Arnica montana: A Clinical Snapshot

By Todd Hoover, MD
December 11, 2017

Arnica montana has been used for centuries as a phytomedicine for its analgesic and anti-inflammatory properties. Commonly known as Wolf’s bane or Leopard’s bane, this herb is found in high mountain pastures throughout Europe. The herb is extremely toxic when ingested due to the presence of helenalin in the plant. Toxicity is marked by diarrhea, gastrointestinal bleeding, liver inflammation, tachycardia, and nervous system excitability. A recent Cochrane review of the topical herbal gel form found it to be equivalent to NSAID gels for control of pain and inflammation of osteoarthritis (though Arnica was associated with higher frequencies of adverse events).

The homeopathic use of Arnica montana began with one of Hahnemann’s earliest provings in 1805. While we often think of this medicine today primarily for soft tissue injuries, bruises, and head trauma, the medicine has demonstrated a wide range of action in many disorders. Hahnemann reported the medicine was effective in the treatment of an epidemic of prolonged fever in children. Many prescribers today consider the medicine one of the important remedies for influenza.

Arnica montana is the most researched of all homeopathic medicines. More than 100 randomized trials have been conducted using this medicine.[i] Most of the trials have focused on effects on trauma due to injuries or surgical procedures. A sampling of the scientific literature is provided below:

Year of Study	Measure	No. of Subjects	Outcome
2006	Bruising after face lift[ii]	29	Significant improvement
2006	Swelling after knee reconstruction[iii]	57	Significant improvement
2006	Swelling after knee arthroscopy[iv]	227	No effect
2007	Pain after tonsillectomy[v]	190	Significant improvement
2007	Pain control after knee surgery[vi]	158	No effect
2010	Bleeding and pain after aortic valve surgery[vii]	92	No effect
2016	Seroma and bleeding after mastectomy[viii]	53	Significant improvement

 

Different clinicians have recommended many schemes for the dosing of Arnica montana around the time of surgery. Some recommend the medicine before surgery, while others suggest the use after the procedure. The various studies show mixed results. This could be due to variations in dosing, unsuitability of outcome measures, and the general lack of selection criteria for the indication of the medicine. When randomized controlled trials of single homeopathic medicines are conducted with little or no attention to individualization of treatment, the outcomes are likely to be mixed or negative. By combining patients who are likely to improve with the medicine with those who are unlikely to respond, the results only reflect the mixed pool and not the homeopathic effect. Whenever possible, patients should be selected for treatment according to homeopathic indications.

Clinical hallmarks indicating the potential usefulness of Arnica montana include the following:

1. Conditions where trauma is the etiology including head injuries, eye injuries, bruises, shock, and birth-related trauma.
2. Trauma or other conditions where the patient is figuratively “knocked out of their body.” (This is typically manifested as a type of delirium, such as when someone is injured severely in a car accident, yet states that it is only a scratch and not to worry. There is disconnection between the severity of injury and the perception due to a psychological shock.)
3. Cases where the patient describes intense pain and soreness; the soft tissue is very sore and can be excruciatingly sensitive to touch.
4. When a patient guards the body and fears to be touched. (The patient may become irritable or this behavior grows worse when people try to console them. Often there is a state of fatigue or exhaustion.)

The following describes a case in which Arnica montana may be useful: At the scene of a car accident, a man is seen wandering about in a daze. He has a bleeding head injury and a fracture of the upper arm with bruising, but seems unaware of any issue. He insists that there is no need for treatment and gets angry when his wife urges him to take the ambulance. Finally, he is sent to the hospital and admitted overnight. The following day he has severe pain and is sensitive to the lightest touch. He is guarding his arm and will not let the doctor examine it further. The headache is pounding and severe.

Arnica montana might be considered in the following clinical scenarios provided that the homeopathic picture of the medicine is present.

1. Head injury
2. Fracture
3. Surgical procedure
4. Barotrauma to ears
5. Post-traumatic Stress Disorder
6. Headaches since an injury
7. Acne with abscesses and excruciating tenderness
8. Ulcers in the mouth that are continually reinjured with chewing
9. Diarrhea with odor of sulfur
10. Whooping cough
11. Pneumonia
12. Persistent numbness after injury
13. Herpes Zoster
14. Symmetrical rashes
15. Influenza-like illness

Arnica montana is overused in traumatic injuries. Many mothers will give this medicine whenever a child falls or bumps their head. While there are many case reports of dramatic cures using this medicine, frequent use for minor injuries that need no treatment should be discouraged.

[i] Clausen J, Moss S, Tournier A, Lüdtke R, Albrecht H.Homeopathy. CORE-Hom: a powerful and exhaustive database of clinical trials in homeopathy. 2014 Oct;103(4):219-23. doi: 10.1016/j.homp.2014.07.001. Epub 2014 Aug 8.

[ii] Brook M. Seeley, MD; Andrew B. Denton, MD; Min S. Ahn, MD; et al. Effect of Homeopathic Arnica montana on Bruising in Face-lifts: Results of a Randomized, Double-blind, Placebo-Controlled Clinical Trial

Arch Facial Plast Surg. 2006;8(1):54-59. doi:10.1001/archfaci.8.1.54.

[iii] Brinkhaus B, Wilkens JM, Lüdtke R, Hunger J, Witt CM, Willich SN. Homeopathic arnica therapy in patients receiving knee surgery: results of three randomised double-blind trials. Complement Ther Med. 2006 Dec;14(4):237-46. Epub 2006 Oct 13.

[iv] Ibid.

[v] Robertson A, Suryanarayanan R, Banerjee A Homeopathic Arnica montana for post-tonsillectomy analgesia: a randomised placebo control trial. Homeopathy. 2007 Jan;96(1):17-21.

[vi] A. Paris, N. Gonnet, C. Chaussard, P. Belon, F. Rocourt, D. Saragaglia, & J. L. Cracowski. Effect of homeopathy on analgesic intake following knee ligament reconstruction: a phase III monocentre randomized placebo controlled study. 180 / Br J Clin Pharmacol / 65:2 / 180–187.

[vii] Cornu C1, Joseph P, Gaillard S, Bauer C, Vedrinne C, Bissery A, Melot G, Bossard N, Belon P, Lehot JJ. No effect of a homoeopathic combination of Arnica montana and Bryonia alba on bleeding, inflammation, and ischaemia after aortic valve surgery. Br J Clin Pharmacol. 2010 Feb;69(2):136-42. doi: 10.1111/j.1365-2125.2009.03574.x.

[viii] Luca Sorrentino, Salvatore Piraneo, Eliana Riggio, Silvia Basilicò, Alessandra Sartani1, Daniela Bossi, Fabio Corsi1. Is there a role for homeopathy in breast cancer surgery? A first randomized clinical trial on treatment with Arnica montana to reduce post-operative seroma and bleeding in patients undergoing total mastectomy. J Intercult Ethnopharmacol . 2017: Vol 6; Issue 1. Pages 1-8.