Black sage, Salvia mellifera
, is a traditional medicine of the Chumash Indians of California [1
]. It is used as a sun tea made from the stems and leaves of the plant to treat pain. S. mellifera
sun tea is also traditionally used to cure chronic pain. The authors have used this and other Chumash medicines to treat many pain patients. Black sage contains 54 monoterpenoids and several diterpenoids such as carnosol (41%), carnosic acid (22%), salvicanol (15%) and rosmanol (9%) [3
]. The monoterpenoids are 1.8-cineole (39.8%), camphor (12.2%), α-pinene (9.2%), limonene (2.2%), myrcene (2%), γ-terpinene (2%), terpene-4-ol (2%) and many less abundant monoterpenoids.
Currently in the US, chronic pain affects 60%, or more, of people over the age of 65 [5
]. Chronic pain is pain that continues long after the initial cause of the pain is gone, such as back injuries, car accidents, surgery, nerve damage and infections. Unfortunately, there is no cure for chronic pain—only partial short-term therapies are available—but chronic postsurgical pain can sometimes be prevented [6
The causes of chronic pain are only now being understood and may involve chemokines. It has been proposed that peripheral and central sensitization mechanisms perpetuate chronic pain [6
] but none of these mechanisms adequately explain how to cure chronic pain. Opioids and other drugs are used to manage pain and chronic pain [6
]. Patients seek these drugs that cause 100,000 or more deaths every year [8
]. In the US, there is an opioid crisis and a non-steroidal anti-inflammatory drugs (NSAIDs) crisis due to excessive use of these dangerous oral drugs. Many patients believe that pain comes from the brain. Therefore, pain must be treated with drugs that penetrate into the brain.
Pain is felt in the skin due to the abundance of pain receptors in the skin, such as transient receptor potential cation (TRP) channels, prostaglandin receptors, histamine receptors, muscarinic receptors and many more [9
]. The safest and most effective treatment for pain is to apply a medicine to the skin [9
]. Topical medicines are safer than oral medicines and could save the lives of thousands of pain patients. The dilemma with topical pain medicines is to find potent medicines that can treat even severe pain, yet do not have toxicity problems. Sagebrush liniment contains cineole, which is more powerful than morphine [11
] and is used by topical application to treat broken bones, gunshot wounds, cancer pain and other severe pain [11
]. Sagebrush liniment can also provide long-term relief from chronic pain. Several topical pain medicines are commercially available with more under development [13
Chronic pain may be caused by a pain chemokine cycle that involves the release of chemokines in the skin by damaged or stressed cells [8
]. Chemokines attract macrophages to the skin and induce cyclooxygenase-2 (COX-2) in macrophages, which release prostaglandins. Prostaglandins cause pain by binding to prostaglandin receptors and prolong pain by inducing the phosphorylation of TRP channels [11
]. This activates TRP channels and makes them more sensitive to stimuli. Phosphorylation of Na+
channels is also induced by prostaglandins [15
], which may make them more sensitive to stimuli. Both TRP and Na+
channels, as well as many other skin receptors, are important in pain [10
]. Prostaglandins also enhance the release of chemokines in the skin. Chemokines cause the activation of TRP channels to increase and prolong pain. Macrophages secrete IL-23 and IL-1β that induce the synthesis of IL-17 by skin resident T cells. IL-17 induces chemokine release in the skin. Chemokines stimulate the release of IL-17. This establishes a self-perpetuating pain chemokine cycle in which prostaglandins, chemokines and IL-17 cause, enhance and prolong pain. The skin produces pain during chronic pain. Curing chronic pain involves inhibiting TRP channels, chemokine production, IL-17 production, COX-2 expression and perhaps other mechanisms [8
The brain may be involved in the pain chemokine cycle (Figure 1
). The activation of afferent sensory neurons in the skin leads to chemokine release in the brain [17
]. Chemokines in the brain modulate the actions of other neurons, including descending and peripheral neurons, which may result in chemokine release in the skin [17
]. These chemokines can be released in sites distant from the site of application of medicine to the skin.
3. Case Reports: Use of Black Sage Sun Tea in Pain Patients
There are reports of pain patient treatment with black sage sun tea and long-term improvements in chronic pain with the medicine [1
]. The following are previously unreported patient results. Patients were recruited at talks about traditional medicine given by the authors to the public (Table 1
). The authors are not medical doctors and did not perform any diagnostic tests or examinations on any patient. Patients reported the diagnoses they had been given by other medical professionals. Most patients declined to discuss their family histories, medications or other health conditions. The authors did not examine patients after treatment but relied on the ability of patients to rate their pain on a scale of 0–10. Many patients were treated one time with black sage sun tea, reported pain relief, but did not respond to requests for follow-up information. These patients are not included in the current report. The total number of patients recruited was probably between 100 and 200.
