Pain is our friend. It alerts us that something is wrong and that we need to act. Without pain, we would not survive very long. Imagine having appendicitis and no pain, imagine having bone cancer and no pain, or imagine having wounds and infections and no pain. All these outcomes would be disastrous. So, one could argue, pain is our friend.
However, pain is also our enemy. Pain that cannot be resolved can be intolerable. Pain is exhausting and can cause both anxiety and depression. Pain can make us incapable of work and can ruin relationships. So, pain is our enemy.
Perhaps a newish vocabulary word can describe this experience: pain is our frenemy. We need it but it’s awful but it can save our lives, but it can cause overwhelming despair. It is certainly complicated.
The market for over-the-counter pain drugs in the ibuprofen and acetaminophen families are estimated to be more than $23 billion a year. And the saddest part is that these drugs have dreadful, sometimes life-threatening side effects. Use of ibuprofen is linked to more than 16,000 deaths a year from adverse effects, and acetaminophen is the No. 1 cause of acute liver failure in America. This is not even counting the problems that have occurred and are still occurring with prescription drugs for pain relief, especially opioids.
This is a situation in which health food retailers and practitioners of natural medicine can be a shining light and great resource, because there are many natural products that can alleviate pain and suffering without causing serious adverse effects. In fact, supplements that address pain have side benefits instead of side effects, like improving heart health or helping to prevent cancer. I would much prefer side benefits to side effects!
The first step in addressing pain is to determine the cause and address it. If your mouth pain is caused by an abscess on the root of your tooth, it makes much more sense to get rid of the abscess than to medicate daily for pain. Unfortunately, not all pain is that easy to diagnose and ameliorate. For the purpose of this article, let’s assume the root cause of the pain has already been assessed and addressed and now we are moving on to pain relieving supplements.
Curcumin
In my opinion, there is no single herb better for reducing inflammatory pain than curcumin. Curcumin is found in very small amounts in the spice turmeric (about 2 to 5 percent) so while turmeric is a healthy food, you need curcumin for stronger health benefits like pain relief. Curcumin is poorly absorbed, so much of the more recent clinical research has focused on enhanced absorption curcumin. The most clinically studied enhanced absorption curcumin is called BCM-95. It is a patented process that uses turmeric essential oil embedded in the curcumin to boost absorption about 700 percent. There are other ways to boost absorption, including the clinically studied Phytosome process and nanotechnology. There is also an older process using a compound found in black pepper called piperine to boost absorption, but unfortunately, piperine is contraindicated with a great many prescription drugs as it interferes with drug metabolism.
Studies of curcumin with turmeric essential oil have shown excellent benefits for pain. For example, an osteoarthritis study compared a combination of BCM-95 curcumin and a uniquely standardized boswellia to a prescription drug, celecoxib (better known under the brand name Celebrex) for individuals with osteoarthritis. One group received celecoxib, 100 mg, twice daily while the second group received a 500 mg blend of BCM-95 curcumin enhanced with turmeric essential oil and the uniquely standardized boswellia extract twice daily. Sixty-four percent of those taking the herbal combo versus 29 percent in the drug group experienced pain relief to such a high degree that they were able to move from having “moderate to severe arthritis” to “mild to moderate arthritis.”
Another recent study of knee osteoarthritis found that 500 mg of curcumin with turmeric essential oil three times daily was just as effective as diclofenac sodium, a prescription drug in the non-steroidal anti-inflammatory drug (NSAID) family, which can raise the risk of heart attacks.
In a rheumatoid arthritis study, 45 individuals were randomized into three groups. Group one received the prescription drug diclofenac sodium 50 mg, twice daily; group two received 500 mg of BCM-95 curcumin twice daily; and group three received both diclofenac sodium and curcumin.
In the curcumin group, there were no dropouts due to adverse effects, but in the diclofenac sodium group, 14 percent withdrew because of adverse effects, usually gastrointestinal distress. In the Disease Activity Score in 28 Joints (DAS28) patient assessment, the group taking curcumin noted the highest impact for reducing disease symptoms, followed by those using the combination therapy of curcumin with diclofenac sodium. Interestingly, the diclofenac sodium-alone group scored in last place.
Enhanced absorption curcumins changed the landscape of natural pain relief because it delivers noticeable benefits very quickly, often on the same day. It not only relieves pain, it helps stop the inflammatory damage that causes pain in the first place.
