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Introduction

Pain can be a tricky and difficult thing to deal with. When not effectively managed and relieved, pain can take a toll on your body and mind and affect all aspects of quality of life. These significant effects emphasize the need for safe and effective treatment of pain, be it long- or short-term discomfort.

Yet, not all pain should be treated the same way. What works for you may not work for others, indicating a need for a personally tailored approach to pain management.

Many prescription and non-prescription pain relievers are available on the market, including non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and opioids.

While effective, these agents can cause side effects and are not always recommended for long-term use.

This has led to a shift toward non-prescription agents for treating pain, including natural remedies and supplements.

This article will discuss the current evidence supporting non-pharmacologic options to help you understand alternative choices for pain management.

TURMERIC

Turmeric, a traditional Indian spice, is an essential component of many delicious recipes and meals. What many don’t know, however, is that turmeric possesses natural healing properties.

It exerts numerous positive effects on the body and brain. It affects the body’s inflammatory processes, making it a staple for pain management in alternative medicine.

What makes turmeric anti-inflammatory?

When there is an imbalance of toxic substances in our body, these toxic substances can cause damage and lead to what is known as oxidative stress.

Oxidative stress is closely linked to inflammation, making it a driving component in many chronic diseases.

Inflammation plays a big role in certain diseases such as Alzheimer’s, Parkinson’s, multiple sclerosis, cancer, arthritis, diabetes, and more.

Tumor necrosis factor α (TNF-α) is a substance in our bodies that controls inflammation responses. TNF-α is regulated by another substance called nuclear factor (NF)-κB.

Certain agents that block NF-κB activity are thought to have efficacy in treating certain inflammatory diseases through downstream effects on TNF-α.

Curcumin is the main and most active ingredient in turmeric. Curcumin blocks activation of NF-κB, thus suppressing inflammation.

What conditions can turmeric treat?

• Arthritis: Osteoarthritis (OA) represents a chronic condition characterized by joint pain and inflammation. Cost and potential side effects of these agents indicate a potential for herbal remedies.
  • In one study, 40 participants with mild-to-moderate knee OA received either 500 mg per day of curcuminoid or placebo. The results demonstrated marked improvements in pain and physical functioning in those receiving curcuminoid.
  • Another trial compared curcuminoid to ibuprofen in the treatment of primary knee OA. There was no statistically significant difference between the two treatment groups, suggesting that those taking turmeric and ibuprofen experience similar pain relief.
• Cancer: Cancer develops through a complex mechanism involving multiple signaling pathways, protein activation, and inflammatory substances.
  • Evidence suggests that curcumin can regulate these processes and consequent tumor growth by controlling the mechanisms underlying cancer.
  • In fact, turmeric has been shown to improve the effects of certain chemotherapy and radiation agents used in cancer therapy.
• Metabolic disorders: Metabolic syndrome encompasses many conditions including insulin resistance, high blood sugar, high blood pressure, high cholesterol, and obesity.
  • Remarkably, turmeric shows beneficial effects in many of these diseases. Evidence suggests that curcumin can improve insulin sensitivity, and block fat production.
  • It can also lower blood pressure, inflammation, and oxidative stress.
  • Curcumin may even play a role in altering gene expression in cholesterol processes, thus lowering cholesterol levels.
  • One study found that curcuminoids had greater efficacy than placebo in decreasing certain types of cholesterol.
• Cognition: Due to its antioxidant and anti-inflammatory characteristics, curcumin has been evaluated in animal models for the treatment of Alzheimer’s disease (AD).
  • Curcumin is thought to alter AD by disintegrating toxic plaques and stopping inflammation and oxidation. One study evaluated curcumin and its effects on adult memory and cognition.
  • Individuals taking turmeric performed better on memory and attention tests than those receiving placebo. These benefits correlated with reduced brain lesions in brain regions that control mood and behavior.
• Gastrointestinal (GI) disorders: Curcumin is highly absorbed in the gastrointestinal tract. Therefore, researchers believe curcumin may have a therapeutic benefit in inflammatory bowel diseases, liver scarring, and gastrointestinal cancers.
  • One study evaluated adding curcumin to traditional therapy in ulcerative colitis, an inflammatory bowel disease.
  • The treatment group that added curcumin had better remission rates than those who did not take curcumin. Additionally, no adverse effects were observed.
• Turmeric may also have a role in other conditions such as neurological diseases, cardiovascular diseases, autoimmune disorders, skin conditions, and AIDS.

