American Society of Hirudotherapy

Medicinal leech therapy in pain syndromes: a narrative review

Narrative review published in Wiener Medizinische Wochenschrift (2013)

Last Updated: June 18, 2026Reviewed by: ASH Editorial Board
Research article — evidence reviewArticle reference
Evidence: Narrative reviewClinical TrialsSalivary PharmacologyKoeppen D et al. · Wiener Medizinische Wochenschrift, 2013

Abstract

Medicinal leech therapy is used in a variety of conditions; most of which have pain as a major symptom. Its mode of action relies on the injection of leech saliva into patients' tissues during the process of blood withdrawal. Leech saliva contains active ingredients with anti-inflammatory, thrombolytic, anti-coagulant and blood- and lymph-circulation enhancing properties. A specific analgesic substance within the leech saliva is yet to be identified. Pain relief from leech therapy is rapid, effective and long-lasting in many conditions. This review compiles studies and case reports that provide clinical evidence for leech therapy's analgesic effects.

Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.

Publication typeJournal ArticleReview
Indexed MeSH termsAnimalsChronic PainEdemaHematomaHumansLeechesLeechingOsteoarthritisPalliative CareRandomized Controlled Trials as TopicSalivaTennis Elbow

Summary

Narrative review on leech therapy's analgesic effect across multiple pain syndromes (osteoarthritis, epicondylitis, hematoma, thrombophlebitis, varicose veins); the saliva contains anti-inflammatory, thrombolytic, anti-coagulant and circulation-enhancing molecules, though a specific analgesic compound has not been identified.

Why This Matters for Hirudotherapy

This narrative review compiles clinical evidence for the analgesic effects of medicinal leech therapy across pain-associated conditions. The authors describe leech saliva as containing active ingredients with anti-inflammatory, thrombolytic, anticoagulant, and circulation-enhancing properties, while noting that a specific analgesic substance has not yet been identified. They characterize pain relief as rapid, effective, and long-lasting in many conditions. For ASH, this review is directly relevant, synthesizing clinical evidence supporting leech therapy's role in pain management. CAVEAT: As a narrative review, it lacks systematic methodology; the abstract does not specify the number, design, or quality of included studies, and no quantitative effect sizes or specific condition-by-condition outcomes are reported.

Citation

Medicinal leech therapy in pain syndromes: a narrative review.

Koeppen D et al. · Wiener Medizinische Wochenschrift, 2013

DOI

Added to ASH library: May 27, 2026 · Site last updated: June 18, 2026

This website provides educational information and does not constitute medical advice, diagnosis, or treatment recommendations. Medicinal leech therapy carries clinically meaningful risks and should be performed only by qualified clinicians under institutionally approved protocols. FDA 510(k) clearance for medicinal leeches is limited to specific indications; investigational and off-label discussions are labeled accordingly. For patient-specific guidance, consult a qualified healthcare provider.