Taming Joint Pain Without NSAIDS

Natural botanicals backed by science offer safe, effective solutions to ease inflammation, minimize pain and protect joints from damage.

For joint pain, stiffness and swelling, active patients have few alternatives. NSAIDs like celecoxib, naproxen and diclofenac are linked with an alarming range of adverse effects, including gastrointestinal bleeding, kidney damage, and increased chances of heart attack and stroke. Over-the-counter pain medications are far from benign, and they’re certainly not appropriate for daily use—a problem for active patients and athletes, who need frequent relief from aches and pains. It’s not worth the risk, when better options are available.

Evidence-based botanicals: safe, effective solutions to pain.

Joint pain in athletes is caused by a combination of factors including repetitive strain—especially in sports like running or cycling—injuries, excessive training, sudden increases in intensity without adequate prep and insufficient recovery between strenuous activities. Over time, repetitive strain, injuries and overuse can lead to joint pain and instability, accelerating cartilage degradation and heightening the risk of arthritis and chronic joint pain. Underlying conditions such as tendinitis or osteoarthritis leave joints prone to injury and pain. Other factors—insufficient hydration, nutrient deficiencies, poor sleep patterns, stress and genetic influences—exacerbate joint pain. And the simple process of aging impacts joints, making them more vulnerable.

Along with lifestyle and dietary modifications, a botanical-based protocol can give your active patients safe, effective pain relief, minus the risks of NSAIDs. Research shows bioactive compounds in certain natural supplements have antioxidant, anti-inflammatory, muscle-relaxant and analgesic properties. Most have similar mechanisms of action as synthetic drugs, reducing inflammation and easing joint pain, in some cases as well as or even better than NSAIDs. And many have been shown to protect joints from long-term damage and benefit other physiological systems. ^{1, 2, 3, 4}  Three cornerstones of a comprehensive pain-management protocol:

Boswellia. Also known as Indian frankincense, the gum-resin extract of the Boswellia serrata tree is a common Ayurvedic remedy used for centuries to treat a range of disorders, including chronic inflammatory diseases.^{5, 6}

Its anti-inflammatory and pain-relieving activities are attributed to several boswellic acids, including acetyl-11-keto-beta-boswellic acid (AKBA) and 11-keto-beta-boswellic acid (KBA). “These biologically active pentacyclic triterpenic acids are known to be potent regulators of the activity of specific enzymes involved in inflammation and the immune response,” says Neil Edward Levin, CCN, DANLA, co-founder and former officer of the American Nutrition Association. Boswellia extract also appears to reduce markers of oxidative stress, and its antioxidant and immunoregulatory activities are thought to play prominent roles in its therapeutic benefits.^{7, 8, 9, 10}  

Research confirms its anti-inflammatory and analgesic properties, and multiple studies point to boswellia extract as a safe, effective alternative for managing joint pain, stiffness and swelling, promoting mobility and physical function and enhancing quality of life.^{11, 12, 13, 14, 15, 16}

In a meta-analysis of studies of osteoarthritis patients, boswellia extract relieved pain and stiffness and improved joint mobility. A randomized, double-blind, placebo-controlled trial found boswellia treatment led to a significant decrease in knee pain and swelling, increased knee flexion and greater walking distance compared to placebo. In research examining the analgesic activity of boswellia to placebo, boswellia boosted pain threshold and pain tolerance force and time. Other studies suggest boswellia extract is as effective as valdecoxib for relieving pain and swelling, and, in combination with turmeric, showed superior efficacy compared to nonsteroidal diclofenac.^{17, 18, 19, 20, 21, 22}

Boswellia not only alleviates pain and enhances physical function, but also protects joint health. Human studies show boswellia extract can inhibit cartilage degradation, improve knee joint gap, reduce osteophytes and significantly lower levels of C-reactive protein. Some research suggests boswellia speeds recovery time and minimizes muscle soreness after exercise compared to placebo. And it works fast, with clinical trials demonstrating measurable improvements in pain scores and physical function scores as soon as five to seven days of treatment.^{23, 24, 25, 26, 27} 