How should piperine be used with turmeric?

Piperine is an active compound found in black pepper that has multiple health benefits.

It has demonstrated effects in treating nausea, poor digestion, and headaches in addition to anti-inflammatory conditions.

Piperine also plays an important role in boosting curcumin absorption when taken together with turmeric.

Curcumin contained in turmeric is not well absorbed when given alone.

This means that its effects won’t be as potent as they could be if given with another agent.

One study evaluated the effects of piperine on curcumin efficacy. Individuals received either 2 grams (g) of curcumin alone or in combination with 20 milligrams (mg) of piperine.

Curcumin alone led to absent or very low concentrations in the blood. When co-administered with piperine, the absorption of curcumin was increased by 2,000%.

Therefore, for greatest health benefit, we recommend taking turmeric in combination with piperine.

What else should I consider when taking turmeric?

While taking turmeric in spice form can be tasty, it won’t exert as many advantageous effects as the supplement form. This is because turmeric is actually composed of over 100 compounds.

However, the one we really care about is curcumin, as that is the most active ingredient.

But curcumin only makes up roughly 5% of turmeric’s composition. This is the same for black pepper, where piperine also only makes up about 5% the entire spice.

Supplements contain more potent concentrations of the active ingredient compared to the spice itself.

Another important point to consider when selecting a supplement is the ratio of curcumin to piperine.

In order to achieve maximal curcumin effects, 20 mg of piperine should be administered for every 2 g of curcumin.

Curcumin is usually available in capsule form, each containing 500 mg of curcumin.

The most common way to take curcumin includes taking one to four of these capsules each day without regard to food.

Turmeric is also available in topical and rectal formulations. Dosages of up to 8 grams daily have been used, but high doses may cause worse side effects.

What about safety?

Turmeric and curcumin formulations are relatively safe to take orally or when applied to the skin if taken correctly. Side effects may occur at high doses, specifically in supplements that promote maximal curcumin absorption.

The higher the concentration of curcumin in the body, the more likely it is to cause side effects.

Common side effects may include nausea, diarrhea, rash, or itchiness.

Tell your doctor if you experience symptoms such as abnormal bleeding or bruising.

Additionally, if you take any type of supplement like turmeric, make sure to let your doctor know.

Turmeric supplements may also interact with medications you take.

One study concluded that curcumin can affect the way certain drugs work. These drugs include antidepressants, blood thinners, antibiotics, chemotherapy, antihistamines, transplant medications, and some medications for the heart.

If you take medications like these, it is best to speak with your doctor before starting a supplement.

Additionally, we are unsure if supplements, at concentrations greater than those found in food, affect pregnancy and breastfeeding.

Anyone who is pregnant or breastfeeding should use caution  when taking any medication or supplement, regardless of how safe it may seem.

Turmeric summary

Based on available evidence, turmeric may have a role in the prevention or treatment of many conditions.

Some potentially beneficial uses include osteoarthritis/inflammatory pain, cancer, GI conditions, and neurological diseases amongst many others.

Side effects appear to be minimal. If you would like to use turmeric, we recommend using the supplement form instead of food-grade turmeric powder.

This is because the supplement contains a higher concentration of curcumin, the component that provides most of the health benefits.

