Pain Relief: Beyond NSAIDs

Creating a comprehensive pain-management protocol with safe, science-backed botanicals and nutrients

Pain is an inevitable, even normal, part of life. But when pain lingers, lasting for months or years, it’s devastating to your patients’ well-being. What’s worse, it may have no apparent cause—making it frustrating and nearly impossible to treat. And it’s a big problem. In the United States, chronic pain has reached epidemic proportions: in 2021, almost 21 percent of U.S. adults suffered from pain that lasted longer than three months, and more than 17 million Americans experienced high-impact chronic pain that significantly restricted their daily activities.^{1, 2}

Current pain management protocols are woefully lacking. In the absence of meaningful, long-term approaches, conventional treatments rely primarily on opioids, prescription NSAIDs and over-the-counter remedies—each with its own set of weighty consequences.

The dangers and addictive potential of oxycodone, hydrocodone and other prescription opioids cannot be overstated. In 2020, an estimated 2.7 million adults in the United States had an opioid use disorder, including 2.3 million with a prescription opioid use disorder. Over the past decade, opioid-involved overdoses have dramatically increased, rising to more than 81,806 deaths in 2022—almost double the number from 2019. Besides their addictive nature, opioids can dangerously suppress respiration, and prolonged use is associated with constipation—a common and persistent problem that significantly impacts quality of life—as well as hormonal imbalances and endocrine-related complications.^{3, 4}

In light of the highly publicized opioid crisis, NSAIDs like celecoxib and diclofenac sodium are considered safer alternatives. Frequently prescribed for treating osteoarthritis, rheumatoid arthritis and other chronic joint and muscle pain, they’re far from benign. NSAIDs have been linked with a variety of adverse effects, including headaches, ulcers, gastrointestinal bleeding and kidney damage, and a heightened risk of heart attack and stroke.^{5, 6}

Even over-the-counter medications like acetaminophen and ibuprofen are associated with a troubling range of adverse effects, including gastric bleeding, ulcers, liver and kidney damage, and increased risk of heart attack and stroke. Overall, NSAIDS are implicated in nearly 25 percent of all drug reactions and OTC pain relievers are the most common cause of serious overdose in the United States.

A better, safer solution: clinically validated botanicals and other nutrients shown to tame inflammation, treat pain and improve quality of life. “Curcumin and boswellia should form the cornerstone of a natural pain-relief protocol,” says Lexi Loch, ND, Medical Educator for EuroPharma USA, makers of EuroMedica® brand supplements. “Curcumin is excellent for helping to modulate pain and resolve inflammation. Boswellia pairs well with curcumin because of their complementary activities: curcumin can downregulate almost every inflammatory pathway in the body, whereas boswellia excels at reducing the formation of pro-inflammatory leukotrienes through the 5-lipoxygenase (5-LOX) pathway.”

The anti-inflammatory properties of curcumin are well established, and clinical trials demonstrate its ability to relieve pain without adverse effects. Unlike synthetic drugs, curcumin impacts multiple inflammation pathways and acts as a potent antioxidant, preventing cellular damage. Curcumin also interferes with pain perception and transmission and minimizes joint cartilage breakdown. Boswellia not only lessens inflammation, but also improves arthritis symptoms, pain and physical function. Like curcumin, boswellia exhibits powerful antioxidant and analgesic properties, decreasing the sensation of pain, and research suggests its potential to protect cartilage from degradation.^{7, 8, 9, 10}

Because curcumin is poorly absorbed and rapidly metabolized and excreted, achieving therapeutic doses can be difficult. “The curcumin I recommend is enhanced with turmeric essential oil and has been the subject of 90 studies,” says Loch. “Research shows this combination can reach about seven times greater concentration than standard 95 percent curcumin. Plus, turmeric essential oil contains its own anti-inflammatory and antioxidant compounds, like ar-turmerone.” One study found curcumin with turmeric essential oil crossed the blood-brain barrier fourteen times better than a standard curcumin. In other research, curcumin with turmeric essential oil increased blood levels of curcumin tenfold and significantly improved blood retention, compared to regular curcumin.^{11, 12, 13}

Choosing the right boswellia supplement is also vital. Boswellia contains a family of bioactive compounds called boswellic acids, with 3-acetyl-11-keto- beta-boswellic acid (AKBA) considered the most medicinally active. However, beta-boswellic acid (BBA) can interfere with AKBA’s actions. “You want a high standardization of naturally occurring (not spiked) AKBA levels, with lower levels of BBA since they can interfere with AKBA’s activity,” says Loch. “The boswellia I recommend is standardized to at least 10 percent AKBA, with less than 5 percent BBA, which provides a more robust boswellia extract overall.”

