SaveYourself.ca • Sensible advice for aches, pains & injuries
Traumeel is a popular homeopathic remedy for aches and pains. What does it do?
Traumeel® is the most popular of several brands of a type of homeopathic (dilute) cream for aches and pains. These products usually contain several herbs, but mostly Arnica montana, and they are often called “Arnica cream.” Manufacturers claim that the main benefits are “anti-inflammatory effects.” Traumeel enjoys a strong reputation for being good for muscular pain, joint pain, bruising, and sports injuries.1
A 100g tube of Traumeel costs about CDN $35 in Vancouver right now. There are now other several other similar products available.
In my career, I have often heard colleagues and patients sing the praises of Traumeel — stories of its miraculous healing powers, for people and animals, are common. It is often spoken of as if it is a “secret” weapon against pain, under-rated and little known but powerful. But can testimonials be believed? If it works, how does it work? This article explores the science of these products.
Traumeel is primarily promoted as a treatment for pain caused by inflammation, but many kinds of pain are not caused by inflammation. Pain has many possible causes, many of which cannot be treated by the application of any cream or ointment. By far the most common cause of stubborn pain is the humble “muscle knot” — a non-inflammatory problem, mostly deep and aching. Traumeel is recommended by the manufacturer for inflamed superficial injuries like bruising and tendinitis.
Painful muscle is a “sneaky” problem because it can cause and complicate and mimic other pain problems. Many people can go for years assuming that they have untreatable “arthritis,” for instance, yet at any time they could have been helped by a 10-minute self-massage. Not every case is so easy, but many are.
People probably try Traumeel for quite a few problems that aren’t actually inflammatory in nature. Many stubborn, erratic, aching pains are quite likely to be caused by muscle and might be better treated with massage. Please be aware of this possibility as you continue reading about Traumeel, and you can read much more about muscle knots.
Many people who use Traumeel aren’t aware that it is a homeopathic product, because it is not always labelled that way. They may also not know what homeopathy is. However, many others buy Traumeel because the know it is homeopathic — they believe it is a selling point.
Homeopaths treat by prescribing highly diluted substances. They believe that diluted ingredients are medicinally effective because the solution “remembers” something about the active ingredient — sort of like an echo. They also believe that this effect gets more potent as the original ingredient is further diluted — less is more, the homeopathic “Law of Infinitesimals”2 — even to the point that no molecules of the original substance remain, just their essence or vibrational imprint on the water.
Some products are not actually homeopathic, but use the marketing power of the word — its good reputation — to sell products, as with the cold-remedy Zicam. Zicam is labelled as homeopathic, but there’s actually enough zinc in Zicam to damage your sense of smell.3 Homeopaths might consider Zicam to be a “low potency” preparation, but such a mild dilution is usually considered too concentrated to be truly homeopathic.4
The complete family of homeopathic Traumeel products. The word “homeopathic” does not appear on most of the packaging.
The complete family of homeopathic Traumeel products. The word “homeopathic” does not appear on most of the packaging.
Traumeel’s manufacturer, however, either leaves the word off the packaging or makes it small. I have seen Traumeel packaging both with and without the word “homeopathic,” and you may have to read the fine print.56
Traumeel is definitely still a homeopathic remedy, albeit one of “low potency.” If you just want some herbal Arnica cream, you won’t find much in a dose of Traumeel. The packaging reads “Arnica montana 0.75g” and “3X”, a homeopathic notation meaning “diluted to 10% of its original concentration three times.”7
Although less than many other homeopathic products, 3X is still a lot of dilution: 7.5 micrograms of actual Arnica in a gram dosage of Traumeel. In the whole tube, that’s .75mg — not quite even a milligram (thousandth of a gram)! This is what a scientist would call a “trace amount.”8 See this note for the math.9
As they would say on MythBusters: “It’s plausible … but not likely.”
Dilution really takes the punch out of biochemical effects.10 Even if an infinitesimal concentration of a potent herb has some kind of effect, it’s doubtful that it would be a significant effect … and that’s the key to this question.
Have you ever tangled with poison ivy? I have! On the edge of a natural hot spring in the Kootenay region of British Columbia. It was memorable, but not all that bad. If the poison ivy toxin (urushiol) had been diluted 90% — 1X — it would only have been mildly irritating. I could rub urushiol 3X in my eyes with no trouble!
