Musculoskeletal Inflammation and Natural Products: What the Science Says
Clinical Guidelines, Scientific Literature, Info for Patients:
Musculoskeletal Inflammation and Natural Products
Turmeric (Curcuma longa)
Turmeric has a long history of use in Ayurvedic medicine for the treatment of inflammatory disorders. Curcumin, a chemical extracted from turmeric, is often used as a remedy for the treatment and prevention of inflammatory diseases. Preliminary findings from laboratory research suggest that curcumin, a chemical found in turmeric, may have anti-inflammatory properties, but in spite of its long history of use for inflammatory disorders, there is insufficient evidence to support the use of turmeric supplementation for these disorders.
The Evidence Base
- The evidence base on efficacy of turmeric for inflammation consists of several laboratory studies and only a few clinical trials.
- A 2015 review of laboratory, translational, and clinical data of curcumin for musculoskeletal disorders found that curcumin is an effective therapeutic agent for osteoarthritis.
- A 2013 randomized controlled trial of 120 participants with primary knee osteoarthritis found that curcumin extract showed significant decrease of pain symptom and function compared to placebo.
- A 2013 systematic review of plant food supplements with anti-inflammatory properties found that in spite of the long-term traditional use for inflammatory disorders, turmeric warrants further investigation.
- Turmeric is considered safe for most adults, but high doses or long-term use may cause indigestion, nausea, or diarrhea.
Bromelain (Pineapple Plant)
Bromelain is a mixture of enzymes found in the pineapple plant. Bromelain is often used as a dietary supplement for nasal swelling and inflammation, osteoarthritis, cancer, poor digestion, and muscle soreness. In spite of its use, the exact mechanism of action remains poorly understood. There is some evidence that bromelain may be useful as adjunctive therapy to help improve acute nasal and sinus inflammation, but there is insufficient evidence as to whether bromelain has any beneficial effects on other inflammatory conditions.
The Evidence Base
- The evidence base on efficacy of bromelain for inflammatory disorders consists of several studies and a systematic review.
- A 2014 prospective, placebo-controlled trial of 34 patients evaluated the anti-inflammatory and analgesic effect of bromelain in the postoperative after extraction of impacted lower molars. The study found no statistically significant differences between the bromelain and placebo groups, a trend toward less inflammation and improved oral aperture was observed in the bromelain group, compared to placebo.
- Findings from a 2006 systematic review of three randomized controlled trials suggest that bromelain is helpful in relieving symptoms of acute nasal and sinus inflammation when used as adjunctive therapy with standard medications such as antihistamines, analgesics, and/or antibiotics.
- A 2004 review concluded that current data suggests the potential of bromelain in treating osteoarthritis, but that further studies are needed before a definitive conclusion can be drawn.
- There have been some reports of gastrointestinal problems, increased heart rate, and menstrual problems in people who have taken oral bromelain.
- Allergic reactions may occur in individuals who are sensitive or allergic to pineapples or who may have other allergies.
Willow Bark (Salix alba)
Willow bark has been used for centuries as a treatment for pain, headache, and inflammatory conditions such as bursitis and tendinitis. The bark of white willow contains salicin, the chemical that was used to develop aspirin. In spite of its long history of use, only a few small clinical trials have been conducted that support the use of willow bark extracts in chronic low-back pain and osteoarthritis.
The Evidence Base
- The evidence base on efficacy of willow bark extract for inflammatory conditions consist of only a few small clinical studies and a couple of reviews.
- A 2015 review of willow bark extract concluded that based on available evidence in conjunction with its anecdotal use for hundreds of years, the findings suggest that willow bark extract is effective as an analgesic and anti-inflammatory.
- A 2014 Cochrane review of two clinical trials involving 261 participants found moderate quality evidence that daily doses of white willow bark are probably better than placebo for short-term improvements in low-back pain and may reduce the use of rescue medication.
- A 2009 systematic review of three randomized controlled trials involving a total of 415 participants examined the effectiveness of willow bark extract on musculoskeletal pain and concluded that there is moderate evidence of effectiveness for the use of willow bark extract for treating low-back pain.
In general, side effects of willow bark appear to be mild. However, people who are allergic or sensitive to salicylates should not use willow bark.
Omega-3 Fatty Acids
There is some evidence that omega-3 fatty acids may provide a modest benefit for symptoms of rheumatoid arthritis.
The Evidence Base
- The evidence base on efficacy of omega-3 fatty acids for inflammatory conditions such as rheumatoid arthritis consists of many randomized controlled trials and a few reviews.
- A 2012 systematic review of 23 studies concluded that evidence is seen for a fairly consistent, but modest, benefit of marine omega-3s for rheumatoid arthritis on joint swelling and pain, duration of morning stiffness, pain and disease activity, and less need for anti-inflammatory drugs to control symptoms.
- A 2015 randomized controlled trial conducted in overweight/obese pregnant women who received DHA plus EPA or placebo twice a day from week 10-16 to term found that supplementation with omega-3 fatty acids for more than 25 weeks reduced inflammation in maternal adipose and the placental tissue.