If you are interested in purchasing a Turmeric and Bioperine combination supplement that has great reviews and is manufactured in an FDA-registered manufacturing facility with GMP certification, then I highly recommend this supplement. As always, please consult with your doctor first before starting any supplement.

WILLOW BARK

Willow bark, a therapy often used in traditional medicine, originates from the branches of two- or three-year-old willow trees.

Most medicinal types of willow bark come from white and black willow trees. People have used willow bark for centuries, and its use originates in the Mediterranean.

However, it has historically been used for over 2000 years around the world in places such as China, North America, Europe, and South America.

The point of taking willow bark is to utilize its active ingredient called salicin. Salicin is closely related to aspirin, a common over-the-counter pain reliever.

Salicin exhibits anti-inflammatory and analgesic effects and has been used to treat a variety of inflammatory conditions.

What makes willow bark anti-inflammatory?

Though its exact mechanism is unknown, willow bark seems to block the release of inflammatory substances known as prostaglandins.

Willow bark does this by blocking activity of an important enzyme involved in inflammation called cyclooxygenase (COX)-2.

The body breaks salicin down very similarly to how it does aspirin. It starts by converting salicin to salicyl alcohol and then to salicylic acid.

There is some evidence that willow bark needs to be taken consistently and for a long time to see its medicinal effects.

What conditions does willow bark treat?

Willow bark extract is used most commonly in disease states that involve inflammation, pain, and fever.

It may also have utility in treating headache, flu symptoms, and menstrual cramps.

We will primarily focus on evidence supporting willow bark’s use in managing pain and inflammatory conditions.

Pain and inflammation

One study summarized current findings of three clinical studies that examined how willow bark can improve musculoskeletal pain.

These three studies included a total of 415 participants.

The first study by Chrubasik and colleagues examined patients with chronic lower back pain treated with either 120 milligrams (mg) or 240 mg of salicin over four weeks.

A total of 39% of patients in the high-dose treatment group were free of pain compared to 6% in the placebo group at trial completion, with relief occurring roughly one week after initiating treatment with willow bark.

Schmidt and colleagues studied osteoarthritis patients given either placebo or 240 mg salicin daily for two weeks. Individuals receiving willow bark demonstrated a statistically significant reduction in pain scores.

Finally, another trial evaluated patients with osteoarthritis and rheumatoid arthritis who received 240 mg of salicin daily for 6 weeks.

However, no difference in pain reduction was seen. Researchers were unsure as to why these results differed from previous studies

Other well-controlled studies have had positive findings when using willow bark to treat pain.

The totality of this data, in combination with anecdotal evidence from centuries worth of use, supports the use of willow bark in inflammatory conditions.

Weight loss and athlete performance

Willow bark has also been used in weight loss and sport performance supplements.

These effects are probably because willow bark can elevate your pain tolerance due to its anti-inflammatory characteristics.

When you have a higher threshold for pain, intense exercise can become more tolerable. Thus, you may experience increased performance, mobility, and energy during physical activity which can lead to increased weight loss.

One study looked at participants who did resistance training. Those that took acetylsalicylic acid had profound reductions in pain and better training performance. Acetylsalicylic acid is a salicylate and therefore is likely to produce similar effects to the salicin found in willow bark.

What about safety?

The salicin in willow bark is similar to the compounds found in aspirin. However, salicin does not seem to have as many stomach effects as aspirin.

The most common side effects of willow bark, though, include GI symptoms such as abdominal pain, diarrhea, dyspepsia, heartburn, and vomiting.

It may also cause itching and rash. Yet, willow bark is thought to be relatively safe. If you have a sensitivity or allergy to aspirin, though, you should avoid willow bark.

For example, the Chrubasik and colleagues study included a case of serious allergic reaction to willow bark.