Indeed, dilution makes homeopathic treatments safe for exactly this reason.
Biochemically speaking, a subtle effect is not helpful for a terrible bruise or raging bursitis. But not even full-strength Arnica has any clear effect on inflammation,11 according to the research done so far. That’s why medicinal anti-inflammatory creams like Voltaren® Gel use diclofenac12 — not Arnica.
So if Traumeel works for aches and pains, it’s unlikely that it’s due to a straightforward biochemical effect, like aspirin. If Traumeel works, it has to do it homeopathically, not chemically.
To understand Traumeel, we must understand homeopathy — a controversial subject. I will do my best to review the key issues without judgement, and leave it up to the reader to decide. Several key information resources about homeopathy are presented in an appendix to this article. There’s one resource that matters more than all the others, though: The National Center for Complementary and Alternative Medicine (NCCAM).
NCCAM’s raison d’etre is to study and validate alternative health care practices such as homeopathy, and they have massive taxpayer funding, and they employ hundreds of real scientists.13 If you can’t cite NCCAM in support of homeopathy, who can you cite? Unfortunately, even after many years of expensive research, NCCAM has still made no clearly encouraging statement about the effectiveness of homeopathy. The best-funded organization for alternative medicine research in history has not produced evidence that homeopathy works, and this is stated on their website:
Most analyses of the research on homeopathy have concluded that there is little evidence to support homeopathy as an effective treatment for any specific condition.
Homeopathy: An Introduction, National Center for Complementary Medicine (NCCAM.nih.gov)
So what’s the problem?
Next: two more homeopathic controversies that are especially relevant to Traumeel.
The homeopathic “Law of Similars” is that “like cures like.” This idea is one of the two most important “laws” of homeopathy (along with the Law of Infinitesimals).
Guided by the Law of Similars, homeopaths choose ingredients whose normal effects are in some way similar to the problem they want to treat. For instance, an inflammatory condition is treated with an ingredient that would normally cause inflammation at detectable chemical concentrations.
Traumeel seems to break the Law of Similars. Its primary ingredient, Arnica, is believed to be an anti-inflammatory herb. Therefore, using Arnica is not “like cures like,” and breaks homeopathy’s own rules without any explanation I am aware of.
I may be ignorant of other homeopathic remedies that do not obey the Law of Similars, and the reasons for doing so. Homeopaths are invited to contact me with a proposed explanation — I will publish any explanation provided, in this spot. I have received plenty of email from homeopaths about this article, but none has addressed this point.
As mentioned homeopathic Arnica is often recommended for any kind of pain problem, even though many of them don’t have much in common with each other. For instance, consider tendinitis: acute tendinitis and chronic tendinitis are quite different conditions, with different chemistry.2324 It’s unlikely that one medicine could be truly effective for both.
Another good example: delayed onset muscle soreness (DOMS), that nasty soreness for a day or two after exercise. It can be savage, and its physiology is quite mysterious.25 Whatever causes it, it’s quite different than any other common pain problem. It’s also widespread and deep in the tissues — not in one convenient spot to rub Traumeel into. It is simply impractical to treat DOMS with a cream.
Anything is possible, but it does seem unlikely that any single medicine can be effective for many different kinds of pain.
Traumeel is popular! A great many people firmly believe that it works. The standard Traumeel story is, “I was amazed by how fast I healed.” Maybe so. I have experienced this myself on occasion, experimenting with the product. It may seem strange to many readers, but I am actually inclined to doubt my own experience. There are many good reasons not to trust ourselves too well. But this is the most important: have you wondered how fast healing would have occurred without Traumeel? How can you possibly know?
Patients are in a poor position to judge how quickly healing normally occurs.26 It is actually extremely difficult to accurately predict healing time from anything — everyone is different — and impossible for patients to accurately declare that their recovery was accelerated. Surprisingly quick recoveries occur routinely, Traumeel or no. This can create an illusion of success or failure that has nothing to do with own own actions or treatments:
Some patients recover very quickly from surgery. If those taking Arnica attribute their good recovery to the homeopathic remedy and this apparent association is widely reported, it is easy to see how the reputation can build. Since the experiences of patients who recover well without taking Arnica and those who receive no benefit from Arnica are less likely to be reported, the myth becomes reinforced.
