Analgesic

Ancient ‘Indian’ Herb Has Long List of Medicinal Properties

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Studies reveal asafoetida has diuretic, analgesic, antioxidant, antimicrobial, antiviral, anti-diabetic, anti-carcinogenic, and other properties

Powdered and raw Asafoetida, also known as Hing or Devil's Dung on a wooden surface. (mirzamlk/Shutterstock)

Powdered and raw Asafoetida, also known as Hing or Devil’s Dung on a wooden surface.

Asafoetida has been an important herb and spice in Indian cooking and Ayurvedic medicine for centuries. India has always had to import it from Iran and Afghanistan, where it thrives in their cold climates. A new experimental crop in the cold Lahaul valley may eventually bring this herb home to India while reducing India’s import cost, which currently averages $100 million a year for 1,200 tons.

What Is Asafoetida?

Asafoetida (Ferula asafoetida) is a wild perennial fennel plant that grows up to six feet and has pale greenish-yellow flowers. It takes about five years to reach maturity. It is a strange astringent ingredient with a foul smell due to its high concentration of sulfur compounds, thus giving it names like Devil’s Dung or Hing. There are two main varieties: the more popular Hing Kabuli Sufaid, a sweeter milky white that is water soluble, and Hing Lal, which is red, very bitter, and oil soluble.

The juice of the roots is processed into a resin that is ground into a powder for Indian cooking and medicinal treatments. The pure, full-strength powder is brown; the yellow powder has flour and turmeric added to reduce its strength. Like other Indian spices, asafoetida works best when it is fried in a bit of hot oil, butter, or ghee for several seconds before starting to cook your dish. Once heated, it smells and tastes almost like garlic or leeks. It is commonly used in lentil and vegetable dishes such as yellow dal, poha, yogurt soups, classic rogan josh, and some curries.

Historical Significance

To understand why this herb is so important to the Indian culture, we must look at its history and religious beliefs. Hindus and the Hindu tradition of Jains do not believe in eating garlic, onions, or any of the plants in the Allium family. All these plants are considered too stimulating to the nervous system and major internal organs. The Hindus believe this detracts from focusing on the spiritual life and practices. Ayurvedic medicine also uses garlic to stimulate sexual desires as it is an aphrodisiac and thus is also a distraction from the spiritual life.

Asafoetida has been around for over 2,000 years. It was first mentioned in the Babylonian catalog of medicinal plants in the ancient library of King Ashurbanipal of Assyria as early as 600 BC. It is also mentioned in Hindu and Buddhist texts of that era. Some scholars believe it was eventually brought to India by way of Afghanistan during Alexander the Great’s expeditions of 336–323 BC.

Current Research Experiment

Farmers in the northern valley of Luhaul, high in the Himalayan mountains of India, have been given 800 plants by the government research group, Institute of Himalayan Bioresource Technology, to cultivate as a pilot project. This area in the Luhaul Valley is a cold desert and ideal because asafoetida thrives in temperatures varying from 10–20 degrees C (50–68 degrees F). The soil is similar to the regions in Iran where a majority of the Indian import of asafoetida grows.

If this experiment is successful, it will make asafoetida a local crop and boost the local economy while cementing the pride Indians already have for asafoetida. The target is to plant 750 acres of the herb over the next five years. Farmers have covered approximately 2.5 acres so far.

Medicinal Uses

Ayurvedic medicine, the traditional medical system of India for thousands of years, is based on three basic cleansing principles for balancing body, mind, and spirit. These three categories, called doshas, are Vata (air), Pitta (digestion), and Kapha (earth and water). As an alternative practice, treatments use holistic and natural approaches to healing. In addition to herbal medicines, it incorporates other healing methods like exercise, meditation, breathing, and physical therapy.

In early Ayurvedic practices, asafoetida, besides having nutritional benefits, was often used for stomach problems as it enhances the activities of the digestive enzymes of the pancreas and small intestine, according to a paper in the Journal of Traditional and Complementary Medicine. A tincture was topically used to relieve abdominal pain and gas, especially from foods such as lentils or beans. An extract from the dried stem and leaves was known to have an aphrodisiac effect on both men and women, so it was used to treat problems of libido. It was a common herb prescribed for treating hysteria.

