Long known for alleviating chronic pain, these anti-inflammatory agents may also relieve pain from a variety of acute musculoskeletal injuries.
Reference
Rudrappa GH, Murthy M, Saklecha S, Kumar Kare S, Gupta A, Basu I. Fast pain relief in exercise-induced acute musculoskeletal pain by turmeric-boswellia formulation: a randomized placebo-controlled double-blinded multicentre study. Medicine. 2022;101(35):e30144.
Study Objective
To determine if the dietary supplementation of the plant extracts of curcumin and Boswellia can be used for acute pain relief from musculoskeletal conditions
Key Takeaway
A turmeric and Boswellia dietary supplement effectively reduced pain intensity and relieved acute musculoskeletal pain.
Design
Double-blinded, randomized, and placebo-controlled model conducted in multiple centers.
Participants
The study involved 232 healthy participants (aged 18 to 65 years) presenting with an acute musculoskeletal injury. Randomization was 1:1 male to female ratio.
Inclusion criteria consisted of the following injuries diagnosed within 24 hours of baseline (all not requiring hospitalization): “Exercise-induced musculoskeletal injuries, myalgia, neck pain, limb pain, low back pain, joint pain, widespread musculoskeletal pain, painful uncomplicated acute soft tissue injury of the upper or lower extremity, including acute injuries of ligaments, tendons, or muscles (including Grade 1 sprain or strain).”
Interventions
Researchers assessed pain intensity every 30 minutes over 6 hours following oral administration of a single dose of either intervention or placebo. The 3 conditions during the 6 hours were: at rest, with movement, or with pressure.
The intervention group received two 500-mg soft gels, each containing curcuminoids (266 mg) and acetyl keto-boswellic acid (10 mg) in a sesame-oil base (Rhuleave-K™). The placebo capsules consisted of maltodextrin in a base of polysorbate-80, propylene glycol, and polyethylene glycol-400.
Study Parameters Assessed
Investigators used several pain scales for assessment. They obtained data using the NRS (numerical pain rating scale), PRS (pain relief scale), and MPQ (short form of the McGill Pain Questionnaire). They measured the onset of analgesia via stopwatches.
Primary Outcome
Changes in the “pain intensity difference” at 6 hours after intervention/placebo at rest
Key Findings
NRS in the turmeric-Boswellia (TBF) group at the end of 6 hours was significantly improved vs placebo. The area under the curve (AUC) differed by:
- 95.39% at rest (P≤0.0001)
- 93.52% with movement (P≤0.0001)
- 93.28% with pressure (P≤0.0001)
Onset of analgesia
- Perceptible pain relief (PPR): 99.1% had relief in the TBF group vs 10.4% in the placebo group (P=0.0001).
- Meaningful pain relief (MPR): 95.7% had relief in the TBF group vs 1.7% in the placebo group (P=0.0001).
PRS Scale
- Total pain relief at 6 hours (TOTPAR6) at rest, with movement, and with pressure all showed significant improvement with TBF (P=0.0001).
- Restricted mean time to reach maximum pain relief: 194 minutes at rest, 197.7 minutes with movement, 194.2 minutes with pressure (P=0.0001 for each)
McGill Pain Questionnaire
- Significant reduction in affective, sensory, and total domains comparing pretreatment and posttreatment values (P=0.0001)
Transparency
Arjuna Natural Private Ltd of India provided the Rhuleave-K™ capsules as well as placebo.
Practice Implications & Limitations
Boswellia tree resin extract, also known as Indian frankincense, and turmeric have been used in traditional ayurvedic medicine for thousands of years. Both botanical medicines are touted for rejuvenating joints and for their many other anti-inflammatory-based health benefits. They can each be taken orally or applied topically. Curcumin, one of the active compounds in turmeric, has been shown to ameliorate obesity, metabolic syndrome, diabetes, depression, and fatty liver disease.1
In recent years, turmeric and Boswellia supplements have become popular for the relief of chronic pain and discomfort, largely owing to their reliable anti-inflammatory effects. Theimplications for acute applications, however, are less well studied,1 and this clinical trial aimed to shed light on their use for acute situations, namely injury-induced musculoskeletal pain.
Recent research shows a potential synergistic effect between turmeric and Boswellia for treating the inflammation and pain of osteoarthritis.
Turmeric (and its active compound, curcumin) is widely known for its anti-inflammatory effects. Fewer studies focus on Boswellia, as it is less available and less popular than turmeric. Research, however, has found that long-term use of Boswellia for patients with osteoarthritis is safe and effective.2 Recent research shows a potential synergistic effect between turmeric and Boswellia for treating the inflammation and pain of osteoarthritis.3
The study reviewed here was placebo-controlled, randomized, and double-blinded, and researchers conducted it at multiple centers in India. The design, intervention, and randomization used sound procedures. The study uses several pain scales to obtain a variety of data points, leading to a more rigorous conclusion. However, it must be noted that the data collected are subjective. Researchers did not collect any objective measures, such as functional changes (improved activity level or range of motion of the affected joint). There was no comparison to an over-the-counter analgesic, such as a nonsteroidal anti-inflammatory drug (NSAID) or to any prescription medications.
The study used a product called Rhuleave-K™, created by Arjuna Natural Private Ltd and manufactured in India. Extraction of the turmeric rhizomes and Boswellia serrata gum resin used a proprietary technology. It is unknown whether this technology is utilized by other companies.
Prior randomized control trials have shown the efficacy of other curcumin and Boswellia formulations for pain relief with fewer adverse gastrointestinal effects than NSAIDs.4 The dosage was chosen for this particular study’s healthy participants, but there was no mention of dosage adjustments for special populations such as the elderly or those with liver or renal impairment. Turmeric is generally considered safe at the dose of 500 mg, twice daily.5 However, mention of special populations may provide a better clinical application.
The study did not report any side effects that the participants may have suffered. A literature search finds that excessive intake of curcumin can have several adverse effects, including on the liver, kidney, cardiac system, and blood, and immune system.6 Although these adverse effects are rare and mostly seen in cases of excessive intake, they must be considered. Investigators also did not discuss the bioavailability and absorption, which could be considered outside the context of this study.
As an intervention for acute musculoskeletal pain in urgent settings, a turmeric and Boswellia supplement looks promising. The implications are great, with the possibility of avoiding opioids or NSAIDs, which have a more dangerous safety profile, in high-risk populations. More research is needed to determine the efficacy outside of healthy populations and examine adverse effects before making clinical conclusions.
