Comfrey (Symphytum officinale L.) is a perennial plant with long rough leaves and white, creamy yellow, or light purple flowers. Several chemical compounds are responsible for the pharmacological effects of comfrey extracts. Allantoin, a compound that increases cell proliferation; rosmarinic acid, an anti-inflammatory constituent; polysaccharides (local soothing effect); and tannins, which are astringent, are related to its pharmacological impact which is not well-established (Frost et al., 2013). The diversity, bioactivities, and efficacies of comfrey represent its dynamic effects and a source of opportunities for researchers from different disciplines.
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Comfrey is a medicinal plant that has a long history of being used to treat painful muscle and joint problems. Since about 50AD, the herb has been used to close fresh wounds and treat inflammations. The plant, which is native to Europe and parts of Asia, has also become naturalized in North America, where it has eventually spread (Staiger, 2012a). Comfrey’s healing abilities were also remembered by Native Americans, who used it in their medicinal arsenal. Boils, fractures, discomfort, and sprains were still treated with it by European doctors in the early twentieth century; moreover, the herb is still used in folk medicine today.
Comfrey Root’s usage has been proven in over centuries of herbal treatment, however, it needs to be clinically examined to extract sufficient evidence of the herb’s effectiveness in treating inflammation and relieving pain.
Comfrey root has a broad range of indications, which allow for the herb to be used in a variety of treatments. The most prevalent conditions for applying comfrey root are traumatic and inflammatory lesions of the bones, muscles, and joints, as well as infected skin lesions such as furunculosis, mastitis, and phlebitis. (Stickel & Seitz, 2000). Moreover, the healing properties of this herb allow using it as a natural treatment for joint and muscle pain, as well as closed wounds.
Comfrey root extract, in particular, can be used topically to relieve muscle, joint pain, and swelling. Clinical trials have recently shown that comfrey can help with neuromuscular disorders, including acute ankle sprains, by reducing pain and improving function (Smith & Jacobson, 2011). For instance, the herb is widely applied in cases of osteoarthritis, which refers to pain in the afflicted joints either after exercise or during rest. Comfrey root ointment is widely used to reduce the pain in the previously mentioned and supplementary muscular pain conditions.
While comfrey is best known for its anti-inflammatory and analgesic properties, it also promotes granulation and tissue regeneration, as well as callus formation. Comfrey has wound-healing properties, according to some clinical reports, and can help heal abrasion wounds. It is still used as a natural treatment for joint and muscle pain, as well as closed wounds.
The traditional topical application of comfrey root preparations is supported by current clinical evidence.Comfrey root is prevalently applied externally as a cream for treating wounds and relieving inflammations (Staiger, 2012a). Other external forms of the herb include comfrey extracts, ointments, or compress pastes of comfrey leaves and roots; all used to treat the conditions described above. Such a form of usage is most prevalent and recommended by the health providers for using, as opposed to internal intake, which is proven to have a somewhat harmful effect.
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There are certain conditions in which comfrey may be internally applied, like the tea for treating hepatic disorders and rheumatism. Comfrey is said to help with gastritis and gastroduodenal ulcers when taken internally, but its effects have never been shown in a controlled study (Stickel & Seitz, 2000). Comfrey capsules are also recommended by herbalists for the treatment of rheumatoid arthritis, bronchitis, asthma, and diarrhea, regardless of the pathogenic trigger. However, while comfrey has a long history of applying, studies have shown that the pyrrolizidine alkaloids (PAs) present in comfrey can have potentially harmful effects during internal use (Salehi et al., 2019).
Because of the alkaloid content of comfrey, applying the cream to the skin is the best approach to treatment. The skin, as the body’s largest organ, is readily available, allowing for long-term application of formulations for transdermal absorption, making it an easier choice for drug delivery techniques. In a study comparing a 10% comfrey cream to a 1% reference cream, those who used the 10% cream for 2 to 3 days saw a clinically meaningful faster reduction in wound size compared to those using 1%cream (Smith & Jacobson, 2011). Thus the traditional topic method of the appliance is recommended for comfrey root.
