You're in pain, and ibuprofen just won't cut it. NSAIDs don't agree with your stomach, and you're wary of stronger meds. Fortunately, you have alternatives - natural ones.

From herbs that attack inflammation to techniques that leverage the brain's remarkable healing powers, nature offers many treatments for conditions such as arthritis, fibromyalgia, and even muscle strains.

CAPSAICIN: For arthritis, shingles, or neuropathy

What the science says:

An active component of chile pepper, capsaicin temporarily desensitises pain-prone skin nerve receptors called C-fibres; soreness is diminished for three to five weeks while they regain sensation.

Nearly 40 per cent of arthritis patients reduced their pain by half after using a topical capsaicin cream for a month, and 60 per cent of neuropathy patients achieved the same after two months, according to a University of Oxford study.

Patients at the New England Center for Headache decreased their migraine and cluster headache intensity after applying capsaicin cream inside their nostrils.

How to try it:

Capsaicin ointments and creams are sold in pharmacies and health stores. For arthritis or neuropathy, try 0.025 per cent or 0.075 per cent capsaicin cream one to four times daily; best results can take up to two weeks, says Philip Gregory, PharmD, a professor at Creighton University and editor of the Natural Medicines Comprehensive Database.

But research on capsaicin and headaches remains limited - and don't expect stronger versions anytime soon: "Current formulations are better suited for more acute problems, like a sore muscle or an arthritis flare-up, than everyday pain and stiffness," Gregory says.

INFLATHERA OR ZYFLAMEND: For arthritis

What the science says:

Both supplement brands contain ginger, turmeric, and holy basil, all of which have anti-inflammatory properties.

Turmeric (a curry ingredient) may be the best: A component, curcumin, eases inflammatory conditions like rheumatoid arthritis and psoriasis, according to the Methodist Research Institute in Indianapolis.

Researchers are now testing Zyflamend in RA patients, but some experts are already sold: "Each herb has its own scientific database of evidence," says James Dillard, MD, author of The Chronic Pain Solution.

How to try it:

ProThera, InflaThera's maker, will only sell to health care professionals, so your doctor has to order it for you; that said, it's reportedly stronger (and slightly cheaper) than Zyflamend.

InflaThera's suggested dosage is twice daily with food. For the more readily accessible Zyflamend, take one capsule two or three times daily, but avoid it near bedtime - each pill contains 10 mg of caffeine (another version, Zyflamend PM, is reportedly less stimulating).

To save money try curcumin to start: Taking 500 mg four times daily, along with fish oil and a diet low in animal fat, can ease arthritis, says Jane Guiltinan, ND, immediate past president of the American Association of Naturopathic Physicians.

ARNICA: For acute injury or post-surgery swelling

What the science says:

This herb comes from a European flower; although its healing mechanism is still unknown, it does have natural anti-inflammatory properties. Taking oral homeopathic arnica after a tonsillectomy decreases pain, say British researchers, and German doctors found that it reduces surgery-related knee swelling.

How to try it:

Use homeopathic arnica as an adjunct to ice, herbs, or conventional pain meds, suggests Guiltinan. Rub arnica ointment on bruises or strained muscles, or take it in the form of three lactose pellets under the tongue up to six times per day.

AQUAMIN: For osteoarthritis

What the science says:

This red seaweed supplement is rich in calcium and magnesium. A preliminary clinical study showed that the ingredients may reduce joint inflammation or even help build bone, says David O'Leary of Marigot, Aquamin's Irish manufacturer.

In a study of 70 volunteers published in Nutrition Journal, Aquamin users reduced arthritis pain by 20 per cent in a month, and had less stiffness than patients taking a placebo.

How to try it:

Marigot recommends 2400 mg a day (two capsules) of Aquamin in tablet form, sold domestically in products such as Aquamin Sea Minerals and Cal-Sea-Um.

SAM-e (S-ADENOSYLMETHIONINE): For osteoarthritis

What the science says:

SAM-e is made from a naturally occurring amino acid and sold as capsules. Doctors aren't entirely sure why it tamps down pain, but it reduces inflammation and may increase the feel-good brain chemicals serotonin and dopamine.

Studies by the University of Maryland School of Nursing and the University of California, Irvine, showed that SAM-e was as effective as some NSAIDs in easing osteoarthritis aches; the California researchers found that SAM-e quashed pain by 50 per cent after two months, though it took a few weeks to kick in.