Boswellia
Boswellia is not an all-around anti-inflammatory powerhouse like curcumin, but what it does, it does brilliantly. Inflammation is not a single activity in the body. There are many kinds of inflammation and inflammatory pathways. That is why a drug like ibuprofen may work for a twisted ankle but not help asthma—because it is not the same kind of inflammation. There is a type of inflammation called 5-lipoxegenase (5-LOX) that no over-the-counter drug can touch. Prescription drugs called steroids can reduce 5-LOX inflammation, but steroids cannot be used long term for a multitude of reasons.
Curcumin touches this pathway, but boswellia can jump on it with both feet. It is very powerful against this type of inflammation, and that is why it is so very valuable. We see a lot of 5-LOX activity in joint pain, psoriatic arthritis, and gout. There are also high levels of this kind of inflammation in lung and intestinal disorders.
When used for pain, boswellia is often used with curcumin, because together they can effectively address all the inflammatory pathways in the body.
Boswellia’s most beneficial compound is acetyl-11-keto-β-boswellic acid (AKBA). Boswellia should be standardized to a minimum of 10 percent AKBA. Another boswellia acid, beta boswellic acid (BBA), is problematic as it interferes with AKBA’s activity. Purifying boswellia can reduce BBA from 20 percent down to less than 5 percent, which intensifies boswellia’s anti-inflammatory activity.
Palmitoylethanolamide (PEA)
Palmitoylethanolamide (PEA) is found naturally in the body and some foods. Research shows this endocannabinoid-like compound improves muscle pain, arthritis symptoms, nerve pain like sciatica, and even fibromyalgia. It is especially effective for pain with nerve involvement.
In a clinical study of people with sciatic nerve problems associated with chronic low back pain, PEA was given at two dosage levels, 300 mg and 600 mg daily. Both dosages were compared to a placebo for three weeks. By the end of that test period, the higher dosage of PEA at 600 mg daily was much more effective, reducing pain significantly.
In scientific research on osteoarthritis, PEA lowered levels of inflammatory markers, slowed damage to cartilage, and reduced knee swelling. In another study of a condition called chronic idiopathic axonal polyneuropathy (CIAP), a form of neuropathy that causes an unpleasant tingling sensation and greatly affects walking, PEA was found to be an effective treatment. One clinic reported using PEA at relatively high doses of 1,200 mg per day for two weeks to reduce pain by 30 to 50 percent, and in some cases, PEA reduced pain by 50 percent in just one week.
Helper Compounds
While not heavy lifters on their own, there are many natural compounds that work synergistically in pain relief formulas or protocols.
Dl-phenylalanine or DLPA is a useful helper compound in pain formulas. Though it does not address pain directly, it does help keep mood-elevating chemicals in the brain, such as dopamine, epinephrine and norepinephrine. DLPA helps prevent the breakdown of one of the brain’s natural pain-killing substances, enkephalins, which are in the same family as endorphins.
Nattokinase is an enzyme from the fermented soy food natto that improves microcirculation. This improves nutrient delivery to hard-to-reach places in the body, such as the joint capsule.
Serratiopeptase is also an enzyme with excellent research showing that it can reduce inflammation and improve healing. Vitamin D and the bioactive forms of B vitamins also play a role in nerve health and are beneficial for a variety of chronic pain syndromes.
Summary
Pain may be useful, but as stated early on, it can be a real pain. Using natural products for pain relief can make a huge difference in health and quality of life, without the serious adverse effects reported for over-the-counter drugs.VR
References:
Stiller CO, Hjemdahl P. Lessons from 20 years with COX-2 inhibitors: Importance of dose-response considerations and fair play in comparative trials. J Intern Med. 2022 Oct;292(4):557-574. doi: 10.1111/joim.13505. Epub 2022 May 31. PMID: 35585779.
Antony B, Kizhakedath R, Benny M, Kuruvilla BT. Clinical Evaluation of a herbal product (Rhulief™) in the management of knee osteoarthritis. Abstract 316. Osteoarthritis Cartilage. 2011;19(S1):S145-S146.
Shep D, Khanwelkar C, Gade P, Karad S. Safety and efficacy of curcumin versus diclofenac in knee osteoarthritis: a randomized open-label parallel-arm study. Trials. 2019;20(1):214.
Chandran B, Goel A. A Randomized, Pilot Study to Assess the Efficacy and Safety of Curcumin in Patients with Active Rheumatoid Arthritis. Phytother Res. 2012 Mar 9. doi: 10.1002/ptr.4639.