Research validates the safety and efficacy of curcumin and boswellia in decreasing pain and inflammation, and in some cases they’re as effective or even superior to prescription and OTC medications. Besides easing inflammation and pain, both protect and enhance multiple systems in the body.^{14, 15, 16, 17}

“Over 24,000 published studies to date demonstrate curcumin’s benefits for major depressive disorder, various types of cancer, liver issues, type 2 diabetes, cardiovascular disease, dyslipidemia and more,” Loch says. “Because boswellia can reduce 5-LOX inflammatory activity, this makes it a wonderful option for respiratory issues, gastrointestinal conditions, arthritis and other joint problems, and various types of cancer.  I like to tell patients curcumin and boswellia have more side benefits than side effects.”

Bioavailable curcumin with turmeric essential oil and standardized boswellia are especially powerful in treating pain and inflammation, outperforming common NSAIDs, and a combination of the two demonstrates synergistic properties that increase overall  effectiveness and offer additional health advantages.^{18, 19} Some highlights:

• In a randomized, controlled trial of osteoarthritis patients, a combination of curcumin and boswellia resulted in a greater reduction in pain severity and frequency, compared to NSAIDs alone.²⁰
• Another trial of osteoarthritis patients found a combination of curcumin and boswellia significantly improved mobility, pain, discomfort, anxiety and depression and increased quality of life, compared to NSAIDs alone.^{21, 22}
• In a study of patients with knee osteoarthritis, a bioavailable curcumin extract with turmeric essential oil was significantly more effective that paracetamol in treating pain, stiffness and function. In the turmeric extract group, 18 percent of patients had more than 50 percent improvement and 3 percent reported more than 70 percent improvement in pain, function and stiffness, compared to the paracetamol group. The turmeric extract group also exhibited significant decreases in CRP and TNF-α (37.21 percent and 74.81 percent respectively).²³
• Another trial of patients with knee osteoarthritis found a curcuminoid complex was superior to diclofenac alone for pain relief, and patients who received the curcuminoid complex plus diclofenac showed significant improvements in pain, functional mobility and quality of life, with fewer adverse effects and increased tolerability.²⁴
• In a study of rheumatoid arthritis patients, curcumin blended with turmeric essential oil was compared with diclofenac sodium. Patients in the curcumin group showed the highest percentage of improvement with the greatest reduction in joint pain and swelling, in contrast to the diclofenac sodium group. Using both interventions concurrently did not yield additional benefits. Patients taking diclofenac sodium also experienced more side effects, withdrawing from the study.²⁵
• In a clinical trial assessing the efficacy and safety of curcumin and boswellia for treating osteoarthritis, curcumin with turmeric essential oil and standardized boswellic acid extract were better than placebo in improving physical performance and joint pain. Combining the formulations increased the efficacy of treatment, presumably due to the synergistic activities of curcumin and boswellic acid.²⁶
• A study of curcumin and boswellia for osteoarthritis of the knee found a combination of curcumin blended with turmeric essential oil and standardized boswellia extract was equally as effective as celecoxib for improving range of joint movements and superior to celecoxib for pain relief, distance walked and treatment of knee osteoarthritis.^{27, 28}

Along with standardized forms of curcumin and boswellia, other science-backed nutrients can complement pain management strategies. For a comprehensive protocol, include these:

• DLPA, a combination of the amino acids d- and l-phenylalanine, inhibits the enzymatic degradation of endorphin and enkephalin as well as improving mood—a significant consideration. Research suggests DLPA supplementation reduces pain, including chronic pain associated with migraines, multiple sclerosis and fibromyalgia.^{29, 30}
• Nattokinase, an enzyme derived from fermented soybeans, promotes blood flow, supporting the delivery of oxygen and allowing nutrients like curcumin, boswellia and DLPA to reach sites of pain even more effectively. It’s especially beneficial for painful circulatory conditions, and in studies, nattokinase supplementation significantly improved headache pain, neck and shoulder pain and muscle stiffness of the neck.^{31, 32}
• Omega-3s lower inflammatory markers, including those responsible for cartilage degradation. When combined with boswellia, the effects are magnified: in one study of patients with persistent knee pain, a combination of boswellia and omega-3s was associated with a significant decrease in pain intensity and improved functionality and quality of life. ^{33, 34, 35}
• Vitamin D plays a vital role in nitric oxide synthesis, inflammation reduction and various cellular activities involved in pain development and modulation, and low levels have been linked with chronic pain, including osteoarthritis, back pain, rheumatoid arthritis and fibromyalgia. Research also suggests bioavailable curcumin, in combination with higher intake of vitamin D and omega3s may protect against collagen-induced arthritis.^{36, 37, 38}

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