- Omega-3 fatty acid supplements are generally safe and well-tolerated. When side effects do occur, they typically consist of minor gastrointestinal symptoms and fishy aftertaste.
- There is some concern that omega-3 supplements may extend bleeding time. The risk appears to be minimal, and should never be used in patients who take drugs that affect platelet function. It is important to discuss any potential herb-drug interactions with patients if they are considering using omega-3 fatty acids.
- It is uncertain whether people with fish or shellfish allergies can safely consume fish oil supplements and should not be used in such patients.
Devil’s Claw (Harpagophytum)
Devil’s claw is an herb native to Africa. Devil’s claw is sometimes used for arthritis, gout, myalgia, tendonitis, and other conditions. There is some limited evidence that devil’s claw may provide modest improvements in low-back pain over the short term. There is some moderate evidence that devil’s claw is beneficial for osteoarthritis of the spine, hip, and knee.
The Evidence Base
- The evidence base on efficacy of devil’s claw for non-specific low-back pain consists of a few reviews of a small number of low-quality clinical trials. The evidence base on efficacy of devil’s claw for osteoarthritis consists of a few reviews of several randomized controlled trials.
- A 2014 Cochrane review of two clinical trials involving 315 participants found low quality evidence that daily doses of devil’s claw may be better than placebo for short-term improvements in low-back pain and may reduce use of rescue medication.
- A 2008 review of dietary supplements for osteoarthritis concluded that there is insufficient reliable evidence of long-term safety or effectiveness of devil’s claw for this condition.
- A 2004 systematic review of 12 clinical trials suggests that specific preparations and doses of devil’s claw may be effective in some types of musculoskeletal pain conditions, including osteoarthritis. An earlier study of 122 participants found that devil’s claw is comparable in efficacy to diacerhein for improving osteoarthritis pain in the hip and knee.
- A 2008 systematic review of 28 clinical trials on the safety of devil’s claw for osteoarthritis and low-back pain concluded that although the incidence of adverse events during treatment with devil’s claw is low, more long-term safety data are needed.
- Devil’s claw may affect heart rate and blood pressure and may be harmful in people with heart disease or circulatory system disorders.
- Devil’s claw may lower blood glucose levels, so people with diabetes should monitor blood glucose levels closely.
- People with gallstones or peptic ulcer disease should avoid using devil’s claw.
Ginger (Zingiber officinale)
Historically, ginger has been used in Asian medicine to treat stomach aches, nausea, and diarrhea. Today, ginger is used as a folk or traditional remedy for postsurgery nausea; nausea caused by motion, chemotherapy, and pregnancy; rheumatoid arthritis; osteoarthritis; and joint and muscle pain. Based on available evidence, it is unclear whether supplementation of ginger is beneficial in treating rheumatoid arthritis, osteoarthritis, or joint and muscle pain.
The Evidence Base
- The evidence base on efficacy of ginger for inflammatory conditions such as muscle pain and osteoarthritis consists of only a few studies and reviews.
- A 2010 study of a total of 74 participants examined the effects of ginger on muscle pain and inflammation caused by eccentric exercise. The study found that daily consumption of raw and heat-treated ginger resulted in moderate-to-large reductions in muscle pain following exercise-induced muscle injury.
- A 2008 review of dietary supplements for osteoarthritis concluded that there is insufficient reliable evidence of long-term safety or effectiveness of ginger for this condition.
- Few adverse reactions are linked to ginger when taken in small doses. Minor side effects most often reported are gas, bloating, heartburn, and nausea; however, these effects are most often associated with powdered ginger.
Thunder God Vine (Tripterygium wilfordii)
Thunder god vine is a perennial vine native to China, Japan, and Korea. It has been used in China for health purposes for more than 400 years. In traditional Chinese medicine, it has been used for conditions involving inflammation or overactivity of the immune system. There is some evidence that thunder god vine may reduce some symptoms of rheumatoid arthritis (RA); however, thunder god vine may be associated with some serious adverse side effects.
The Evidence Base
- The evidence base on efficacy of thunder god vine for inflammation consists of several laboratory studies and systematic reviews of only a few high-quality clinical trials.
- A 2011 Cochrane review of three studies compared thunder god vine with sulfasalazine for rheumatoid arthritis, concluded that thunder god vine may reduce some RA symptoms, but may be associated with some serious adverse side effects.
- Another 2011 systematic review of complementary health approaches for the management of RA examined three studies on thunder god vine and found positive effects. However, there was no consistent evidence for any of the reviewed substances to suggest that they were efficacious.
- Thunder god vine can cause severe adverse side effects and can be poisonous if it is not carefully extracted from the skinned root. Other parts of the plant—including the leaves, flowers, and skin of the root—are highly poisonous and can cause death.
- A number of participants in one study experienced gastrointestinal adverse effects, as well as upper respiratory tract infections. (The rate of adverse effects was similar in the thunder god vine and sulfasalazine groups.)