Multiple studies focused on researching comfrey roots’ abilities to reduce and treat inflammation indicate a positive effect. One study reported joint pain decrease after 7 and 12 days in experiments using comfrey, and ankle pain and swelling were reduced in as little as 4 days (Smith & Jacobson, 2011). Comfrey root is used to treat inflammation injuries; however, since comfrey can contain toxic pyrrolizidine alkaloids, such uses are generally discouraged. Certain studies were able to prevent this problem by selecting and cultivating a comfrey variety with no detectable pyrrolizidine alkaloids in the aerial plant pieces. (Kucera et al., 2018) The accompanying medicinal preparation can be used in medical conditions where the skin is damaged due to the selection of this particular comfrey.
Several clinical trials were conducted to evaluate the effectiveness of various comfrey root preparations in the treatment of osteoarthritis-related symptoms. Researchers looked at the effects of a comfrey root extract-based cream (10% to 20%), which helped patients with osteoarthritis pain (Salehi et al., 2019). Thus the effectiveness of comfrey root in relieving pain and inflammatory processes has been proven by multiple studies. Moreover, it has been tested on both children and adults, demonstrating that the product is safe to use if applied correctly.
Several studies of comfrey root healing features include patient reports that demonstrate the satisfaction rate and the effectiveness of this herb. According to patients, comfrey root medication was effective in relieving pain and stiffness, as well as enhancing physical function (Smith & Jacobson, 2011). The effectiveness of wound healing was reported by patients in another study, where the participants reported a significantly faster healing process after several days of use, leaving good reviews (Staiger, 2012a). Thus, clinical trials with patient feedback report a positive attitude of people to such herb medication, recommending it for further use.
In other patient preferences, comfrey root application was chosen for other unconventional reasons. Patients with mild inflammatory or pain conditions often rely on herbal self-medication because clinical care is unavailable or inconvenient (Stickel & Seitz, 2000). Natural remedies are thought to be less dangerous, and they may be considered of as a “less offensive” way to deal with unpleasant but otherwise harmless grievances. Furthermore, patients complain that the severe side effects of certain conventional medications have increased their demand for therapies that work in harmony with nature rather than against it (Stickel & Seitz, 2000). Therefore, the reasoning behind using comfrey root as a medication for pain relief and other conditions is not only influenced by its healing abilities but also as a conscious choice against contemporary drugs.
Topical application of comfrey root extract has been used to treat sore muscle and joint problems. It has been scientifically proven to relieve muscle and joint pain, inflammation, and swelling. Because of its anti-inflammatory, de-swelling, and pain-relieving powers, comfrey root has a long history of use in the treatment of blunt injuries. Medical evidence has been used to back up the effectiveness of the herb. In a clinical trial on patients with ankle distortion, the percutaneous efficacy of the cream containing the aforementioned comfrey root fluid extract was confirmed (Salehi et al., 2019). Thus its effectiveness in treating swelling and pain is proven.
In other conditions, the comfrey root effectiveness has been established. Among patients with different forms of musculoskeletal rheumatism, the comfrey root ointment proved superior to placebo in patients with epicondylitis and tendovaginitis, but not in patients with periarthritis (Staiger, 2012b). Back pain is a common ailment that affects a large number of people’s quality of life and ability to move about. The topical anti-inflammatory approach has been widely used and has proven to be effective in the management of symptoms, resulting in decreased discomfort, more effortless healing, and quicker recovery (Staiger, 2012b). Thus, such medication repeatedly shows efficacy in treating conditions connected with pain relief.
Under local strain, however, there is a greater sensitivity to pain or tenderness; in cases where the damage occurs near or with the involvement of a joint, a lower but still evaluable sensitivity may be observed in terms of pain at movement (Predel et al., 2005). However, given comfrey root’s toxicity, the extent to which comfrey alkaloids and other plant medicines cause organ damage is still unknown (Stickel & Seitz, 2000).
