Top Herbs for Pain

Article at-a-glance:

  • Nearly one in four American adults suffer from arthritis and most take over the counter or prescription painkillers, such as Tylenol or Ibuprofen
  • Herbal remedies have been used for centuries in traditional cultures around the world to help people who are struggling with pain. 
  • Modern clinical trials have shown that plant extracts from bromelain, Turmeric, Boswellia and other plants can provide significant relief and help get people back to doing what they love.
Caution Sign

by Dr. John Neustadt


We all know that exercise offers enormous benefits to our well-being and is critical to lifelong health and strength.1 But what happens when you injure or strain a muscle or joint? How can you play that great game of tennis, jog on your neighborhood trail, swim, lift weights, or do calisthenics if it’s too painful? And what about the slow indignities of age that eventually hit us all—the achy, creaky joints, the loss of resilience? 

These are important questions because, in the United States, 23% of all adults suffer from arthritis. This translates to approximately 58 million adults, with an estimated increase to 78.4 million by 2040.2 More than one in four adults with arthritis report severe joint pain. According to the CDC, the annual direct medical costs of arthritis are at least $140 billion. The most common form of arthritis is osteoarthritis.3

Arthritis pain is caused by inflammation in the joints. And the solution for most Americans is simple and dangerous: take painkillers. The most popular painkillers include NSAIDs (non-steroidal anti-inflammatory drugs such as ibuprofen or naproxen) and acetaminophen (Tylenol). 

On any given day, more than 30 million people take over the counter and prescription NSAIDs for pain relief, headaches and arthritis. But these medications have hidden dangers. They’re linked to gastrointestinal problems such as stomach upset, heartburn, nausea, ulcers, kidney damage, and liver injury.4 

Once the medication causes a side effect, the typical conventional approach is to simply take more drugs. This can create a situation where each medication causes a side effect and the approach to treating the side effect is to prescribe another drug. For exmple, NSAIDs can create stomach ulcers and stomach bleeding. When this happens, the conventional approach is to prescribe an acid-blocking medication. That reduces stomach acid, which alleviates the pain when the stomach acid irritates the ulcer. But the acid-blocking medication can then cause further problems. Long-term acid-blocking medication use is linked to intestinal dysbiosis and increased risk for stomach cancer,5 dementia6,7, and hip fracture.8 

Each year, the side effects of long-term NSAID use cause more than 100,000 hospitalizations.9 And, as you might guess, there is one or more medication for each problem caused by the acid-blocking medications, and each one of those drugs has their own list of side effects.

The number one cause of non-alcoholic liver failure in this country is acetaminophen. The reason this drug damages the liver is because it depletes the liver of glutathione, the most potent antioxidant our body makes.10 Without enough glutathione, the liver is more vulnerable to free radical damage and serious injury.

Fortunately, there are nutrients people can take that support joint health and promote inflammation balance. Rigorous clinical trials have shown nutrients can reduce pain and inflammation while improving pain-free activity in volunteers. These include ancient herbs with a long history of safe use that modern science has now confirmed. Here are a few of the best herbs and an explanation of how and why they work.

Indian Frankincense (Boswellia serrata)

Boswellia has been used for centuries in Ayurvedic medicine for inflammatory disorders, including arthritis. Boswellia extract has shown promise for helping people with asthma,11 osteoarthritis,12,13,14 and collagenous colitis.15

One way inflammation contributes to arthritis, getting wrinkles, and pain is by destroying cartilage and collagen. Boswellia stops this breakdown caused by inflammation.16 A 2014 review of five different studies in humans found Boswellia superior to placebo in reducing pain and increasing function.17 People can experience these benefits within a few days to one week.18 

Like all plants, Boswellia contains thousands of molecules. In modern research and dietary supplement manufacturing, to help maintain quality control and consistency from one batch of raw material to the next, a standardized extract of the plant is often used. A common benchmark molecule used in clinical trials is 3-O-acetyl-11-keto-beta-boswellic acid (AKBA). Boswellia studies often report the percent AKBA in the herbal extract being used. 

