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A recent pilot study by Michalsen et al showed that a single brief treatment with medicinal leeches (Hirudo medicinalis) can give relatively long term relief from pain in osteoarthritic joints. A number of leech salivary components are known, which may contribute to this effect.1 Although there was no evidence for any therapeutic outcomes, other than pain relief, the extended timescale suggests that one or more leech components may exert more than an anaesthetic or analgesic effect. Independent evidence indicates that the leech …