A Multicenter, Randomized, Double-Blind, Placebo-Controlled Clinical Study of Jianyao Migu Granules in the Treatment of Osteopenic Low Back Pain

Migu Capsules in the Treatment of Osteoporotic Low Back Pain in Postmenopausal Women: A Single-Center Randomized Controlled Trial

Purpose

This trial aimed to investigate the efficacy of Migu capsules in treating osteoporotic low back pain.

Patients and Methods

In this single-center trial, we randomly assigned patients with osteoporotic low back pain that had lasted for 3 months in a 1:1 ratio to receive Migu capsules alongside Caltrate D in treatment group or to receive Caltrate D only in control group, both for 48 weeks. The primary outcome measure was the intensity of low back pain on a visual analog scale at 24 weeks after enrollment. Secondary outcome measures included the Roland-Morris Disability Questionnaire (RMDQ), bone turnover markers, and bone mineral density.

Results

A total of 100 patients were enrolled, with 50 in each group. At baseline, the mean score for low back pain intensity was 6.2 in the treatment group and 6.1 in the control group. The primary outcome of the low back pain intensity score at 24 weeks was 2.9 in the treatment group and 4.7 in the control group (adjusted mean difference, -1.8; 95% confidence interval, -2.3 to -1.4; P<0.001). Secondary outcomes including the score on RMDQ and pain at 48 weeks were in the same direction as the primary outcome. Compared to the control group, the treatment group only showed a difference in bone density after continuous intervention for 48 weeks (P<0.05). Three patients experienced a mild adverse event associated with the intake of Migu capsules.

Conclusion

Migu capsules can alleviate bone pain and reduce functional disabilities caused by osteoporotic lower back pain.

Biochemical Mechanisms and Rehabilitation Strategies in Osteoporosis-Related Pain: A Systematic Review

BACKGROUND/OBJECTIVES

Osteoporosis causes a bone mass reduction and often determines acute and chronic pain. Understanding the biochemical and neurophysiological mechanisms behind this pain is crucial for developing new, effective rehabilitative and therapeutic approaches. This systematic review synthesizes recent advances in muscle-bone interactions and molecular pathways related to osteoporosis-associated pain.

METHODS

We carried out a systematic review including studies published from 2018 to 2024 using PubMed, Scopus, clinicaltrials.gov and Cochrane Library. The Cochrane Collaboration tool was used to assess bias risk. The review adhered to PRISMA guidelines and is registered with PROSPERO (CRD42024574456); Results: Thirteen studies were included. It emerged that osteoporosis causes progressive bone loss due to disruptions in biochemical processes and muscle-bone interactions. This condition is also closely associated with the development of pain, both acute and chronic. Key findings include the role of the miR-92a-3p/PTEN/AKT pathway and the impact of muscle-bone disconnection on bone health. Mechanotransduction is critical for bone maintenance. Effective pain management and rehabilitation strategies include physical therapy and physical exercise, yoga, Pilates, and cognitive behavioral therapy (CBT); they all improve pain relief and functional outcomes by enhancing muscle strength, flexibility, and balance. Pharmacological options such as NSAIDs, opioids, and new agents like SHR-1222, along with surgical interventions like percutaneous vertebroplasty, offer additional pain reduction, especially when included in individualized rehabilitation projects; Conclusions: This review highlights advancements in understanding osteoporotic pain mechanisms and identifies promising treatments. Integrating targeted therapies and rehabilitation strategies can enhance patients' pain relief.

Traditional Chinese herbal compound as complementary treatment for nonspecific low back pain: A randomized controlled trial

BACKGROUND

This prospective randomized controlled trial was designed to evaluate the clinical efficacy and safety of Bu Shen Tong Luo herbal compound as a complementary treatment for nonspecific low back pain (NSLBP).

METHODS

A total of 76 patients with NSLBP included from January 2022 to June 2023 according to the criteria were randomly divided into Bushen Tongluo formula (BSTL) group (n = 38) and celecoxib group (n = 38). According to Traditional Chinese Medicine principles, patients of 2 groups were divided into 5 syndrome types. Celecoxib or BSTL herbal compound were used to treat NSLBP of each group for 3 weeks, every week the Visual Analog Scale (VAS), Oswestry Disability Index, and Japanese Orthopaedic Association scores of each patient was record and compared to evaluate the clinical efficacy, and adverse reaction was reported to evaluate the safety of 2 interventions.

RESULTS

A total of 71 patients finished the follow-up, including 36 patients in BSTL group and 35 patients in celecoxib group. The result showed that within 3 weeks, both BSTL and celecoxib interventions were able to treat NSLBP, with improvements in VAS scores and waist function index. However, there were no significant differences in clinical outcomes between these 2 interventions. Then we divided the patients into 5 syndromes on the basis of traditional Chinese medicine principles and observed their clinical outcomes. We found that celecoxib had similar improvements in VAS score and waist function index for each syndrome type and most of the syndromes in the BSTL group, except for the SRBZ syndrome. In the treatment of SRBZ syndrome, BSTL prescription showed no statistically significant clinical improvement. Meanwhile, in the treatment of HSBZ syndrome of NSLBP, BSTL prescription showed better clinical results than celecoxib, although there was no difference in VAS scores between the 2 groups, patients in BSXL group had better waist function than those in celecoxib group.

CONCLUSION

Both BSTL herbal compound and celecoxib are effective and safe in the clinical treatment of NSLBP, and BSTL herbal compound had unique advantages in the treatment of HSBZ syndrome type of NSLBP especially in waist function improvement.

Plant-derived natural medicines for the management of osteoporosis: A comprehensive review of clinical trials

Background

Osteoporosis is a chronic and systemic skeletal disease that is defined by low bone mineral density (BMD) along with an increase in bone fragility and susceptibility to fracture. This study aimed to overview clinical evidence on the use of herbal medicine for management of osteoporosis.

Methods

Electronic databases including Pubmed, Medline, Cochrane library, and Scopus were searched until November 2022 for any clinical studies on the efficacy and/or safety of plant-derived medicines in the management of osteoporosis.

Results

The search yielded 57 results: 19 on single herbs, 16 on multi-component herbal preparations, and 22 on plant-derived secondary metabolites. Risk of fracture, bone alkaline phosphatase, BMD, and specific bone biomarkers are investigated outcomes in these studies. Medicinal plants including Acanthopanax senticosus, Actaea racemosa, Allium cepa, Asparagus racemosus, Camellia sinensis, Cissus quadrangularis, Cornus mas, Nigella sativa, Olea europaea, Opuntia ficus-indica, Pinus pinaster, Trifolium pretense and phytochemicals including isoflavones, ginsenoside, Epimedium prenyl flavonoids, tocotrienols are among plant-derived medicines clinically investigated on osteoporosis. It seems that multi-component herbal preparations were more effective than single-component ones; because of the synergistic effects of their constituents. The investigated herbal medicines demonstrated their promising results in osteoporosis via targeting different pathways in bone metabolism, including balancing osteoblasts and osteoclasts, anti-inflammatory, immunomodulatory, antioxidant, and estrogen-like functions.

Conclusion

It seems that plant-derived medicines have beneficial effects on bone and may manage osteoporosis by affecting different targets and pathways involved in osteoporosis; However, Future studies are needed to confirm the effectiveness and safety of these preparations.