- Thunder god vine can also cause hair loss, headache, menstrual changes, and skin rash.
- There are no consistent, high-quality thunder god vine products being manufactured in the United States. Preparations of thunder god vine made outside the United States can sometimes be obtained, but it is not possible to verify whether they are safe and effective.
- Thunder god vine has been found to decrease bone mineral density in women who take the herb for 5 years or longer.
- Thunder god vine contains chemicals that might decrease male fertility by changing sperm.
- Black CD, Herring MP, Hurley DJ, et al. Ginger (Zingiber officinale) reduces muscle pain caused by eccentric exercise. J Pain. 2010;11(9):894–903.
- Brien S, Lewith G, Walker A, et al. Bromelain as a treatment for osteoarthritis: a review of clinical studies. Evid Based Complement Alternat Med. 2004;1(3):251–257.
- Cameron M, Gagnier JJ, Chrubasik S. Herbal therapy for treating rheumatoid arthritis. Cochrane Database Syst Rev. 2011;(2):CD002948.
- Chantre P, Cappelaere A, Leblan D, et al. Efficacy and tolerance of Harpagophytum procumbens versus diacerhein in treatment of osteoarthritis. Phytomedicine. 2000;7(3):177–183.
- De la Barrera-Núñez MC, Yáñez-Vico RM, Batista-Cruzado A, et al. Propsective double-blind clinical trial evaluating the effectiveness of Bromelain in the third molar extraction postoperative period. Med Oral Patol Oral Cir Bucal. 2014;19(2):e157–162.
- Di Lorenzo C, Dell’Agli M, Badea M, et al. Plant food supplements with anti-inflammatory properties: a systematic review (II). Crit Rev Food Sci Nutr. 2013;53(5):507–516.
- Gagnier JJ, Chrubasik S, Manheimer E. Harpgophytum procumbens for osteoarthritis and low back pain: a systematic review. BMC Complement Altern Med. 2004;4:13.
- Gregory PJ, Sperry M, Wilson AF. Dietary supplements for osteoarthritis. Am Fam Physician. 2008;77(2):177–184.
- Guo R, Canter PH, Ernst E. Herbal medicines for the treatment of rhinosinusitis: a systematic review. Otolaryngol Head Neck Sug. 2006;135(4):496–506.
- Haghiac M, Yang XH, Presley L, et al. Dietary omega-3 fatty acid supplementation reduces inflammation in obese pregnant women: a randomized double-blind controlled clinical trial. PLoS One. 2015;10(9):e0137309.
- Macfarlane GJ, El-Metwally A, De Silva V, et al. Evidence for the efficacy of complementary and alternative medicines in the management of rheumatoid arthritis: a systematic review. Rheumatology. 2011;50(9):1672–1683.
- Madhu K, Chanda K, Saji MJ. Safety and efficacy of Curcuma longa extract in the treatment of painful knee osteoarthritis: a randomized placebo-controlled trial. Inflammopharmacology. 2013;21(2):129–136.
- Miles EA, Calder PC. Influence of marine n-3 polyunsaturated fatty acids on immune function and a systematic review of their effects on clinical outcomes in rheumatoid arthritis. Br J Nutr. 2012;107(Suppl 2):S171–184.
- Oltean H, Robbins C, van Tulder MW, et al. Herbal medicine for low-back pain. Cochrane Database Syst Rev. 2014;(12):CD004504.
- Peddada KV, Peddada KV, Shukla SK, et al. Role of curcumin in common musculoskeletal disorders: a review of current laboratory, translational, and clinical data. Orthop Surg. 2015;7(3):222–231.
- Shara M, Stohs SJ. Efficacy and safety of white willow bark (Salix alba) extracts. Phytother Res. 2015;29(8):1112–1116.
- Vlachojannis J, Roufogalis BD, Chrubasik S. Systematic review on the safety of Harpagophytum preparations for osteoarthritic and low back pain. Phytother Res. 2008;22(2):149–152.
- Vlachojannis JE, Cameron M, Chrubasik S. A systematic review on the effectiveness of willow bark for musculoskeletal pain. Phytother Res. 2009;23(7):897–900.
NCCIH Clinical Digest is a service of the National Center for Complementary and Integrative Health, NIH, DHHS. NCCIH Clinical Digest, a monthly e-newsletter, offers evidence-based information on complementary health approaches, including scientific literature searches, summaries of NCCIH-funded research, fact sheets for patients, and more.
The National Center for Complementary and Integrative Health is dedicated to exploring complementary health products and practices in the context of rigorous science, training complementary health researchers, and disseminating authoritative information to the public and professionals. For additional information, call NCCIH’s Clearinghouse toll-free at 1-888-644-6226, or visit the NCCIH website at nccih.nih.gov. NCCIH is 1 of 27 institutes and centers at the National Institutes of Health, the Federal focal point for medical research in the United States.
Content is in the public domain and may be reprinted, except if marked as copyrighted (©). Please credit the National Center for Complementary and Integrative Health as the source. All copyrighted material is the property of its respective owners and may not be reprinted without their permission.