purpurea
• Hamamelis Virginiana
• Hypericum Perforatum
• Millefolium
• Symphytum Officinale

The 2 artificial ingredients in Traumeel are (2):

• Hepar Sulphuris Calcareum
• Mercurius solubilis

Mechanisms of the ingredients

For those of you who are interested in why the ingredients work, read this paragraph. For those of you who could care less, skip to the next section. These certain ingredients were chosen by Dr. Reckeweg for specific reasons, all which play varying roles in pain, inflammation and healing. The main effect of Traumeel has been found that the effect was greater than the sum of the active ingredients, suggesting a synergistic interaction between all the compounds (1). Here are some of the individual effects:

• Pain relief associated with inflammation
• Inflammation- some Herbs promote inflammation while others inhibit it
• Acceleration of wound healing
• Shown to have effects on the innate and acquired immune system.
  • Traumeel regulates secretion of pro-inflammatory mediators IL -1Beta, TNF alpha IL-8. It has effects T-cells, monocytes, and gut epithelial cells.
  • It also stabilizes immune cells by inhibiting secretion of inflammatory mediators.
  • Stimulates production of the inhibitory cytokineTGF-Beta.
  • Inhibits production of NF-KB which controls gene expression of pro-inflammatory mediators.
• Reduces microvascular leakiness to albumin and mast cell degranulation.

The evidence shows that Traumeel does not act in the same way as NSAIDs (Cox 1 or 2 inhibitors) do. Rather it preserves the normal functions of cells at the site of injury ie. preventing superoxide anion production and adhesion to the site of injury, and preventing platelet adhesion. It can be concluded that Traumeel speeds up the healing process by blocking edema from happening at the start of injury (1).

 

Additional types of treatments

I am not saying Traumeel is the end all to pain. But it can beneficial to use at home in order to reduce pain and control inflammation in between visits to your Chiropractor.  Chiropractors have many other types of techniques that help to reduce pain and inflammation. A quick list includes:

• Kinesiotaping- Also very good to help reduce pain at home in between visits
• Nutrition
  • Omega 3 fatty acids
  • Proteolytic enzymes
  • SAMe- Shown to be just as beneficial as NSAIDs (after 2 months) with no side effects (6)
  • Vitamin C and Zinc help in the healing process of connective tissues
• Cold laser
• Active Release Technique or other soft tissue treatment
• Chiropractic Manipulations and Mobilisations
• Graston Therapy
• Exercise
• Other modalities such as electrical stimulation and ultrasound.

Chiropractors play a crucial role in the musculoskeletal injury system.  We are trained to find the cause of the pain, which at many times is different than the source of the pain. This concept is the basis for the Selective Functional Movement Assessment (SFMA), in which Chiropractors and other health care professionals can become certified in. For more information visit my blog and SFMA.com

 

Summary

• Musculoskeletal injuries are the most common reason for visit to a Medical Doctor. Medical Doctors have very little to offer in treating musculoskeletal injuries other than prescription drugs and surgery. These techniques have their place but are very invasive and have many harmful effects. Think of the band-aid analogy.
• Traumeel is a natural pain reliever which can benefit musculoskeletal problems by increasing healing time with little to no effects (1,2)
• NSAIDS are not the preferred treatment for musculoskeletal problems with very dangerous side effects and may prevent healing.
• Chiropractors have many tools to successfully manage musculoskeletal injuries

Evidence of Traumeel

Table 3 from Schneider 2011 (1)

Clinical trials on Traumeel in acute musculoskeletal injury

 

