When patients are asked about the medications they use to help with pain, the most common answers typically are ibuprofen (Advil, Motrin), acetaminophen (Tylenol), and acetylsalicylic acid (Aspirin). There are risk factors associated with each of these medications, including but not limited to gastrointestinal pain and bleeding or in severe cases, death. With regard to aspirin, the use of white willow bark (WWB) has been demonstrated multiple times to be more effective and safer for treatment of musculoskeletal pain. In a double-blind, placebo-controlled clinical trial of 210 patients with moderate-to-severe low back pain, WWB showed analgesic (pain-relieving) effects within one week of treatment. 

 In another study comparing the WWB with (now-recalled) Vioxx, treatments for low back pain were equally effective, yet WWB was safer and 40% less expensive.

 It is essential to note that while the salicylates present in WWB were the original source for pharmaceutical manufacture of aspirin, to classify them together clinically would be a mistake. Aspirin has two primary effects via three primary mechanisms of action:

1). anti-coagulant effects mediated by the permanent inactivation of an enzyme termed thromboxane-A synthase. This inhibition leads to the inactivation of the pro-coagulant Thromboxane A2.

2). anti-prostaglandin action 

3). antiprostaglandin formation which leads to inactivation of COX-2 gene transcription.

 White Willow Bark does not exert the first two effects as aspirin does, but it does exert the latter effect, that of COX-2 Inhibition. This leads to the inactivation of the cylco-oxygenase system, a pro-inflammatory cytokine. A daily dose of 240 mg of salicin has shown to be safe and salicylates are widely present in fruits, vegetables, herbs and spices and are partly responsible for the anti-cancer, anti-inflammatory and health-promoting benefits of fruit and vegetable consumption.