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Willow bark. Derived from the bark of various species of the willow trees (Salix), willow bark extract has been used for thousands of years in traditional medicine for its  analgesic and anti-inflammatory benefits. Salicin, the primary constituent thought to be responsible for its therapeutic effects, is metabolized into the active form, salicylic acid, a forerunner to modern aspirin and one of the earliest examples of modern drug development from a botanical source.^{28, 29}

Salicin works in part by inhibiting pro-inflammatory cytokines. However, willow bark contains small amounts of salicin, insufficient to produce an analgesic effect. “Other naturally occurring components such as polyphenols and flavonoids play a role in the analgesic activity of willow bark, as well as its ability to modulate inflammation,” says Levin. The combination of these constituents is thought to offer a broader mechanism of action than aspirin, without serious adverse events. Research suggests willow bark extract alleviates pain and inflammation as effectively as aspirin, but at a lower dose, presumably because of activities of these additional compounds.^{30, 31, 32}

A number of studies point to willow bark extract as a promising long-term therapy for painful musculoskeletal disorders, with some showing willow bark extract was better than placebo for improving pain. In one review, its analgesic benefits were similar to rofecoxib in patients with low back pain. In other research, willow bark significantly decreased back and osteoarthritis pain from baseline values after only three weeks, resulting in a 46 percent reduction in pain by the end of the trial.^{33, 34, 35, 36}

Willow bark appears to be especially effective for treating osteoarthritis, with one meta-analysis showing marked differences in pain relief and improvement in physical status compared to placebo. In another study of osteoarthritis patients, willow bark extract led to significant improvements in pain, stiffness and physical function compared to placebo, with a 14 percent reduction in pain scores after two weeks, versus a 2 percent increase in the placebo group. Overall assessments found willow bark extract to be superior to placebo. For knee and hip osteoarthritis, willow bark extract was equal to or better than conventional therapy, with no adverse effects.^{37, 38, 39, 40}

While willow bark is generally considered safe, it’s contraindicated in patients with known aspirin allergy and in children who are at greater risk of Reye’s syndrome. It may also interact with oral anticoagulants like warfarin and should be avoided in combination with other salicylate-containing medication.^{41, 42, 43}

Related:

White Willow Bark for Pain: 2 Supporting Studies

Ginger. Derived from the roots of the Zingiber officinale, in the same plant family as cardamom and turmeric, ginger extract has historically been used in herbal medicine to treat a variety of ailments, including arthritis, muscle pain and swelling. Its primary constituents demonstrate a wide range of biological activities, says Levine, regulating the release of compounds involved in acute responses to biological stress, modulating inflammation and easing pain.^{44, 45}

Studies validate ginger’s anti-inflammatory activities, showing a significant decrease in C-reactive protein and pro-inflammatory genes. Additionally, gingerol, shogaol and other constituents in ginger have potent antioxidant properties, reducing oxidative stress and protecting cells from damage.^{46, 47, 48, 49, 50, 51}

In research, ginger markedly alleviated joint pain and inflammation, relieving osteoarthritis pain better than placebo and in some cases as well as ibuprofen. A meta-analysis of randomized placebo-controlled trials found significant decreases in pain and disability in osteoarthritis patients taking ginger, compared to placebo. Another study showed ginger resulted in moderate-to-large reductions in muscle pain following exercise-induced muscle injury. In one trial, ginger combined with black pepper and curcumin found the combination of herbs improved PGE2 levels in patients with chronic knee osteoarthritis similar to naproxen. Its anti-inflammatory properties make it a valuable treatment for  rheumatoid arthritis, and ginger may also inhibit rheumatoid arthritis-induced bone destruction.^{52, 53, 54, 55, 56, 57}

In terms of safety, ginger has a long history of use as a food and medicine, with few adverse effects. Because of its antiplatelet activity, it should be used cautiously in patients taking anticoagulative drugs.

While these three ingredients are powerful individually, they’re even more potent when combined, addressing multiple pathways and exhibiting synergistic activities. “A combination of botanicals with similar but not identical properties tends to magnify the efficacy of a formula, with overlapping effects,” says Levin. “Certain botanicals supply specific compounds that affect the balance of enzymes and internally produced chemicals to help the body regulate its repair cycles properly and maximize mobility and comfort.”

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