Boswellia for Osteoarthritis Pain

Boswellia serrata extract may be as effective as a selective COX-2 inhibitor for osteoarthritis pain relief, according to the results of a new study.

Researchers in India from Government Medical College, Government Ayurved College, Indira Gandhi Government Medical College, and Pharmanza compared the efficacy, safety and tolerability of Boswellia serrata extract (BSE) in knee osteoarthritis (OA) with valdecoxib, a selective COX-2 inhibitor.

In the randomized, prospective, open-label, comparative study, the efficacy, safety and tolerability of BSE was compared with valdecoxib in 66 patients of OA of knee for six months. The patients were assessed by WOMAC scale at baseline and thereafter at monthly intervals until one month after drug discontinuation. Antero-posterior radiographs of affected knee joint were taken at baseline and after six months.

The study found that in the BSE group, the pain, stiffness and difficulty in performing daily activities showed statistically significant improvement with two months of therapy that lasted one month after stopping the intervention. In the valdecoxib group, the statistically significant improvement in all parameters was reported after one month of therapy but the effect persisted only as long as drug therapy continued.

Three patients from the BSE group and two from the valdecoxib group complained of acidity. One patient from the BSE group complained of diarrhea and abdominal cramps.

Researchers concluded that BSE showed a slower onset of action but the effect persisted even after stopping therapy, while the action of valdecoxib became evident faster but waned rapidly after stopping the treatment.

Previous studies have found that unlike non-steroidal anti-inflammatory drugs (NSAIDs), long-term use of boswellia has not been shown to cause gastrointestinal irritation or ulceration, although side effects have not been systematically studied in humans. Boswellia has traditionally been used for a number of topical applications, including the treatment of acne, bacterial and fungal infections, boils, wound healing, scars and varicose veins. It is used cosmetically as a facial toner and to smooth wrinkles. Chinese herbalists use boswellia in powder form and in teas for rheumatism, menstrual pain and as an external wash for sores and bruises.

Historically, boswellia has been used to improve emotional well-being and as part of religious rituals. It has been reported that boswellia can enhance spirituality, mental perception, meditation, prayer and consciousness when burned (burning is said to produce a psychoactive substance, trans-hydrocannabinole). Boswellia has been noted in animal and in vitro studies to possess anti-inflammatory properties.

For more information on integrative therapies for osteoarthritis, please visit Natural Standard's Medical Conditions database.

Comments

[jim reinhart]

I practice Chinese herbal medicine and use Boswellia along with myrrh quite often for pain associated with trauma. In Chinese medicine, the pattern treated is "blood stasis," which is the root cause of the pain and discomfort. These would be two medicinals in a formula consisting of at least 10 or more (i.e., polypharmacy). Having been on the other side of the fence (hospital pharmacist), Chinese formulas work very well in relieving pain syndromes without significant side effects...Thanks, Jim.

[Dexter Otis Grenne]

Since burning boswellia is said to produce a psychoactive substance for religious or meditative purposes, is there any chance of addiction or withdrawal symptoms?

[Cultural relativism]

What is the cost of producing the extract for patients? Is it more, less or about the same as the currently available medications?

Inflammation is a problem in all of the traditional uses listed in this article, so it makes sense that boswellia would also help with osteoarthritis pain.

Most drugs do cause some sort of withdrawal symptoms, but their intensity is often too minor for people to notice. I’m sure that bosweilla must cause some sort of withdrawal.

[W. Thomas]

As someone with arthritis who is ever on the lookout for alternative treatments that work with less risk and side effects than currently available NSAIDs, I am interested in this study. However, it is unclear in this report whether boswellia was taken orally or applied topically. One would assume it was taken orally, since there were reports of "acidity" but even this was unclear. (Stomach acidity?)

I am familiar with boswellia as a topical treatment but am unfamiliar with its use as an orally administered agent and would certainly want to know more about its safety before consuming it.

[Shirley O]

This sounds like it could be a nice alternative for someone who wants to avoid conventional medicine. I would be interested in knowing what kind of long-term side effects or toxicities could occur with long-term chronic use. I'd be more than happy to stop seeing the druggist for my osteoarthritis medications and try something a little more natural.

Have there been any long-term studies with boswellia?

[Rachelle Provost]

RE: Safety and efficacy of boswellia...here is what I found...

The most common complaints in trials have been nausea and acid reflux. Patients with pre-existing gastritis or gastroesophageal reflux disease (GERD) should use it cautiously, since reflux and epigastric pain have been associated with the use of boswellia.

Also, patients taking lipid-soluble medications should use cautiously, since the gum resin of boswellia has been reported to lower cholesterol and triglyceride levels, and may bind to/impair absorption of these medications.

Possible side effects: A feeling of fullness, altered cholesterol, diarrhea, heartburn (acid reflux), increased menstrual blood flow, miscarriage, nausea, skin rash, stomach pain, and stomach upset.

Possible interactions: Asthma drugs (like montelukast), pain-relievers, cancer drugs, cholesterol-lowering drugs, anti-inflammatories, anti-fungals, garlic, mistletoe, tea tree oil, high-fat meals, or herbs or supplements with similar effects.

[Lee]

Does anyone know of any cardiac problems associated with this herb like the Cox-2 inhibitors? Stroke/MI?

[Kalyn]

Osteoarthritis is not an inflammatory disorder. So, I don’t understand how boswellia would relieve pain as an anti-inflammatory. It would make more sense if boswellia has analgesia effects. Or maybe I’m wrong.

[Woods]

Kalyn is right that osteoarthritis is classified as an inflammatory disease. Osteoarthritis is a degenerative joint disease that occurs when the cartilage in the joints starts to break down.

However, inflammation does occur as a result of this process. When the joint becomes damaged, the body tries to repair it, which causes swelling.

[MV]

It is interesting that the effects of boswellia persisted one month after stopping treatment, compared to the other drug tested. More research should be conducted about the long-term effects of the boswellia. Dosages are also unclear, so it would be beneficial to see various dosages monitored over a period of time.

[Emily P.]

I think this could be a good alternative to NSAIDs, but I think it needs to be researched further to get a complete list of interactions and side effects.

[Paul]

When news like this comes out, I am always cautious. It wasn't long ago that the COX-2 selective antagonists were being called the savior for arthritics, but now look at where they are. I do wonder why this study was performed on osteoarthritis instead of rheumatoid arthritis, since rheumatoid is more associated with constant inflammation, which is the cause of the joint degeneration. The safety looks good though, so hopefully more research will be performed, and maybe this will become a mainstay in therapy.

[Varicose veins]

Varicose veins are caused by many factors, such as hormonal imbalances, heredity, etc. I heard that the Laser Lipo & Vein Center is famous for varicose vein pain http://laserlipoandveins.com