Turmeric & Boswellia Formulation Effectively Reduces Acute Musculoskeletal Pain

by | Dec 15, 2022 | 2022, Boswellia, Botanicals

Written by Taylor Woosley, Staff Writer. Results of this single-day single-dose study using KM survival plots for perceptible pain relief (PPR) show that 45 (39%) participants in the TBF group experienced PPR as early as 30 minutes and 115 (99%) within 190 minutes, whereas in the placebo group, only 2 (1.7%) participants experienced PPR as early as 30 minutes and 12 (10.3%) within 285 minutes. 

back painPain prevalence has increased among United States adults by 25% from 1998 to 2014, with at least 70 million U.S. adults experiencing chronic pain1. Musculoskeletal (MSK) pain is a multi-factorial condition involving complex interactions between structural, physical, psychological, social, lifestyle and comorbid health factors2. Chronic MSK pain is attributable to conditions such as osteoarthritis, rheumatoid arthritis, fibromyalgia, and chronic low back pain3. Musculoskeletal disorders are recognized as a significant threat to maintaining health in older age and have been associated with reduced quality of life4.

MSK pain management options are limited primarily to medications (nonsteroidal anti-inflammatories, injections, physical therapy), with a need for alternative approaches5. Turmeric is a well-studied natural compound for pain relief with the ability to exert a wide spectrum of biological activities in part due to its high levels of polyphenols and curcuminoids6. Turmeric assists in the control of inflammation and pain by modulating several transcription factors and signaling pathways related to inflammation7. Additionally, plant extracts of boswellia have been widely used due to their anti-oxidative and anti-inflammatory properties, with recent evidence suggesting that boswellia has been shown to inhibit collagen matrix degradation8.

Rudrappa et al. conducted a randomized, placebo-controlled, double-blinded multicenter study to assess the efficacy of a single dose of a 1000 mg turmeric-boswellia formulation (TBF) on exercise-induced moderate-to-severe acute musculoskeletal pain. Subject inclusion consisted of being between 18 to 65 years with exercise-induced acute musculoskeletal pain with a resting numerical rate scale (NRS) of 5 or above (0-10 scale), which occurred withing 24 hours before presenting at the site. Healthy participants (n=232) were stratified into male and female in a 1:1 ratio and randomized to receive either the TBF (Rhuleave-K) 1000 mg (500 mg x 2 softgels) containing 266 mg curcuminoids and 10 mg acetyl keto-boswellic acid (AKBA) or the matching placebo 1000 mg (500 mg x 2 softgels).

The primary outcome was a change in the sum of pain intensity difference (PID) at 6 hours at rest (SPID6rest) calculated from NRS. Secondary outcomes included the time to perceptible pain relief (PPR) and time to meaningful pain relief (MPR) using the double-stopwatch method. Further outcomes included changes in the quality of pain measured using the short form of McGill pain questionnaire (SF-MPQ). Pain intensity was assessed over 6 hours following oral administration of either TRF or placebo. Analysis of PID, SPID, and AUC (NRS-derived endpoints) was completed using linear mixed models for repeated measures, t-test, or Mann-Whitney test. Wilcoxon signed-rank test was utilized in MPQ, VAS, and PPI for within-group analysis.

There was no significant difference between groups in the baseline parameters of NRS rest (P = 0.53), movement (P = .357), and pressure (P = .266). Significant findings of the single-day single-dose study are as follows:

  • Onset of analgesia was significantly faster in the TBF group, with 99.1% of subjects experiencing a PPR and 95.7% of participants achieving MPR compared to 10.4% of participants experiencing PPR and 1.7% achieving MPR in the placebo group (P < .0001).
  • The AUC responder analysis using NRS at rest, movement, and pressure registered a difference of 95.39%, 93.52%, and 93.28% more that placebo responders at the end of 6 hours.
  • The LSM difference of TBF compared to placebo showed a statistically significant difference for all categories (NRS rest, movement, and pressure, P < .005) from 1 hour onwards until the end of the study.

Findings of the study show that TBF significantly reduced acute musculoskeletal pain intensity in about 3 hours compared to placebo. Further research should continue to explore the pain alleviating effects of TBF on a variety of inflammation-related conditions. Study limitations include the use of subjective data from participants and lack of biomarker analysis and positive controls.

Source: Rudrappa, Girish H., Meghana Murthy, Santosh Saklecha, Sanjeev Kumar Kare, Ajay Gupta, and Indraneel Basu. “Fast pain relief in exercise-induced acute musculoskeletal pain by turmeric-boswellia formulation: A randomized placebo-controlled double-blinded multicentre study.” Medicine 101, no. 35 (2022): e30144.

© 2022 the Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Posted December 15, 2022.

Taylor Woosley studied biology at Purdue University before becoming a 2016 graduate of Columbia College Chicago with a major in Writing. She currently resides in Glen Ellyn, IL.

References:

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