Stevinson et al, “Homeopathic arnica for prevention of pain and bruising: randomized placebo-controlled trial in hand surgery,” Journal of the Royal Society of Medicine, 2003
What if there really was a “wonder drug” for pain? Powerful and safe? Effective on nearly any kind of pain? What if it sold as well as Traumeel does? What if it that product was already being used by literally millions of people?
Shouldn’t the world be nearly free of pain?
If you really want to know how well a pain remedy works, ask someone with severe chronic pain. I get many notes from people telling me how Traumeel helped their pain, but these stories are all about relatively minor injuries and pain problems — the kinds of things that tend to go away on their own sooner or later.
I do not receive notes from people claiming to have treated severe pain problems. There are no emails from runners who fought for years with iliotibial band syndrome — a repetitive strain injury of the knee which can be quite nasty — only to finally beat it with a dab of Traumeel each day. I have never gotten a message from a formerly debilitated victim of the most painful inflammatory diseases, liberated from their prison of agony by Traumeel.
It’s not for lack of trying. Severe pain drives patients to all manner of cures, whether indicated or not. But personally, I have yet to hear a Traumeel success story from someone who used to have serious pain.
As they'd say in Missouri, the Show-Me State, “If it works, show me.” Better yet, impress me. If Traumeel works, there’s no reason why it shouldn’t be able to ace a fair test, showing obviously superior results than a placebo, or even competing products.
“No other homeopathic remedy [than Traumeel] has been subject to more controlled clinical trials” (Ernst et al) … but that’s really not saying much. Less than a dozen somewhat noteworthy studies about the efficacy of Traumeel have been undertaken, a couple dozen if you include some really poorly designed ones. Considering the popularity of the product, that’s almost no research at all — much less, say, than what is required for FDA approval of a new drug, and most of that research has been of poor quality.272829
If you make even a token effort to separate the good research from the bad, it’s the small, poorly-designed studies30 that claim to have proven that Traumeel works on the basis of minimal data, while better and larger studies found that it had no effect that could be distinguished from placebo.
The only significant review of the scientific research is from 1998.31 It was co-authored by Dr. Edzard Ernst. Dr. Ernst used to be a homeopath, so he may probably understands the issues better than a physician or scientist without training in homeopathy. Ernst looked only at studies that compared homeopathic Arnica to a placebo, chose only eight,32 and found even those wanting:
Two studies yielded a statistically significant positive result (ie, Arnica superior to placebo), 2 studies had a numerically positive result (ie, no formal test statistics were applied but an advantage of the Arnica groups was apparent) and 4 studies showed a significantly negative result (ie, Arnica not superior to placebo).
… the more rigorous studies tended to be the ones that yielded negative findings.
On balance, the trial data do not support the notion that Arnica is efficacious.
… the hypothesis claiming that homeopathic Arnica is clinically effective beyond a placebo effect is not based on methodologically sound placebo-controlled trials.
And what about the research since 1998? One good study, better-designed and a little larger than most, was conducted in 2003. Researchers tested homeopathic Arnica to see if it would reduce swelling and pain after hand surgery for carpal tunnel syndrome. It did not: “The trial data do not support the notion that [homeopathic] Arnica is efficacious.”33
In 2006, two more studies are noteworthy because their data seems clearly negative to me, but the authors wrote conclusions that sound positive.3435 In the next section, I’ll describe another example of research like that in detail.
SINECCH™ is another homeopathic Arnica preparation, in the form of a pill. The manufacturer (Alpine Pharmaceuticals) publishes a research page that cites the conclusions of one study of SINECCH … a study that is itself a good example of science of questionable quality .
The study was conducted by surgeons at a cosmetic surgery clinic — not scientists. They wanted to see if SINECCH would reduce post-operative bruising after nose jobs.3637 Their experiment is tiny and sloppy. Key data is omitted from the conclusion — for instance, patients actually had more pain with homeopathy! Instead, a trivial improvement in the size of bruising is emphasized — a difference so small that it could only be detected by instrumentation,38 and not by patients or doctors, and was statistically significant (barely) on only two of five measurements taken.
And yet this paper has been widely cited as a “thumbs up” study of homeopathy, not only by the manufacturer of SINECCH, but by homeopaths everywhere.
Does that sound like a positive result to you? What good is a reduction in bruising so small that the patient cannot detect it? With an actual worsening of pain? This is the ultimate in ho-hum scientific results — and that’s even if we accept the published conclusions as statistically meaningful.
