Research paperEthnopharmacological survey of plants used in the traditional treatment of pain conditions in Mali
Graphical abstract
Introduction
Pain represents a major public health issue worldwide (Phillips, 2006). An important challenge in analgesia is to provide more effective and safer treatments with fewer side effects. Indeed, more than 1.5 billion people worldwide suffer from chronic pain (Global Industry Analysts Inc., 2011) while almost 5% of the global population suffer from neuropathic pain (Global Industry Analysts Inc., 2011). Chronic pain can lead to depression and/or job loss (Breivik et al., 2006) as well as increasing direct and indirect health-care costs. Developing new solutions in pain management has become a priority. During the last decade, pain mechanisms have been better elucidated (Basbaum et al., 2009); however, progress in pain therapy is stagnating. Strategies used by drug developers consist mainly of reformulations of current drugs (Global Industry Analysts Inc., 2011), but there is a pressing need for new active molecules with fewer side effects.
Natural products represent a very large source of new bioactive principles, illustrated by the fact that more than 50% of clinically-approved drugs are in fact of natural origin (Newman and Cragg, 2007).
Moreover, the effectiveness of medicinal plants used by traditional healers has been proved by scientific studies (Al-Sayed and El-Naga, 2015; Gismondi et al., 2013; Scott et al., 2004). Literature data shows that several plant extracts, commonly used for the treatment of painful and inflammatory conditions, demonstrate anti-nociceptive and anti-infammatory activities (Melo et al., 2013; Silva et al., 2013a,b).
Many countries rely on traditional medicine. In Mali, 75% of the population regularly consult traditional healers (WHO, 2015) for small health problems, such as headache or back pain, or even more important conditions such as diabetes, malaria or fractures. In Mali, traditional healers are organized in associations, which belong to the Malian Federation of Tradipraticians and Herbalists (FeMaTH). They are taught by their parents how to recognise diseases and treat people using local plants. This knowledge is based on empirical observations but has many times proved its accuracy (Gurib-Fakim, 2008).
The current survey has gathered data in relation to traditional remedies used to treat pain conditions such as stomach aches, muscle aches and back pains, but also pain due to sickle cell disease or diabetes as well as traumatic pains. In Mali and in neighbouring countries within the same climate zones, such as Burkina Faso, to the best of the authors’ knowledge, no ethnopharmacological survey concerning pain has ever been published before. Many studies have aimed at identifying traditional medicine (Inngjerdingen et al., 2004; Nadembega et al., 2011; Tapsoba and Deschamps, 2006), but none were found to focus on pain. The present survey constitutes an original approach to identifying potential analgesic plants. This might be due to the fact that pain is often considered as a symptom rather than a disease. Thus care should be taken, during interviews, to ensure that the remedies described do not cure the disease that is responsible for pain but rather diminish the pain itself.
This survey will pave the way for the scientific community to investigate novel analgesic strategies, and for the local community to develop improved traditional medicine along the same lines as Malarial®, which is a plant-based drug used against malaria, developed by the Department of Traditional Medicine (DMT) in Bamako and sold in drugstores in Mali.
Section snippets
Study areas and climate
This ethnopharmacological survey was conducted in the South of Mali, in four different cities and their surroundings (Fig. 1): Bamako (Médine market, Médine market Kouloudjou, Hamdallaye market, Djikoroni Para market, Kalabancoura, Niamakoro), Siby (Kati Cercle, 50 km south-west of Bamako), Dioïla and its surroundings (Seremanbougou, Banko and Massigui in Dioïla), Sikasso and its surroundings (Ziasso and Finkolo in Sikasso Cercle).
The south of Mali belongs to the Sahelo-Sudanian and
Demographic characteristics of the traditional healers
The survey was conducted with 108 respondents (25% women and 75% men) belonging to local associations of traditional healers. The mean age was 60 ± 13 years old. The youngest was 30 years old and the oldest 89. The number of traditional healers increases with age (Fig. 2), underlining the risk that knowledge could disappear and the need for the younger healers to take over.
Most of the respondents had no formal education (79%) and learned traditional medicine from their parents or grand-parents
Discussion
The present survey documents traditional medicinal plants commonly used for pain management and treatment in the South of Mali. The first observation of this study was that the average age of traditional healers is relatively high: 57% of traditional healers were over 60 years old and the new generation has not yet taken over; only 7% of traditional healers were under 40 years old. In future years, this could lead to the loss of precious knowledge about plants and their uses. Thus, it is
Conclusion
This survey has catalogued plant-based traditional remedies with potential analgesic activities. 108 traditional healers were interviewed in south of Mali. 66 plant species, distributed across 29 families, were recorded. Stomach aches and external pains were the most frequently-cited pain conditions. Cassia sieberiana, Zanthoxylum zanthoxyloides, Pericopsis laxiflora, Flueggea virosa and Sarcocephalus latifolius were the most cited plants. Even though their analgesic properties have already
Competing interests
The authors declare that there are no competing interests. The interviews of traditional healers were undertaken with the agreement of the FeMaTh, and the results of this study were shared with the interested parties (associations and healers). Moreover, the funding sources had no involvement in the study.
Associated content
The questionnaire used in the study is available as on-line supplementary data.
Authors’ contributions
PC and SD designed the project. PC, DD and LS conceptualized the study. OD, AS and BF performed the interviews with the healers. DD and AS identified all plant materials described. OD analysed the field data with PC. AE, FM and CRC helped define analgesic terms to use during interviews. OD reviewed the research proposal, which was corrected by PC and SD.
All the authors have read and approved the
Funding
This work was supported by the Service de Coopération et d’Actions Culturelles (SCAC) of the French Embassy in Mali [grant number 12CGC59EXXXC] and the Conseil Régional d'Auvergne [grant number: 13CGC72EXXXC].
Acknowledgments
This work is part of the partnership between the University Clermont-Auvergne and the University of Sciences, Techniques and Technologies of Bamako. Our sincere thanks go to the traditional healers for participating in this study and to the team of the Department of Traditional Medicine for introducing us to the healers’ community and helping us identify the plants.
References (50)
- et al.
Pharmacological evidence favouring the use of Nauclea latifolia in malaria ethnopharmacy: Effects against nociception, inflammation, and pyrexia in rats and mice
J. Ethnopharmacol.
(2010) - et al.
Protective role of ellagitannins from Eucalyptus citriodora against ethanol-induced gastric ulcer in rats: impact on oxidative stress, inflammation and calcitonin-gene related peptide
Phytomedicine
(2015) - et al.
Cellular and molecular mechanisms of pain
Cell
(2009) - et al.
Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment
Eur. J. Pain
(2006) - et al.
The distribution of glutathione and homoglutathione in leaf, root and seed tissue of 73 species across the three sub-families of the Leguminosae
Phytochemistry
(2015) - et al.
Identification of medicinal plants in the family Fabaceae using a potential DNA barcode ITS2
J. Ethnopharmacol.
(2010) - et al.
An ethnopharmacological survey of plants used for wound healing in Dogonland, Mali, West Africa
J. Ethnopharmacol.
(2004) - et al.
COX-1 inhibitory effect of medicinal plants of Ghana
South Afr. J. Bot.
(2015) - et al.
Antinociceptive, neurobehavioral and antioxidant effects of Eupatorium triplinerve Vahl on rats
J. Ethnopharmacol.
(2013) - et al.
Medicinal plants in Baskoure, Kourittenga Province, Burkina Faso: an ethnobotanical study
J. Ethnopharmacol.
(2011)