Today, Ayurveda uses asafoetida for many other ailments besides those of the stomach, such as those listed in the aforementioned paper. Breathing problems such as asthma and bronchitis are treated using a paste of asafoetida gently smeared around the chest and under the nose so that its aroma enters the body and lungs for a curative response. Often prescribed to kill parasites and worms, a paste can also be used directly on the skin to treat corns and calluses.

There is some scientific evidence that the chemicals in asafoetida might help treat irritable bowel syndrome (IBS) and intestinal gas. It may also protect against high levels of certain fats, including cholesterol and triglycerides, but further studies are necessary.

Recent pharmacological and clinical studies have shown that asafoetida has several important properties, including diuretic, analgesic, antioxidant, antimicrobial, antiviral, antifungal, antidiabetic, anticarcinogenic, antispasmodic, and hypotensive. For example, records show it was used as a treatment during the swine flu epidemic and for the Spanish influenza pandemic of 1918.

Indian wholesalers who import asafoetida sell it in blocks, coarse granules, or fine powder. Due to asafoetida’s strong properties, they use minimal amounts to make various grades. Mr. Bhatia, a third-generation Indian merchant who sells more than 630,000 kilograms of asafoetida every year, claims all he needs is a whiff of asafoetida to distinguish the Afghani from the fruitier Iranian kind. Today, asafoetida is readily available from many suppliers worldwide and in various forms, including powder, oil, tablets, and capsules.

Side Effects and Risks

Although asafoetida has been used for thousands of years in Ayurvedic treatments, records show there are possible side effects and risks for some people if ingested in large amounts. Some have reported tingling of the lips, burping, intestinal gas, diarrhea, and headaches. It may cause nausea and vomiting because of its intense flavor.

Women who are pregnant or breastfeeding should avoid using asafoetida. The chemical substances in this spice might cause a miscarriage, and it has not been proven safe for babies.

Asafoetida is known to decrease blood pressure and slow blood clotting. Therefore, it is not recommended if you are taking medications for bleeding disorders, epilepsy, or high blood pressure.

Dosages have not yet been scientifically determined. Ayurvedic practitioners rely on their knowledge and experience to determine the appropriate amounts of asafoetida to prescribe depending on the ailment and the patient’s dosha. Those with questions or concerns should seek a qualified practitioner before taking asafoetida.

FDA Okays First Single-Entity Extended-Release Hydrocodone.

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The US Food and Drug Administration (FDA) has approved the first single-entity extended-release formulation of hydrocodone bitartrate (Zohydro ER, Zogenix Inc) for the management of pain severe enough to require daily around-the-clock long-term treatment and for which alternative options are inadequate.

“Zohydro ER, a Schedule II controlled substance under the Controlled Substances Act, is the first FDA-approved single-entity (not combined with an analgesic such as acetaminophen) and extended-release hydrocodone product,” a statement from FDA released today notes.

“Zohydro ER will offer prescribers an additional therapeutic option to treat pain, which is important because individual patients may respond differently to different opioids.”

This formulation belongs to the class of extended-release/long-acting (ER/LA) opioids, the statement notes. “Due to the risks of addiction, abuse, and misuse with opioids, even at recommended doses, and because of the greater risks of overdose and death with ER/LA opioid formulations, Zohydro ER should be reserved for use in patients for whom alternative treatment options are ineffective, not tolerated, or would be otherwise inadequate to provide sufficient management of pain,” the FDA release said.

It is not approved for as-needed pain relief.

In addition, the labeling approved for this drug conforms to updated labeling requirements for all ER/LA opioids announced by the FDA on September 10 and reported at that time by Medscape Medical News, the first opioid to be labeled in this way, the statement notes.

“The new class of labeling and stronger warnings will more clearly describe the risks and safety concerns associated with ER/LA opioid analgesics, along with the appropriate use of these medications,” the FDA said. “These warnings are expected to improve the safety of all such medicines by encouraging more appropriate prescribing, patient monitoring, and patient counseling practices.”

Schedule II drugs can be dispensed only by prescription, and no refills are allowed. Stringent record-keeping, reporting, and physical security requirements are also in place for these substances.