Study design	Indication	Number of patientsa	Therapies	Main outcomes
Randomized, double-blind trials
Zell et al,53 Single center study in Germany 2-weeks duration	Ankle sprains	N = 73 n = 69	Traumeel ointment vs placebo ointment	More rapid and more frequent improvement in upper-ankle mobility in the Traumeel group vs placebo at 2 weeks.
Böhmer and Ambrus,54 Single center study in Germany 15-days duration	Varied musculoskeletal sport injuries	N = 68 n = 68	Traumeel ointment vs placebo ointment	Reduction in swelling and pain significantly greater in patients using Traumeel vs placebo after 15 days. No difference between the groups in skin temperature. Overall effectiveness of Traumeel was superior to placebo.
				Traumeel was well tolerated with all patients rating the treatment as “good” or “very good”.
Thiel and Borho,55Single center study in Germany 8-days duration	Post traumatic hemarthrosis of the knee	N = 80 n = 73	Traumeel injections vs physiological saline injections	Greater degree of movement and greater reductions in pain and swelling with Traumeel vs saline after 3 injections over 8 days. No treatment-related adverse events.
Observational studies
Birnesser et al,58Multicenter study in Germany; nonrandomized 2-week duration	Epicondylitis	N = 184 n = 163	Traumeel injections vs unspecified NSAID (mainly diclofenac)	Noninferior effects of Traumeel on three pain relief and two joint mobility variables. Global outcome rated as “good” and “very good” by 71% of Traumeel patients and 44% of NSAID patients.
				Tolerability assessed as “very good” by 88% of Traumeel patients and 45% NSAIDs patients.
Schneider et al,9Multicenter study in Germany; nonrandomized 28-days duration	Tendinopathy of varying etiology (based on excessive tendon load rather than inflammation)	N = 457 n = 357	Traumeel ointment vs diclofenac 1% gel	Traumeel noninferior to diclofenac on all pain and mobility variables after 28 days. In the Traumeel and diclofenac groups, respectively, the mean (±standard deviation) reduction in summary score for pain-related variables was 5.3 ± 2.7 and 5.0 ± 2.7 units, and for mobility-related variables was 4.2 ± 3.8 and 3.7 ± 3.4 units. Global evaluation of therapies rated as “very good” or “good” by 88% of Traumeel cases and 82% of diclofenac cases.
Schneider et al,62Multicenter study in Germany; prospective; nonrandomized Up to 3 months duration	Various musculoskeletal injuries	N = 133 n = 132	Traumeel (tablets and gel) vs conventional management	Rates of complete symptomatic resolution at the end of therapy were similar between treatment groups, occurring in 59.4% of Traumeel-treated patients and 57.8% of the conventionally treated group. No adverse events reported in the Traumeel group vs six (6.3%) mild-moderate events in the conventional group. Physician-rated tolerability was “very good” for 90% of Traumeel cases vs 50% of conventional cases (P = 001).
Surveillance studies
Zenner and Weiser,61Multicenter study in Germany, Italy, and Portugal; prospective; randomized; standardized questionnaires	Variety of injuries (eg, sprains, post-traumatic edema), and degenerative and inflammatory conditions (arthrosis, and epicondylitis)	N = 1359	Traumeel tablet or drop forms (69% tablets, 29% drops, 2% both). One-third of patients were treated without other therapies (drug and nondrug)	Symptom improvement occurred in about half of all patients within the first week of treatment and an additional 34% of patients within 1 to 3 weeks. Treatment rated as “very good” or “good” by 83% of cases.
Zenner and Metelmann,59Multicenter, drug monitoring trial	Variety of injuries, and degenerative and inflammatory conditions	N = 3241	Traumeel injection. Used exclusively by 17% of patients; adjuvant medications taken by 47% of patients; 65% received nonmedication therapies	Used most frequently in arthrosis (19%), particularly in inflammation of the knee and degenerative joint diseases, myogelosis (12%), sprains (12%), periarthropathia humeroscapularis (10%), epicodylitis (10%), and tendinovaginitis (8%). Traumeel, used exclusively, was highest for sprains (27%). Outcomes of Traumeel therapy was assessed as “very good” or “good” by 79% of patients.
Zenner and Metelmann,60Multicenter, drug monitoring trial	Variety of injuries, and degenerative and inflammatory conditions	N = 3422	Traumeel ointment. Used exclusively by 38% of patients; adjuvant medications taken by 30% of patients; 52% received nonmedication therapies	Used most frequently for sprains (21%), hematomas (8%), myogelosis (8%), contusion (8%), tenosynovitis (8%), and arthrosis (9%). Traumeel was used exclusively by half or more of patients with hematomas, contusions and sprains. Outcomes of Traumeel therapy was assessed as “very good” or “good” by 87% of patients.

Notes:

^aN = recruited patient population, n = efficacy population.

Abbreviations: NSAID, nonsteroidal anti-inflammatory drugs.

 

Where to find Traumeel

Call your local health food store to see if they carry Traumeel. I have also seen it at GNC, Vitamin Shoppe and drug stores like Walgreens. You can also purchase it at amazon.com

 

Sources:

1. Schneider, Christian. Traumeel- an emerging option to nonsteriodal anti-inflammatory drugs in the management of acute musculoskeletal injuries. Internal Journal of General Medicine 2011:4 225-234.
2. http://www.traumeel.us/
3. http://www.aaos.org/news/aaosnow/jan08/youraaos15.asp
4. http://www.ncbi.nlm.nih.gov/pubmed/10441838
5. http://www.ncbi.nlm.nih.gov/pubmed/24195606
6. http://www.biomedcentral.com/1471-2474/5/6