Goel A, Kunnumakkara AB, Aggarwal BB. Curcumin as “Curecumin”: from kitchen to clinic. Biochem Pharmacol. 2008 Feb 15;75(4):787-809.
Antony B, Merina B, Iyer VS, Judy N, Lennertz K, Joyal S. A pilot cross-over study to evaluate human oral bioavailability of BCM-95 CG (Biocurcumax™) a novel bioenhanced preparation of curcumin. Ind J Pharm Sci. 2008:445-449. Benny B, Antony B. Bioavailability of Biocurcumax (BCM-95). Spice India. September, 2006:11-15.
Park SY, Jin ML, Kim YH, Kim Y, Lee SJ. Anti-inflammatory effects of aromatic-turmerone through blocking of NF-kB, JNK, and p38 MAPK signaling pathways in amyloid β-stimulated microglia. Int Immunopharmacol. 2012 Sep;14(1):13-20.
Hucklenbroich J, Klein R, Neumaier B, Graf R, Fink GR, Schroeter M, Rueger MA. Aromatic-turmerone induces neural stem cell proliferation in vitro and in vivo. Stem Cell Res Ther. 2014 Sep 26;5(4):100.
Chandran B, Goel A. A Randomized, Pilot Study to Assess the Efficacy and Safety of Curcumin in Patients with Active Rheumatoid Arthritis. Phytother Res. 2012 Mar 9.
Shep D, Khanwelkar C, Gade P, Karad S. Safety and efficacy of curcumin versus diclofenac in knee osteoarthritis: a randomized open-label parallel-arm study. Trials. 2019;20(1):214.
Singhal S, Hasan N, Nirmal K, et al. Bioavailable turmeric extract for knee osteoarthritis: a randomized, non-inferiority trial versus paracetamol. Trials. 2021;22:105.
Ammon HP. Boswellic acids in chronic inflammatory diseases. Planta Med. 2006 Oct;72(12):1100-16.
Antony B, Kizhakedath R, Benny M, Kuruvilla BT. Clinical Evaluation of a herbal product (Rhulief™) in the management of knee osteoarthritis. Abstract 316. Osteoarthritis Cartilage. 2011;19(S1):S145-S146.
Kizhakedath R, Antony B, Benny M, Kuruvilla BT. Clinical evaluation of a herbal product in the management of knee osteoarthritis. Abstract 316. Osteoarthritis Cartilage. 2011;19(S1):S145-S146.
Haroyan A, Mukuchyan V, Mkrtchyan N, Minasyan N, Gasparyan S, Sargsyan A, Narimanyan M, Hovhannisyan A. Efficacy and safety of curcumin and its combination with boswellic acid in osteoarthritis: a comparative, randomized, double-blind, placebo-controlled study. BMC Complement Altern Med. 2018 Jan 9;18(1):7. doi: 10.1186/s12906-017-2062-z. PMID: 29316908; PMCID: PMC5761198.
Banji D, Bandi OJ, Rashida S, Alshaharani S, Alqahtani SS. Bioavailability, anti-inflammatory and anti-arthritic effect of Acetyl Keto Boswellic acid and its combination with methotrexate in an arthritic animal model. J Ethnopharmacol. 2022;292:115200.
Russell AL, McCarty MF. DL-phenylalanine markedly potentiates opiate analgesia – an example of nutrient/pharmaceutical up-regulation of the endogenous analgesia system. Med Hypotheses. 2000 Oct;55(4):283-8. doi: 10.1054/mehy.1999.1031. PMID: 10998643.
Ehrenpreis S. D-phenylalanine and other enkephalinase inhibitors as pharmacological agents: implications for some important therapeutic application. Aupunct Electrother Res. 1982;7(2-3):157-72.
Kurosawa Y, Nirengi S, Homma T, Esaki K, Ohta M, Clark JF, Hamaoka T. A single-dose of oral nattokinase potentiates thrombolysis and anti-coagulation profiles. Sci Rep. 2015 Jun 25;5:11601. doi: 10.1038/srep11601. PMID: 26109079; PMCID: PMC4479826.
Gagnier JJ, van Tulder MW, Berman B, Bombardier C. Herbal medicine for low back pain: a Cochrane review. Spine (Phila Pa 1976). 2007 Jan 1;32(1):82-92.
