Patient consensus on mode of use of nettle sting for musculoskeletal pain.

BACKGROUND: Many patients with musculoskeletal pain prefer topical treatments because they consider them safer than oral drugs. There is a long history of topical use of nettle sting for pain, but no standard method of application. Our objective was to develop a consensus of the experiences of nettle sting users. METHODS: A consensus study was conducted using the expert panel method. Media articles resulted in 16 responses and nine users attended a meeting. Participants first responded to questions on how they chose the leaf and how they applied the nettle sting; then discussed their individual responses; and finally responded once more to the same questions. Consensus was defined as 70% agreement. Participants' consensus was developed from the responses and discussions, and modified in response to repeated feedback and to comments of seven other nettle users. RESULTS: Consensus was present initially on three questions: 'Important to feel a good strong sting', 'Immediately sting the area again' and 'Sting once a day'. Opinions on the method and site of application, and format of a course of treatment varied. This range of advice was incorporated into a treatment consensus document acceptable to all users in the study. CONCLUSIONS: The users' consensus document for the use of nettle sting for musculoskeletal pain is published for anyone who wishes to use this self-care approach to treating their pain. The user's consensus document represents an essential step in undertaking further research into the effectiveness of nettle sting as a treatment for musculoskeletal pain.

Nettle sting for chronic knee pain: a randomised controlled pilot study.

BACKGROUND: Non-pharmacological interventions for chronic knee pain are increasingly requested by patients and are recommended in current treatment guidelines. An intervention that has been used for many years for pain relief is nettle sting. OBJECTIVES: To explore the feasibility of a definitive RCT of nettle sting for chronic knee pain, in particular the acceptability of the research to GPs and patients, and the optimal methods for recruitment and outcome measurement. METHODS: Patient blinded pilot RCT, set in two inner city primary care practices in Plymouth, UK. Potential participants were identified from practice computerised databases using three different approaches: age and analgesic use, age and appropriate Read code, or age alone. Patients had to be aged between 55 and 80 years with knee pain and a presumptive clinical diagnosis of OA knee, with a baseline WOMAC pain subscale score of more than 4. They were randomised to receive either treatment with Urtica dioica, or placebo intervention with Urtica galeopsifolia daily for 1 week. The main outcome measure for the treatment effect was the WOMAC pain subscale; other outcomes included quantitative and qualitative data to inform the design of a future study. RESULTS: Out of 45 patients who were eligible, 42 were recruited. Invitations targeted at patients who were both currently receiving repeat prescriptions for non-steroidal or analgesic drugs and had relevant Read codes proved most efficient for recruitment. Mean baseline WOMAC pain subscale scores were 9.2 (S.D. 3.4) and 7.9 (2.3) in the two groups. The mean reduction in pain score at the end of treatment in the nettles group was 1.7 (95% confidence interval 0.6, 2.9) and in the controls 1.6 (CI 0.5, 2.7). All GP practices, and all patients approached, were willing to be involved in the research. Patients liked the treatment mostly because it was 'natural'. The sting was acceptable and viewed as a minor irritation. CONCLUSION: Research into nettle sting is acceptable to patients and GPs, and patients do not find the treatment more than a minor irritation. Larger rigorous studies are justified to determine the effectiveness of this ancient therapy.