Boswellia also proved helpful and safe in a four-month double-blind, placebo-controlled study.19  The study used a standardized extract of the herb and looked at 48 individuals suffering from knee osteoarthritis. After 120 days, the group taking the Boswellia extract standardized to 30% AKBA experienced a 39% reduction in self-reported knee stiffness and a 52% reduction in pain as evaluated by a physician. Their X-rays also revealed increased knee joint space and fewer osteophytes (bone spurs) and C-reactive protein (CRP) was reduced in the Boswellia group. CRP is a marker of inflammation, an independent risk factor for heart disease,20 and has also been associated with depression21 and metabolic syndrome (pre-diabetes).22 

In another clinical trial, Boswellia combined with Turmeric, which I discuss in detail below, was significantly more effective than the NSAID Celebrex (celecoxib) in improving knee osteoarthritis. There were no side effects in participants taking the herbal blend.23 In this study, a standardized Boswellia extract containing 10% AKBA was used.

A systemic review of Boswellia for the use in people with osteoarthritis was published in 2020 in the journal BMC Complementary Medicine and Therapies24. The researchers evaluated data from seven clinical trials and 545 volunteers. They found that the studies overwhelmingly support the use of Boswellia to support healthy inflammation and promote joint health in people with osteoarthritis. 

Bromelain (from pineapple)

Bromelain is derived from the stem and fruit of the pineapple plant and has long been used as part of traditional healing systems. It contains a mixture of enzymes and molecules that have powerfully promote healthy inflammation and reduce pain. It also promotes healthy blood clotting by dissolving blood clots and supports a healthy immune response by reducing swelling.25 Bromelain is absorbed from the gut without losing its potency or activity.26 

Bromelain has shown benefit alone or in combination with other phytonutrients in relieving joint pain and discomfort. In two separate studies, a blend of bromelain with other natural compounds reduced pain and supported a healthy inflammation response in people with osteoarthritis of the knee and hip.27 Another study of forty patients with knee osteoarthritis found that bromelain improved pain and function, and reduced blood markers of inflammation.28 And a review of ten separate studies on bromelain and knee osteoarthritis—from case reports to randomized trials—found that bromelain reduced tissue swelling, pain, and/or joint stiffness.29

Turmeric (Curcumin)

Curcumin is the primary active ingredient in turmeric and this golden-root plant has been a foundation of both Ayurvedic and Chinese medicine for thousands of years.30 It’s composed of three golden-hued polyphenols that have antioxidant and inflammation-regulating properties, with particular ability to improve pain and decrease unhealthy levels of inflammation.31 Over 7000 articles have reviewed curcumin’s antioxidant, anti-inflammatory and antibacterial potential. More than 100 clinical trials have looked at its role in helping people who struggle with chronic diseases in which inflammation plays a role.32

In one randomized, double-blind study of 40 individuals with mild or moderate osteoarthritis of the knee, curcumin or a placebo was given in three divided doses daily for six weeks—with demonstrated significant improvement in pain and function.33 Another study was an eight-month clinical trial with 50 osteoarthritis patients that compared to standard approach prescribed by a doctor or standard approach plus curcumin. Function, stiffness, and pain all significantly improved more in the group receiving the curcumin.34

Rheumatoid arthritis, which is a chronic autoimmune disease that attacks the joints, also responded to curcumin in clinical trials. One review looked at eight different studies on arthritis and curcumin and found that 8-12 weeks of taking turmeric significantly reduced pain and inflammation.35

Muscle pain often accompanies joint pain, especially after intense exercises. Curcumin shines there as well, as shown in a study of both a low (50 mg) and higher (200 mg) dose of curcumin in 59 healthy, active young adults.36 This eight-week study measured blood levels of creatine kinase (CK), a marker of muscle damage, before and after downhill running. Both the lower and higher doses of curcumin significantly reduced CK, but the nutrient also significantly improved post-exercise pain. Another study, published in 2020, examined 19 males after exercise and found that curcumin decreased muscle soreness and markers of inflammation.37

1 Watson K, Baar K. mTOR and the health benefits of exercise. Semin Cell Dev Biol. 2014;36:130-139.  [Article]

Hootman JM, Helmick CG, Barbour KE, Theis KA, Boring MA. Updated Projected Prevalence of Self-Reported Doctor-Diagnosed Arthritis and Arthritis-Attributable Activity Limitation Among US Adults, 2015-2040. Arthritis Rheumatol. 2016;68(7):1582-1587 [Article]

Centers for Disease Control. Arthritis. [Report]

Davis A, Robson J. The dangers of NSAIDs: look both ways. Br J Gen Pract. 2016;66(645):172-173. [Article]

