LaGrange, IL – May 2004 - A large percentage of patients are not likely to tell their physicians about herbal supplement use because they believe physicians do not support herb use, believe it is unrelated to their care or do not view herbs as medication and fear their physician may not be knowledgeable about them. Worse, many patients do not get information on herbs from health care providers—major sources of information are friends, family, magazines, product labels and advertising. Knowing what your patients are taking is key to preventing adverse events that may harm or even kill them.

In addition to benefits, herbs—like prescription medications—can have unwanted side effects, cause drug interactions and possibly create surgical problems. Many herbs have pharmacologic effects and even those that are generally safe can be dangerous or have side effects under certain conditions. For example, botanicals can interact with anesthesia or other medications commonly used in surgery or the procedure itself, causing surgical complications including enhanced bleeding. Nonsurgical drug-herb interactions are also common. According to a study in the Journal of the American Medical Association, roughly 15 million adults are at risk for possible adverse interactions between prescription drugs and herbs or high dose vitamins.

Because of the potential for herb-drug interactions and surgical complications, it is important carefully question patients about their herbal use.

• Ask all patients about herbal therapy, dietary supplement or other natural substance use in person, using neutral language. Document use in the chart (NASS provides a patient checklist – see following information).
• Ask patients to bring herbal supplements with them to their visits. During discussions about herbal usage, 1 in 5 patients can’t identify the preparation.
• Question patients about symptoms from undiagnosed conditions that may lead to disclosure of herbal usage.
• Be aware of the potential for contamination and variation among products.
• Caution patients to avoid combining herbs and prescription medications due to the risk of potential interactions.
• Advise patients not to use larger-than-recommended doses.
• Advise patients not to use herbs if they plan to become pregnant, or are pregnant or nursing.
• Advise patients to avoid long term use (more than several weeks).
• Tell patients that infants, children and geriatric patients should not be given herbs without the approval of a health care provider.
• Spend time developing and explaining patient-specific treatment plans. Patients who understand and are partners in their treatment are more likely to be compliant. Many patients solicit alternative practitioners because they view them as having beliefs consistent with their own and these practitioners often spend more time talking and listening to them.

To help health care providers educate and protect their patients, the North American Spine Society has developed a patient safety campaign Herbal Supplements: “Natural” Doesn’t Always Mean Safe featuring 3 documents on herbal supplements,

Natural ≠ Safe: Spine Care Provider’s Guide to Herbal Supplements. This guide provides health care professionals with information on herbal usage, regulation and ways to help your patients avoid adverse events. Tables provide various herbs with their uses/effects, potential side effects and potential interactions with references.

Herbal Supplements: “Natural” Doesn’t Always Mean Safe. This patient education brochure will provide your patients with background on herbs, tips for safe use and potential adverse effects, how to report adverse events and how to search the Internet for credible information. Set of 25.

Herbal Supplement Patient History Checklist. This checklist can be given to patients to complete as part of their standard medical history and added to the medical record. Pad of 25.

Order the herbal supplement series here or by contacting NASS at (630) 230-3600. Documents can be purchased separately or as a package.

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NASS is a multidisciplinary medical organization dedicated to fostering the highest quality, evidence-based, and ethical spine care by promoting education, research, and advocacy. Since its start in 1985, NASS has grown to nearly 4,000 members in 22 spine-related specialties. NASS members are MDs, DOs, and PhDs, including orthopedics, neurosurgery, physiatry, pain management, and other disciplines. Nurse practitioners, physician’s assistants, chiropractors, physical therapists, practice administrators, and other allied health care professionals involved in spine care are also represented as affiliate members.

For further information, contact:
North American Spine Society
Toll-free: (866) 960-6277   Direct: (630) 230-3600