Are you having back pain with any of the following?

  • Severe pain, weakness or tingling in your leg(s).
  • Difficulty stopping urination or loss of control of bladder or bowels.
  • Unexplained fever, nausea or vomiting.
  • A history of cancer or unexplained weight loss.

We understand that you are experiencing one or more of the health issues that might be impacting your back pain.

We recommend that you discuss these health issues with your doctor before proceeding with this program.

Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.

Content loading spinner

Complementary and Alternative Medicine (CAM)

Some people prefer treatment options that complement traditional medicine such as acupuncture or herbal supplements that can help you stay healthy, feel better, and manage medical problems safely. To ensure the best possible treatment, please talk to us about your options.


St. John's Wort is an herbal treatment that may relieve symptoms of mild to moderate depression in adults. Symptoms of depression may include:

  • Lack of interest in things you used to enjoy
  • Sadness
  • Loss of appetite
  • Anxiety
  • Worry
  • Sleep problems

St. John's Wort is not effective in treating major depression. You should have a depression diagnosis by your doctor before taking this supplement. If you do begin taking St. John's Wort to treat mild depression, it may take up to 21 days to notice improvement in your mood.  Some evidence suggests that a combination of St. John's Wort plus a specific black cohosh extract (Remifemin) can reduce menopausal symptoms such as hot flashes.  Adding St. John's Wort to black cohosh appears to be superior to black cohosh alone in improving menopausal symptoms. 

It has not been proven that St. John's Wort relieves:

  • Gastritis
  • Insomnia
  • Swelling
  • Hemorrhoids
  • Skin irritations

St. John's Wort can interact with birth control pills, antidepressants, and many other medications. It is important to talk to your doctor or health care provider about any medications you are using if you are considering taking St. John's Wort.


If you take St. John's Wort along with other medications, you may experience dangerous side effects. St. John's Wort may decrease the effect of prescription medications. It is important to discuss herb use with us, especially if you take prescription drugs. St. John's Wort should not be taken by children.

Do not use St. John's Wort if you:

  • Drink alcohol.
  • Take over-the-counter cold or flu medicines, or narcotics such as codeine.
  • Take hormone replacement therapy.
  • Take oral contraceptives, such as the birth control pill.
  • Plan to get pregnant, are pregnant, or are breastfeeding.
  • Have a surgery or other procedure scheduled. Some herbs may cause bleeding problems or interfere with anesthesia. Stop taking herbs 3 weeks before any procedure.
  • Take medications for heart disease, depression, seizures, or cancer. St. John's Wort can decrease the effect of these medications.
  • Take selective serotonin reuptake inhibitor medicines (SSRIs) such as Prozac, Paxil, or tricyclic antidepressants such as Elavil.
  • Take medicines that cause sensitivity to the sun.
  • Have human immunodeficiency virus (HIV).
  • Are an organ transplant patient.

Side Effects

Side effects of St. John's Wort are not common, but they may include:

  • Allergic reactions
  • Dizziness
  • Dry mouth
  • Upset stomach
  • Constipation
  • Restlessness
  • Sleep problems
  • Sensitivity to the sun

If you notice any side effects, stop taking St. John's Wort and call your health care professional. You may report side effects directly to the FDA MedWatch at 1-800-FDA-1088 or on the Internet at

Safety and Quality Issues

Many people think that because an herb is natural, it must be safe. However, anything that is strong enough to affect your health is also strong enough to have side effects. In fact, some herbs can cause sickness and even death.

It's important to know the facts about all of your medications, including natural products. We work with the Natural Medicines Comprehensive Database to provide you with recent information so you can better understand dietary supplements, including:

  • Herbal remedies
  • Vitamins
  • Minerals
  • Other natural products

Before beginning any herbal treatment, talk to your doctor or other medical professional. They will be able to tell you if your treatment helps or interferes with other medications or with your treatment plan.

Our pharmacies carry only herbs and supplements known to be effective in treating certain medical conditions.

Regulation of Herbs and Supplements

In the United States, herbs are not regulated by the Food and Drug Administration (FDA). This means that they are not tested for safety or purity by manufacturers. The amount of any herb in a product can range from 0 to 150 percent of the amount shown on the label. The herb in the bottle may even be different from the herb on the label.

You should be aware of these risks with herbal supplements:

  • Toxicity. Certain herbs can make you sick.
  • Contamination. The herb (or a pesticide used on the herb) may make you sick.
  • Impurity. Herbs imported from other countries may have prescription drugs added to them.
  • Incorrect dosage. You may be getting less – or more – of an ingredient than the label shows, even if it uses the word “standardized” or “certified.” 

However, if a product has the U.S. Pharmacopeial stamp (USP), this means the dietary supplement has passed rigorous testing and contains the ingredients listed on the label, and in the stated strength and amounts. It also does not contain harmful levels of ingredients and is made according to FDA and USP Good Manufacturing Practices by using sanitary and well-controlled processes.  

To manage your health, you need to be informed. We strongly recommend that you talk to your doctor before taking herbs or supplements.

Before You Use Herbs and Supplements

Talk to us before taking any herbs or supplements. We need a full picture of everything you do to manage your health, so that we can take the best care of you. Talk to us in person or by e-mail or visit your nearest Health Education Department.  

Before using herbs or supplements, think about these things:

  • Some herbal supplements can interact with prescription and over-the-counter medicines.
  • Pregnant or nursing women should be especially careful when using herbal supplements. This caution also applies to giving children herbal supplements.
  • The Natural Medicines Comprehensive Database provides information about when to get medical care and when it's safe to self-treat.
  • Information about the safety and effectiveness of herbal supplements can change as new research results are reported. To check for recent updates, please visit the Herbs at a Glance series online at
Additional References:

Related Health Tools:

Classes and Coaching

See more Health Tools »

If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder. This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.

Content loading spinner