The FDA will require postmarketing studies of this agent to assess the “known serious risks of misuse, abuse, increased sensitivity to pain (hyperalgesia), addiction, overdose, and death associated with long-term use beyond 12 weeks,” the FDA release said. “These studies will also be required for other ER/LA opioid analgesics.”

Safety of this new formulation of hydrocodone is based on clinical studies that have included more than 1100 patients with chronic pain. Efficacy is based on a clinical study that enrolled more than 500 patients with chronic low back pain and showed a significant improvement in chronic pain vs placebo.

It will also be part of the ER/LA Opioids Analgesics risk evaluation and mitigation strategy (REMS) approved in 2012. The REMS requires companies to make educational programs on how to safety prescribe these agents to healthcare professionals and provide medication guides and patient counseling documents with information on safe use, storage, and disposal of ER/LA opioids.

The most common adverse effects of this single-entity hydrocodone are constipation, nausea, somnolence, fatigue, headache, dizziness, dry mouth, vomiting, and pruritus.

In December 2012, FDA’s Anesthetic and Analgesic Drug Advisory Committee of independent experts voted 11 to 2, with 1 abstention, to recommended against approval of this agent for the treatment of moderate to severe chronic pain.

Most panel members voted that the drug had met regulatory requirements for safety and efficacy, as indicated by their responses to questions on efficacy and safety. However, for the last question voted on — “Based on the data presented and discussed today, do the efficacy, safety and risk-benefit profile of Zohydro ER support the approval of this application?” — most had negative responses.

The main concern of those voting against approval was that the potential for abuse of these agents; because the product does not include acetaminophen, they feared the potential for abuse might be even greater.

Source: Medscape.com

Codeine risky for kids after certain surgeries, FDA says.

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Children who are given codeine for pain relief after surgery to remove tonsils or adenoids are at risk for overdose and death, U.S. health officials said.

The U.S. Food and Drug Administration said a new boxed warning—the agency’s strongest caution—will be added to the labels of codeine-containing products to warn about this danger.

The FDA strongly recommends against the use of codeine to manage pain in children after surgery to remove tonsils or adenoids, and suggests that doctors use an alternate pain reliever. The agency also said parents and caregivers need to be aware of the risks and ask for a different pain medicine if their children are prescribed codeine after having their tonsils or adenoids removed.

Codeine is an opioid (narcotic) medication used to treat mild to moderate pain and is often prescribed to children after tonsil or adenoid removal. However, some children have died after being given codeine within the recommended dose range.

 

In August 2012, the FDA warned about the danger in children who are “ultra-rapid metabolizers” of codeine, which means their liver converts codeine to morphine in higher-than-normal amounts. High levels of morphine can result in potentially fatal breathing problems.

Since then, a safety review by the FDA identified 10 deaths and three overdosesassociated with codeine that occurred among children in the United States between 1969 and May 2012. Many of these children were recovering from surgery to remove tonsils or adenoids.

All of the children, aged 21 months to 9 years old, received doses of codeine within the normal dose range. Signs of morphine overdose developed within one to two days after the children began taking codeine, the FDA said in an agency news release.

 

Codeine is available by prescription either alone or in combination with acetaminophen and aspirin, and in some cough and cold medications.

When prescribed to treat pain, codeine should not be given on a fixed schedule, but only when a child needs relief from pain. They should never receive more than six doses in a day, the FDA said.

Children receiving codeine for pain should be closely monitored for signs of morphine overdose. These include: unusual sleepiness, such as being difficult to wake up; confusion or disorientation; breathing problems; and blueness on the lips or around the mouth

Girl who feels no pain could inspire new painkillers.

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A girl who does not feel physical pain has helped researchers identify a gene mutation that disrupts pain perception. The discovery may spur the development of new painkillers that will block pain signals in the same way.

People with congenital analgesia cannot feel physical pain and often injure themselves as a result – they might badly scald their skin, for example, through being unaware that they are touching something hot.

By comparing the gene sequence of a girl with the disorder against those of her parents, who do not, Ingo Kurth at Jena University Hospital in Germany and his colleagues identified a mutation in a gene called SCN11A.

This gene controls the development of channels on pain-sensing neurons. Sodium ions travel through these channels, creating electrical nerve impulses that are sent to the brain, which registers pain.