Rudrappa GH, Chakravarthi PT, Benny IR. Efficacy of high-dissolution turmeric-sesame formulation for pain relief in adult subjects with acute musculoskeletal pain compared to acetaminophen: A randomized controlled study. Medicine (Baltimore). 2020;99(28):e20373.
Nicol LM, Rowlands DS, Fazakerly R, Kellett J. Curcumin supplementation likely attenuates delayed onset muscle soreness (DOMS). Eur J Appl Physiol. 2015 Aug;115(8):1769-77. doi: 10.1007/s00421-015-3152-6. Epub 2015 Mar 21.
Sciberras JN, Galloway SD, Fenech A, Grech G, Farrugia C, Duca D, Mifsud J. The effect of turmeric (Curcumin) supplementation on cytokine and inflammatory marker responses following two hours of endurance cycling. J Int Soc Sports Nutr. 2015 Jan 21;12(1):5. doi: 10.1186/s12970-014-0066-3. eCollection 2015.
Agrawal S, Murray BP, Khazaeni B. Acetaminophen Toxicity. [Updated 2025 Apr 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NBK441917/.
Lee WM. Acetaminophen and the U.S. Acute Liver Failure Study Group: lowering the risks of hepatic failure. Hepatology. 2004 Jul;40(1):6-9. doi: 10.1002/hep.20293.
Clayton P, Hill M, Bogoda N, Subah S, Venkatesh R. Palmitoylethanolamide: A Natural Compound for Health Management. Int J Mol Sci. 2021 May 18;22(10):5305. doi: 10.3390/ijms22105305. PMID: 34069940; PMCID: PMC8157570.
D’Aloia A, Molteni L, Gullo F, Bresciani E, Artusa V, Rizzi L, Ceriani M, Meanti R, Lecchi M, Coco S, Costa B, Torsello A. Palmitoylethanolamide Modulation of Microglia Activation: Characterization of Mechanisms of Action and Implication for Its Neuroprotective Effects. Int J Mol Sci. 2021 Mar 17;22(6):3054.
Hesselink JM. Chronic idiopathic axonal neuropathy and pain, treated with the endogenous lipid mediator palmitoylethanolamide: a case collection. Int Med Case Rep J. 2013 Sep 13;6:49-53. doi: 10.2147/IMCRJ.S51572. PMID: 24049461; PMCID: PMC3775671.
Keppel Hesselink JM, Kopsky DJ. Palmitoylethanolamide, a neutraceutical, in nerve compression syndromes: efficacy and safety in sciatic pain and carpal tunnel syndrome. J Pain Res. 2015 Oct 23;8:729-34. doi: 10.2147/JPR.S93106. PMID: 26604814; PMCID: PMC4631430.
Huschtscha Z, Silver J, Gerhardy M, Urwin CS, Kenney N, Le VH, Fyfe JJ, Feros SA, Betik AC, Shaw CS, Main LC, Abbott G, Tan SY, May A, Smith CM, Kuriel V, Barnard J, Hamilton DL.
The Effect of Palmitoylethanolamide (PEA) on Skeletal Muscle Hypertrophy, Strength, and Power in Response to Resistance Training in Healthy Active Adults: A Double-Blind Randomized Control Trial. Sports Med Open. 2024 Jun 7;10(1):66. doi: 10.1186/s40798-024-00732-6. PMID: 38844675; PMCID: PMC11156829.
Jadhav SB, Shah N, Rathi A, Rathi V, Rathi A. Serratiopeptidase: Insights into the therapeutic applications. Biotechnol Rep (Amst). 2020 Oct 17;28:e00544. doi: 10.1016/j.btre.2020.e00544. PMID: 33134103; PMCID: PMC7585045.
Tiwari M. The role of serratiopeptidase in the resolution of inflammation. Asian J Pharm Sci. 2017 May;12(3):209-215. doi: 10.1016/j.ajps.2017.01.003. Epub 2017 Feb 1. PMID: 32104332; PMCID: PMC7032259.
Cheryl Myers is an integrative health nurse, author, and an expert on natural medicine. She is a nationally recognized speaker who has been interviewed by the New York Times, Wall Street Journal and Prevention magazine. Her many articles have been published in such diverse journals as Aesthetic Surgery Journal and Nutrition in Complementary Care, and her research on botanicals has been presented at the American College of Obstetrics and Gynecology and the North American Menopause Society. Myers is the head of scientific affairs and education for EuroPharma, Inc.