The quality of pyrrolizidine alkaloids (PA) in the raw plant material and their toxicity is frequently discussed in comfrey literature. To prevent harmful effects on the body, some authors recommend reducing the length of treatment, including with externally applied comfrey preparations (Staiger, 2012b). The main caution is to advise the doctor when used on broken skin as it may potentially contain toxic unsaturated pyrrolizidine alkaloids.
Comfrey root application may cause mild side effects on the person’s skin. Adverse effects of internal intake may include: abdominal distension or pain, loss of appetite, lack of energy, liver enlargement, decreased urine output, venous-occlusive disease. Few side effects were found in human clinical trials with external use: chaffing, eczema, and erythema are all signs of eczema (Frost et al., 2014). However, no severe side effects were reported in any substantial research.
Comfrey root has been used in herbal medicine for centuries to treat wounds and inflammations. In contemporary medicine, comfrey is still widely applied, substantiated by fundamental research proving its efficacy. Based on multiple studies, comfrey root has shown high efficiency in treating wounds and relieving inflammation. It may be applied both externally and internally, however, prevalently prescribed for external use, as internal usage may cause adverse effects due to its slight toxicity.
Frost, R., MacPherson, H., & O’Meara, S. (2013). A critical scoping review of external uses of comfrey (Symphytum spp.). Complementary Therapies in Medicine, 21(6), 724–745. https://doi.org/10.1016/j.ctim.2013.09.009
Frost, R., O’Meara, S., & MacPherson, H. (2014). The external use of comfrey: A practitioner survey. Complementary Therapies in Clinical Practice, 20(4), 347–355. https://doi.org/10.1016/j.ctcp.2014.07.003
Kucera, A., Barna, M., Holcova, S., Horacek, O., Hladiková, M., & Ottillinger, B. (2018). Tolerability and effectiveness of an antitrauma cream with comfrey herb extract in pediatric use with application on intact and on broken skin. International Journal of Pediatrics and Adolescent Medicine, 5(4), 135–141. https://doi.org/10.1016/j.ijpam.2018.11.002
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Predel, H.-G. ., Giannetti, B., Koll, R., Bulitta, M., & Staiger, C. (2005). Efficacy of a Comfrey root extract ointment in comparison to a Diclo-fenac gel in the treatment of ankle distortions: Results of an observer-blind, randomized, multicenter study. Phytomedicine, 12(10), 707–714. https://doi.org/10.1016/j.phymed.2005.06.001
Salehi, Sharopov, Boyunegmez Tumer, Ozleyen, Rodríguez‐Pérez, Ezzat, Azzini, Hosseinabadi, Butnariu, Sarac, Bostan, Acharya, Sen, Nur Kasapoglu, Daşkaya-Dikmen, Özçelik, Baghalpour, Sharifi-Rad, Valere Tsouh Fokou, & Cho. (2019). Symphytum Species: A Comprehensive Review on Chemical Composition, Food Applications and Phytopharmacology. Molecules, 24(12), 2272. https://doi.org/10.3390/molecules24122272
Smith, D. B., & Jacobson, B. H. (2011). Effect of a blend of comfrey root extract (Symphytum officinale L.) and tannic acid creams in the treatment of osteoarthritis of the knee: randomized, placebo-controlled, double-blind, multiclinical trials. Journal of Chiropractic Medicine, 10(3), 147–156. https://doi.org/10.1016/j.jcm.2011.01.003
Staiger, C. (2012a). Comfrey: A Clinical Overview. Phytotherapy Research, n/a-n/a. https://doi.org/10.1002/ptr.4612
Staiger, C. (2012b). Comfrey root: from tradition to modern clinical trials. Wiener Medizinische Wochenschrift, 163(3-4), 58–64. https://doi.org/10.1007/s10354-012-0162-4
Stickel, F., & Seitz, H. K. (2000). The efficacy and safety of comfrey. Public Health Nutrition, 3(4a), 501–508. https://doi.org/10.1017/s1368980000000586