Harpagophytum procumbens in musculoskeletal disorders: current evidence and comparison with NSAIDs

Harpagophytum procumbens (HP), commonly known as Devil's Claw, is a traditional medicinal plant widely used for musculoskeletal pain and inflammatory conditions. Interest in HP has increased because long-term use of non-steroidal anti-inflammatory drugs (NSAIDs) may be limited by gastrointestinal, cardiovascular, and renal adverse effects. This structured narrative review summarizes current evidence regarding the pharmacological mechanisms, clinical efficacy, safety, pharmacokinetics, regulatory status, and comparative role of HP relative to NSAIDs. Preclinical studies suggest that HP and its constituents, particularly harpagoside, may modulate inflammatory pathways including cyclooxygenase-2, nuclear factor-κB, pro-inflammatory cytokines, and oxidative stress signaling. However, these mechanistic findings represent indirect evidence and should be interpreted cautiously in relation to clinical outcomes. Clinical studies, mainly in osteoarthritis and low back pain, suggest that selected HP preparations may provide symptomatic benefit in some patients. However, the clinical evidence base remains limited by small sample sizes, heterogeneous formulations, variable dosages, short follow-up durations, and a scarcity of high-quality head-to-head randomized trials against NSAIDs. In contrast, NSAIDs are supported by a substantially broader and higher-certainty evidence base for pain relief and functional improvement. Available safety data suggest that HP is generally well tolerated, although product quality, standardization, and long-term safety data remain variable across jurisdictions. Current evidence does not support positioning HP as a general replacement for NSAIDs. Rather, HP may be considered as a complementary or selective option for some patients, particularly where NSAID intolerance or long-term safety concerns exist. Further large-scale, rigorously designed randomized trials using standardized formulations are required.