A 20-year-old Caucasian woman suffered from a sports injury that resulted in compartment syndrome in both legs. She had surgery to relieve the edema in her legs. One year later, she was diagnosed with complex regional pain syndrome in both legs. She described her pain as severe. She had no other disorders and no family history of chronic pain. She used the black sage sun tea for 1 day and reported that her pain decreased temporarily, then returned. She was later given bilateral lumbar pain shots on four occasions that she said made her back hurt.
A 28-year-old Caucasian man suffered from two protruding disks (L4–L5–S1) along with a rotated spine and tilted pelvis, which caused debilitating sciatica and muscle spasms. This was the result of two car accidents. He also had chronic pain in his shoulder from an injury several years previously. He had no other medical conditions and no family history of chronic pain. The patient used black sage sun tea for 7 days and physical therapy and has not felt any chronic pain since treatment. The following are the words of the patient: “The first time I used the sun tea, I could feel my pain subsiding comparable to the effect of an anti-inflammatory drug such as an NSAID or steroidal epidural. After soaking my feet in the sun tea, I felt pain relief without the drowsiness side effects that frequently accompany opioids. After the sun tea soak, I felt relieved of my pain and my mind was also clear and not cloudy. I also was able to notice that my shoulder inflammation that I had always had from a prior injury was gone.” In other words, black sage sun tea, along with physical therapy, improved his chronic pain in his back and shoulder. After more than 6 months without pain, the patient reinjured his back at work. His chronic pain returned. He treated himself with sagebrush liniment and black sage sun tea and said it was helpful. He now says he is pain free.
A 62-year-old male Latino suffered from chronic knee pain for 2 years after knee surgery. He had no other medical conditions and no family history of chronic pain. After using the black sage sun tea for 1 week, he reported his pain was gone and did not return.
A 47-year-old Caucasian female had suffered from plantar fasciitis for 1 month. She had no other medical conditions and no family history of chronic pain. She used the black sage sun tea for 1 week and said her pain was reduced, but still present. Physical therapy was recommended for her to help her learn how to decrease the damage of plantar fasciitis.
A 55-year-old Latina woman had suffered for many months from plantar fasciitis. She had no other medical conditions and no family history of chronic pain. She used the black sage sun tea for 1 week and said her pain had decreased by 20%.
A 48-year-old Caucasian male had suffered for 2 months from pain due to a damaged rotator cuff. He had no family history of chronic pain and no other medical conditions. He used the sun tea for 1 week and reported that his pain was gone and did not return.
Three arthritis patients used the black sage sun tea for 1 week and reported temporarily decreased pain but no cure of their arthritis. The patients were: a 56-year-old Latina female who suffered for 29 years from arthritis in her leg, a 47-year-old Latino male who suffered for 29 years from arthritis in his hand, and a 54-year-old Caucasian male who suffered for 10 years from arthritis in his hip. None of these patients reported their histories or other medications.
A 49-year-old Caucasian man suffered from a pinched nerve in the neck due to degenerative spinal disease. He had no family history of chronic pain and no other medical conditions. He used the black sage sun tea once and reported that his pain was gone the next day and did not return for about 2 weeks. He later reported that he did not notice any neck pain anymore.
A 68-year-old Caucasian woman suffered from whiplash for several months after a car accident. She had no other medical problems and no family history of chronic pain. She used black sage sun tea for 4 days and reported she was “cured” of her pain. She waited 3 months to report her “cure” since she was certain her pain would return.
A 70-year-old Caucasian woman suffered from chronic neck pain for several months. She did not know what caused her neck pain. She used black sage sun tea for 2 days and reported that her neck was very much improved and continued to be very much improved 2 weeks later.
A 37-year-old Caucasian woman suffered from Morton’s Neuroma. She had no other physical conditions or family history of chronic pain. She used black sage sun tea daily for 6 days and reported that her pain disappeared. She was able to do a week-long backpacking trip with manageable pain. She continued to have no pain several weeks later.
A 70-year-old Asian man suffered from polymyalgia rheumatica for several weeks and lost more than 20 pounds since he was too tired and in pain to eat. He had no family history of chronic pain and was not using any medications. He tried acupuncture and Chinese herbs and found good, temporary pain relief. He then tried both black sage sun tea for 1 week and sagebrush liniment for several weeks. He said the sagebrush liniment provided good pain relief. After several weeks, he stopped using all pain medications, was no longer in pain and returned to his normal life.