Cheung KS, Chan EW, Wong AYS, Chen L, Wong ICK, Leung WK. Long-term proton pump inhibitors and risk of gastric cancer development after treatment for Helicobacter pylori: a population-based study. Gut. 2018;67(1):28-35. [Article]

6 Gomm W, von Holt K, Thome F, et al. Association of Proton Pump Inhibitors With Risk of Dementia: A Pharmacoepidemiological Claims Data Analysis. JAMA Neurol. 2016;73(4):410-416. [Article]

Haenisch B, von Holt K, Wiese B, et al. Risk of dementia in elderly patients with the use of proton pump inhibitors. Eur Arch Psychiatry Clin Neurosci. 2015;265(5):419-428. [Article]

8 Yang YX, Lewis JD, Epstein S, Metz DC. Long-term proton pump inhibitor therapy and risk of hip fracture. JAMA. 2006;296(24):2947-2953. [Article]

9 American Gastroenterological Association. Study shows long-term use of NSAIDs causes severe intestinal damage. ScienceDaily. January 2005. [Article]

10 Harvard Women’s Health Watch. FDA limits prescription acetaminophen. April 2011 [Report]

11 Gupta I, Gupta V, Parihar A, et al. Effects of Boswellia serrata gum resin in patients with bronchial asthma: results of a double-blind, placebo-controlled, 6-week clinical study. Eur J Med Res. 1998;3(11):511-514. [Article]

12 Kimmatkar N, Thawani V, Hingorani L, Khiyani R. Efficacy and tolerability of Boswellia serrata extract in treatment of osteoarthritis of knee–a randomized double-blind placebo-controlled trial. Phytomedicine. 2003;10(1):3-7. [Article]

13 Sontakke S, Thawani V, Pimpalkhute S, Kabra P, Babhulkar S, Hingorani L. Open, randomized, controlled clinical trial of Boswellia serrata extract as compared to valdecoxib in osteoarthritis of knee. Indian Journal of Pharmacology. 2007;39(1):27-29. [Article]

14 Sengupta K, Alluri KV, Satish AR, et al. A double blind, randomized, placebo controlled study of the efficacy and safety of 5-Loxin for treatment of osteoarthritis of the knee. Arthritis Res Ther. 2008;10(4):R85. [Article]

15 Madisch A, Miehlke S, Eichele O, et al. Boswellia serrata extract for the treatment of collagenous colitis. A double-blind, randomized, placebo-controlled, multicenter trial. Int J Colorectal Dis. 2007;22(12):1445-1451. [Article]

16 Blain EJ, Ali AY, Duance VC.  Boswellia frereana (frankincense) suppresses cytokine-induced matrix metalloproteinase expression and production of pro-inflammatory molecules in articular cartilage. Phyther. Res. 2009, 24, 905–912. [Article]

17 Cameron, M.; Chrubasik, S. Oral herbal therapies for treating osteoarthritis. Cochrane Database Syst Rev. 2014;5(5):CD002947. [Article]

18 Vishal AA, Mishra A, Raychaudhuri SP. A double blind, randomized, placebo controlled clinical study evaluates the early efficacy of aflapin in subjects with osteoarthritis of knee. Int. J. Med. Sci. 2011, 8, 615–622. [Article]

19 Majeed M, Majeed S, Narayanan NK, et al A pilot, randomized, double-blind, placebo-controlled trial to assess the safety and efficacy of a novel Boswellia serrata extract in the management of osteoarthritis of the knee. Phytother Res. 2019;33(5):1457-1468. [Article]

20 Boncler M, Wu Y, Watala C. The Multiple Faces of C-Reactive Protein-Physiological and Pathophysiological Implications in Cardiovascular Disease. Molecules. 2019;24(11). [Article]

21 Cizza G, Eskandari F, Coyle M, et al. Plasma CRP levels in premenopausal women with major depression: a 12-month controlled study. Horm Metab Res. 2009;41(8):641-648. [Article]

22 Reddy P, Lent-Schochet D, Ramakrishnan N, McLaughlin M, Jialal I. Metabolic syndrome is an inflammatory disorder: A conspiracy between adipose tissue and phagocytes. Clin Chim Acta. 2019;496:35-44. [Article]