SAM-e produced no cardiovascular risks and fewer stomach problems than the conventional meds.

How to try it:

Guiltinan prescribes 400 to 1600 mg daily, often with turmeric or fish oil. SAM-e can interact with other meds, especially MAO-inhibitor antidepressants, so it's vital to talk with your doctor before taking it (and avoid SAM-e entirely if you have bipolar disorder).

Also, inspect the packaging before buying, advises Gregory: Make sure the product carries a USP or GMP quality seal, contains a stabilising salt, has a far-off expiration date, and comes in foil blister packs - SAM-e can degrade rapidly in direct light.

FISH OIL: For joint pain from arthritis or autoimmune disorders

What the science says:

Digested fish oil breaks down into hormonelike chemicals called prostaglandins, which reduce inflammation.

In one study, about 40 per cent of rheumatoid arthritis patients who took cod-liver oil every day were able to cut their NSAID use by more than a third, Scottish scientists recently reported.

People with neck and back pain have fared even better: After about 10 weeks, nearly two-thirds were able to stop taking NSAIDs altogether in a University of Pittsburgh study.

How to try it:

Taking 1000 mg is proven to help your heart, but you should up the dose for pain. For osteoarthritis, try 2000 to 4000 mg daily; for rheumatoid arthritis and autoimmune diseases associated with joint pain (such as lupus), consider a much higher dose of upwards of 8000 mg daily - but ask your doctor about such a large amount first, says Tanya Edwards, MD, medical director at the Cleveland Clinic's Center for Integrative Medicine.

(The same rule applies if you take BP or heart meds, as omega-3s can thin the blood.)

Read the nutrition label carefully: The dosage refers to the amount of omega-3s in a capsule, not other ingredients.

METHYLSULFONYL-METHANE (MSM): For osteoarthritis

What the science says:

MSM is derived from sulfur and may prevent joint and cartilage degeneration, say University of California, San Diego, scientists.

People with osteoarthritis of the knee who took MSM had 25 per cent less pain and 30 per cent better physical function at the end of a three-month trial at Southwest College of Naturopathic Medicine and Health Sciences. Indian researchers also found that MSM worked better when combined with glucosamine.

How to try it:

Start with 1.5 to 3 g once daily and increase to 3 g twice daily for more severe pain, suggests Leslie Axelrod, ND, a professor of clinical sciences at Southwest.

Patients in the Indian trial improved on dosages as low as 500 mg three times daily. Vendors of OptiMSM, the brand tested in Axelrod's trial, can be found at optimsm.com.

COUNTING OUT LOUD: For brief "needle stick" pain

What the science says:

Patients who counted backward from 100 out loud during an injection experienced and recalled less pain, according to a recent Japanese study. None of the 46 patients who counted complained afterward, and only one of them could remember pain from the injection at all (among the 46 who didn't count, 19 said the injection hurt and 10 recalled what it felt like).

Recitation might work by distracting the brain from processing the sensation, says study author Tomoko Higashi, MD, of Yokohama City University Medical Center in Kanagawa, Japan.

The trick is probably only useful for short or acute periods, she says, adding: "The degree of pain reduction really depends on how well patients concentrate on counting."

MIX-AND-MATCH PAIN RELIEF

We asked two MDs and two NDs to name their favourite natural pain-reliever and supplement combos, for even more ache-easing efficacy.

For arthritis, try:

Capsaicin ointment (one to three times daily) + Boswellia, a tree herb (60 per cent concentration, 250 mg three times daily) + curcumin (400 to 600 mg three times daily)

OR

Capsaicin (two or three times daily) + acupuncture (one or two times weekly) + fish oil (1000 to 8000 mg daily) + magnesium (500 to 1000 mg daily) + vitamin D (1000 to 5000 IU daily)

OR

Zyflamend (two or three capsules daily) + fish oil (1000 to 3000 mg daily) + acupuncture (one or two times weekly) for one month

For arthritis or fibromyalgia, try:

Fish oil (1000 to 8000 mg daily) + vitamin D (1000 to 5000 IU daily) + magnesium (500 to 1000 mg daily)

OR

SAM-e (400 to 1500 mg daily) + curcumin (500 mg three or four times daily) + fish oil (1000 to 3000 mg daily)

OR

Curcumin (1000 to 2000 mg daily) + fish oil (1000 to 8000 mg daily)

Always ask your doctor before starting any new supplements. Efficacy and response time for all therapies can vary by individual.

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