Which we can’t. The study was just too small.39 Alpine pharmaceuticals describes the results as “highly statistically significant”! But does the word “highly” appear in the paper? Nope — not once. You can check it yourself: here’s the full-text of the paper.
The surgeons reported that patients who received SINECCH “actually did worse than those in the control group at each time point” (and that is an accurate quote). It was not a statistically important difference, but that doesn’t matter: data showing a lack of benefit is still a thumbs down for SINECCH (evidence of absence). If the stuff works, it should cause a statistically significant reduction in pain, not any increase in pain! And who really cares what else goes on if pain isn’t improved? Who would buy SINECCH if they knew that it would only reduce bruising slightly, but have zero effect on pain?
This highly relevant data is blatantly dodged in the paper’s conclusion. The authors do say that there were “no subjective differences,” but they do not explain that those subjective differences include no difference in pain.
Amusingly, the surgeons also collected data on patient readiness for a night on the town — that is, they asked when patients felt that their bruising had faded enough that they were willing to go out to dinner! It sounds a bit silly, but it’s an interesting piece of data to collect: doubtless plastic surgery patients are acutely conscious of their appearance, and their dinner-readiness does seem to be one fair way to measure their recovery, and it might be even more emotionally important to them than pain.
So, how’d they do?
Amazingly, once again, patients on SINECCH did worse — not much worse, not statistically significant, but still definitely not better. Patients on SINECCH took an average 11.2 days before they felt ready for a public appearance. If only they’d gotten the placebo, they would have been out schmoozing by 10.6 days!
Neither the surgeons, nor Alpine Pharmaceutical — nor any homeopath on Earth I am aware of — has emphasized that result. In effect, omitting it is a lie by omission — blatant concealment of what anyone would actually find most interesting about the results. To try to justify the concealment by arguing that the differences weren’t statistically significant is an obvious evasion — what we care about is the absence of a statistically significant benefit to SINECCH.
An honest conclusion to this study, sans jargon, would have read like this:
15 patients treated with SINECCH had about the same pain and bruise colouration as 14 patients treated with a placebo, and took just as long to feel socially comfortable with the appearance of their faces. The size of their bruising was less, but the difference was so small that it was only detectable with instrumentation, and even then it was barely statistically significant on only 2 of the 5 days on which measurements were taken.
That’s the real conclusion. That’s what Alpine Pharmaceutical is citing to “support” their product. As evidence goes, the best you can say is that it's unconvincing.
Perhaps a more rigorous and larger study of Traumeel would have different results than SINECCH. Perhaps. It might be interesting to compare the two. Perhaps a topical ointment would be a more effective delivery medium, or at least it would give a stronger placebo effect and let people go out for dinner faster. But as I say, there is just no research at all about Traumeel-in-a-tube. And without research, there's no evidence.
It would be amazing if Traumeel worked. And, if it works well enough to matter, it should be easy to prove. So, where is that proof? Where are the results of the simple experiments that could end the argument? Without it, I’m not yet amazed by Traumeel.
It’s been 168 years since Oliver Wendell Holmes wrote “Homeopathy and Its Kindred Delusions.”40 It’s sad that those delusions still persist this long after his masterful debunking. The homeopathy Energizer Bunny is still marching along, banging its drum and trying to drown out the voices of reason. It is still necessary to keep explaining why homeopathic theory is incompatible with known science and to point out that remedies like Traumeel have been shown not to work, as Paul Ingraham does eloquently in this well-researched article.
Dr. Harriet Hall, The SkepDoc, and author of Women Aren’t Supposed to Fly: The Memoirs of a Female Flight Surgeon41
Science-Based Medicine publishes a good collection of critical articles and resources about homeopathy.
Homeowatch is entirely devoted to debunking homeopathy.
The above are some of the most strongly anti-homeopathy sources available, created by physicians and scientists. It is not my impression that they are mindlessly dismissive of homeopathy: they seem to have put a great deal of thought into their criticisms, and the quality of writing is generally excellent. They impress me.
Wikipedia has a thorough article about homeopathy. It’s not neutral — homeopaths probably dislike it. Still, it seems well-written and it’s heavily referenced, and you can’t beat that as a starting point. It provides a lot of well-sourced information.