23 Kizhakkedath, R. Clinical evaluation of a formulation containing Curcuma longa and Boswellia serrata extracts in the management of knee osteoarthritis. Mol. Med. Rep. 2013, 8, 1542–1548. [Article]

24 Yu G, Xiang W, Zhang T, Zeng L, Yang K, Li J. Effectiveness of Boswellia and Boswellia extract for osteoarthritis patients: a systematic review and meta-analysis. BMC Complement Med Ther. 2020;20(1):225. [Article]

25 Pavan R, Jain S, Shraddha et al. Properties and therapeutic application of bromelain: a review. Biotechnol Res Int. 2012;2012:976203 [Article]

26 Castell JV, Friedrich G, Kuhn CS, Poppe GE. Intestinal absorption of undegraded proteins in men: presence of bromelain in plasma after oral intake. Am J Physiol. 1997;273(1 Pt 1):G139-146. [Article]

27 Bromelain Monograph, Alternative Medicine Review. 2010 (15):4. pp. 362-368 [Article]

28 Kasemsuk T, Saengpetch N, Sibmooh N et al.. Improved WOMAC score following 16-week treatment with bromelain for knee osteoarthritis. Clin Rheumatol. 2016;35(10):2531-2540. [Article]

29 Brien S, Lewith G, Walker A et al. D. Bromelain as a Treatment for Osteoarthritis: a Review of Clinical Studies. Evid Based Complement Alternat Med. 2004;1(3):251-257. [Article]

30 Prasad S et al Herbal Medicine: Biomolecular and Clinical Aspects. 2nd ed: CRC Press/Taylor & Francis; 2011. Chap 13.

31 Nelson KM, Dahlin JL, Bisson J et al. The Essential Medicinal Chemistry of Curcumin. J Med Chem. 2017;60(5):1620-1637. [Article]

32 He Y, Yue Y, Zheng X et al. Curcumin, inflammation, and chronic diseases: how are they linked?. Molecules. 2015;20(5):9183-9213. [Article]

33 Panahi Y, Rahimnia AR, Sharafi M, et al. Curcuminoid treatment for knee osteoarthritis: A randomized double-blind placebo-controlled trial. Phytother Res. 2014;28(11):1625-31. [Article]

34 Belcaro G, Cesarone MR, Dugall M, et al. Product-evaluation registry of Meriva®, a curcumin-phosphatidylcholine complex, for the complementary management of osteoarthritis. Panminerva Med. 2010;52:55-62. [Article]

35 Daily JW, Yang M, Park S. Efficacy of turmeric extracts and curcumin for alleviating the symptoms of joint arthritis: a systematic review and meta-analysis of randomized clinical trials. J Med Food. 2016;19(8):717-29. [Article]

36 Jäger R, Caldwell AR, Sanders E, et al. Curcumin reduces muscle damage and soreness following muscle-damaging exercise. FASEB J. 2017;31(1) Suppl lb766 [Article]

37 Waldman SAB, Krings BM, Lamberth J et al. Effect of curcumin supplementation on exercise-induced oxidative stress, inflammation, muscle damage and muscle soreness. J Diet Suppl. 2020;17(4):40

The Best Botanicals for Prostate Health

The Best Botanicals for Prostate Health

The prostate gland is a walnut-sized gland in men located just behind the bladder. The prostate’s primary function is to produce seminal fluid that nourishes and transports sperm. As men age, their risk for prostate issues increases, which can lead to difficulty peeing, erectile dysfunction, incomplete bladder emptying, and waking up during the night to have to go to the bathroom. Prostate cancer risk also increases as men age. This blog discusses the two most common prostate problems—benign prostatic hyperplasia (BPH) and prostate cancer—to help men understand the warning signs and what their options are.

Boswellia Serrata, New Uses for an Old Plant

Boswellia Serrata, New Uses for an Old Plant

Article at-a-glance: Boswellia serrata possesses supports healthy inflammatory activity, with six potent acids that significantly inhibit pro-inflammatory compounds in the body. The most potent of these acids is thought to be acetyl-11-keto-β-boswellic acid (AKBA)...

Top Tips for Healthy Blood Pressure

Top Tips for Healthy Blood Pressure

Article at-a-glance: Blood viscosity is linked to high blood pressure to autoimmune illnesses, cardiovascular disease, stroke, diabetes, depression and even cancer. Many doctors don’t think of blood viscosity when evaluating patients. It’s likely that many Americans...

Share This