Prickly ash, referring to species such as Zanthoxylum americanum or Zanthoxylum clava-herculis, has a long history of use in North American traditional medicine, especially among Native American communities and early settlers. It was often used as a remedy for a variety of ailments, including backache, rheumatism, and as a general pain reliever. The bark and berries were typically prepared as teas, tinctures, or topical poultices. The rationale for its traditional use stemmed from its reputed warming, stimulating, and circulatory-enhancing effects, which were believed to help alleviate musculoskeletal pain, including backaches. Some herbalists have historically classified prickly ash as a "counterirritant," meaning it could stimulate local blood flow and reduce the perception of deeper pain. However, scientific evidence supporting the efficacy of prickly ash for backache is scant. While some laboratory studies suggest that compounds in prickly ash may have anti-inflammatory or analgesic properties, these findings are preliminary and not specific to back pain. No well-designed clinical trials exist to validate its effectiveness for this purpose. Thus, its use for backache is primarily justified by tradition rather than scientific validation.