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Blocked signals

Overactivity in the mutated version of SCN11A prevents the build-up of the charge that the neurons need to transmit an electrical impulse, numbing the body to pain. “The outcome is blocked transmission of pain signals,” says Kurth.

To confirm their findings, the team inserted a mutated version of SCN11A into mice and tested their ability to perceive pain. They found that 11 per cent of the mice with the modified gene developed injuries similar to those seen in people with congenital analgesia, such as bone fractures and skin wounds. They also tested a control group of mice with the normal SCN11A gene, none of which developed such injuries.

The altered mice also took 2.5 times longer on average than the control group to react to the “tail flick” pain test, which measures how long it takes for mice to flick their tails when exposed to a hot light beam. “What became clear from our experiments is that although there are similarities between mice and men with the mutation, the degree of pain insensitivity is more prominent in humans,” says Kurth.

The team has now begun the search for drugs that block the SCN11Achannel. “It would require drugs that selectively block this but not other sodium channels, which is far from simple,” says Kurth.

Completely unexpected

“This is a cracking paper, and great science,” says Geoffrey Woods of the University of Cambridge, whose team discovered in 2006 that mutations in another, closely related ion channel gene can cause insensitivity to pain. “It’s completely unexpected and not what people had been looking for,” he says.

Woods says that there are three ion channels, called SCN9A, 10A and 11A, on pain-sensing neurons. People experience no pain when either of the first two don’t work, and agonising pain when they’re overactive. “With this new gene, it’s the opposite: when it’s overactive, they feel no pain. So maybe it’s some kind of gatekeeper that stops neurons from firing too often, but cancels pain signals completely when it’s overactive,” he says. “If you could get a drug that made SCN11A overactive, it should be a fantastic analgesic.”

“It’s fascinating that SCN11A appears to work the other way, and that could really advance our knowledge of the role of sodium channels in pain perception, which is a very hot topic,” says Jeffrey Mogil at McGill University in Canada, who was not involved in the new study.

Source: http://www.newscientist.com

Testosterone reduced pain perception in hypogonadism.

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During a press conference here at ENDO 2013,Shehzad S. Basaria, MD, medical director of the section of men’s health, aging and metabolism at Brigham and Women’s Hospital, Harvard Medical School, said testosterone therapy administered to men with opioid-induced androgen deficiency led to a decrease in pain perception on Quantitative Pain Testing (QST) in the pain laboratory.

Basaria and colleagues randomly assigned 65 men (mean age, 49 years; BMI: 33 kg/m2) with an androgen deficiency to 5 g transdermal testosterone gel (n=36) or placebo (n=29) for 14 weeks. Abstract data indicate baseline total testosterone (228 ng/dL) and free serum testosterone levels (44 pg/mL) increased significantly among those assigned to testosterone.

At 12 weeks, patients randomly assigned to testosterone displayed significant improvements to pressure pain thresholds (P<.031), mechanical pain intensity (P=.049) and cold pain after-sensations (P=.08), according to data.

Clinical pain perception, as measured by a validated questionnaire, was not different between the two groups, Basaria said.

“Previous data suggest that improvement in pain perception and tolerance on QST testing generally precedes improvement in clinical pain. A longer study might have shown improvement in clinical pain as well,” Basaria said.

These findings suggest that testosterone therapy administered to men with opioid-induced androgen deficiency led to a greater reduction in pain sensitivity compared with placebo. However, further trials examining the anti-nociceptive role of testosterone are warranted. In an interview with Endocrine Today, Basaria said that the most important message to clinicians would be not to initiate testosterone treatment solely for the treatment of pain. He and colleagues are currently looking at longer term studies that may examine improvements in clinical pain perception as well.

“Clinicians should become more aware of this condition called opioid-induced androgen deficiency. Many clinicians do not appreciate that testosterone levels are reduced in a significant number of men who are on opioid analgesics. In some men, testosterone levels are suppressed in castrate range,” Basaria said. “It’s important for clinicians when they have patients in their clinic on opioids to pay attention to complaints of sexual dysfunction, fatigue or decreased energy. Testosterone levels should be checked as these men might benefit from testosterone therapy.” – by Samantha Costa

Source: Endocrine today