The National Center for Complementary and Alternative Medicine is a curious case, as described above. The organization has a mandate and huge budget to prove that homeopathy works, but hasn’t been able to do it. Their information page on homeopathy reads with a friendly-to-homeopathy tone, as though it’s a rather good idea … but openly acknowledges that there is still no evidence that it works (previously quoted), even after many years of well-funded attempts to prove it. An interesting and unusual source.
The National Center For Homeopathy disagrees with NCCAM, and claims that “there are literally hundreds of high quality, published basic science, pre-clinical and clinical studies showing that homeopathy works.” They publish a bibliography and a few articles. There are numerous other homeopathy associations with similar websites.
I have had trouble finding good quality sources of information promoting homeopathy. Information presented by homeopaths is often of such poor quality that citing it is often no favour to their cause. Consider the case of a recent YouTube video by homeopath Charlene Werner: she earnestly makes a case for homeopathy on the basis of a string of appalling misunderstandings of physics. If you know nothing about physics, trust me … neither does she. See Dr. David Gorski’s pained analysis.
I invite anyone reading this to contact me and supply examples of better quality resources about homeopathy. I will happily publish a link to any such source. Although I have received many comments, positive and negative, about this article, no one has yet suggested a single better information resource about homeopathy.
Homeopathy: Cure or Con? Part 1 on YouTube.com. See also: Original CBC show page. Superb investigative journalism from Canada’s CBC television, from a consumer advocacy point of view. A massive homeopathy overdose demonstration; a homeopath is recorded promising to cure stage 1 breast cancer in (such a claim would be condemned by homeopathic professional associations); a chemistry lab proves that active ingredients cannot be identified in homeopathic preparations; and a mom who vaccinates her kids with homeopathy admits that she is a surprised by the lack of active ingredients. That Mitchell and Webb Look: Homeopathic A&E on YouTube.com. Totally hilarious.Friday, June 24, 2011 — Temporarily removed a section summarizing research based on the idea that Homeopathic arnica in ointment form has never been studied, because I found a handful of studies. Eventually I will add an analysis of those studies to the article.
Tuesday, January 18, 2011 — A few more references added.
Tuesday, April 13, 2010 — Added endorsement from Dr. Harriet Hall.
February 25, 2010 — Editing to make the article shorter, more readable. Move a lot of optional information into footnotes. Added and clarified of a few citations.
January 30, 2010 — Complete re-write and major expansion.
2008 — Original publication of basic article.
“The Homoeopathic Pharmacy lists as its first indication "trauma" and even recommends it as a first-aid treatment.” BACK TO TEXTHowever, other sources contradict this, explaining that “potency” does not actually mean “strength.” What it does mean is hard to be sure of. Some say that low potencies are for localized problems, while high potencies are for system-wide problems. Other sources describe low potencies as being appropriate for “minor” problems, though, which sounds more like the “strength” definition. Homeopath Gina Tyler describes 9 considerations in choosing the potency, including vague and subjective considerations like “the susceptibility of the person” and their constitution, temperament and habits! So, a more dilute preparation is always considered a more potent preparation, but the definition of “potency” seems to be rather flexible. BACK TO TEXT
| grams | micrograms | quantity | comments | ||||
|---|---|---|---|---|---|---|---|
| .75g diluted arnica | ÷ | 1000 | = | 0.00075g | 750µg | actual arnica per tube | The .75g of arnica on the tube is diluted to “3X,” a.k.a. 1000 times less actual arnica than .75g, so divide .75 by 1000 to get the amount of actual arnica. |
| .00075g actual arnica | ÷ | 100 | = | 0.0000075g | 7.5µg | actual arnica per dose | Assume that a dose is about 1 gram, there are about 100 doses in a tube, so the amount of arnica in a dose is 1% of the arnica in the tube. |
9:37. BACK TO TEXT Comments: From the abstract: “If physicians acknowledge that overuse tendinopathies are due to tendinosis, as distinct from tendinitis, they must modify patient management …” BACK TO TEXT “… burdened with a multitude of methodological limitations. Small sample size and lack of test statistics are frequent and obvious ones.” BACK TO TEXT BACK TO TEXT BACK TO TEXT BACK TO TEXT In this study, surgeons found a small positive effect in 57 patients, and emphasized that in their conclusions … instead of emphasizing their best data, which showed no benefit in 227 other patients. Averaged out, it would have been a strongly negative study — good evidence of absence. But they spun it as a positive study. See the full bibliographic record for details. BACK TO TEXT BACK TO TEXT
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