Willow bark may also be dangerous if you have certain conditions such as gastritis, stomach ulcers, asthma, diabetes, or hemophilia. Additionally, willow bark may interact with certain drugs such as:

• blood thinners. Willow bark may increase your risk of bleeding with certain medications affecting the thickness of your blood.
• blood pressure medications. These medications include beta-blockers and diuretics. Willow bark can decrease the efficacy of these medications, which can harm your health.
• non-steroidal anti-inflammatory drugs (NSAIDs). You may be at increased risk of a stomach bleed if you take NSAIDs together with willow bark.

Willow bark summary

Willow bark has been used for centuries in the treatment of pain and inflammatory diseases.

A few human studies have provided evidence that willow bark is both safe and effective in conditions such as osteoarthritis.

However, it is important to be aware of certain side effects and drug interactions that may occur.

ARNICA ROOT

Arnica root is another herbal compound that has been used widely in the world of homeopathic medicine.

Arnica root is found in Siberia and central Europe and is derived from the sunflower family. It has been used for dozens of conditions, the most common being for inflammatory conditions such as osteoarthritis.

The flowers of the plant provide the most potent benefits, some of which include antibiotic, pain-relieving, and blood-thinning properties.

Administration of the flower comes in many forms, including creams, ointments, gels, and solutions.

How does arnica root work?

The most important part of arnica root includes the substance known as sesquiterpene lactone. This is a chemical compound that is the active component of arnica root. Through this substance, arnica root produces anti-inflammatory effects and pain relief.

What is arnica root used for?

Arnica has been used for many disease states and conditions, including:

• inflammation
• pain
• osteoarthritis
• bacterial and fungal infection
• conditions relating to restricted blood flow
• anxiety
• hair loss

We will focus primarily on arnica roots use in osteoarthritis and infection, as detailed below.

Osteoarthritis

One study evaluated arnica root in the form of a topical gel in osteoarthritis. The results show that arnica root significantly reduced pain activity in osteoarthritis.

The underlying mechanism involves arnica root blocking two important substances in the body called NF-aB and NF-AT.

Participants treated with arnica root showed better use of their hands and less morning stiffness, pain intensity, and painful joints.

Activity in bacteria and fungus

Arnica root has been shown to kill certain types of bacteria and fungi. In particular, arnica root has activity against Streptococcus bacteria strains.

What about the safety of arnica root?

Arnica root can interact with certain medications, including blood thinners such as warfarin. Arnica can also cause multiple side effects, especially when taken orally.

Oral route

Arnica route is generally considered safe when taken by mouth if it is well-diluted.

Pure arnica should never be taken orally because it can cause dangerous side effects and injure your heart and other organs. Certain arnica root forms may also contain a substance known as helenalin, which can be dangerous to your health. When taken orally, helenalin can cause:

• stomach pain and upset
• diarrhea
• vomiting
• irritation to the mouth and throat
• high blood pressure
• shortness of breath
• bruising and bleeding
• increased heartbeat

Topical route

Arnica may cause allergic reactions, specifically if you have pre-existing allergies. If you are allergic to plants in the Asteraceae family, such as ragweed, daisies, and marigolds, you may have a bad reaction to arnica root.

Topical arnica can also cause short-term elevations in blood pressure and heart rate if you use too much of it on broken skin.

This is because broken skin can lead to increased absorption of arnica. Stinging can also occur.

A topical product with good anecdotal evidence for positive pain relief is Penetrex. It contains arnica root, Vitamin B6, and MSM.

It has a nice consistency, absorbs easily and completely into the skin, does not have a noxious scent, and is non-greasy.

I have used it for years for my chronic low back pain and it has been incredibly effective.

You can purchase it below by clicking on the image.

S-ADENOSYL-METHIONINE (SAM-e)

SAM-e is a naturally occurring molecule that can be found throughout our body. It is made from a substance known as methionine, which is found in food. It plays a key role in regulating certain cell functions.

What conditions can SAM-e treat?

SAM-e has been used in a variety of different conditions, including depression, osteoarthritis, and liver diseases. However, data in each of these diseases is inconclusive.

Depression

To date, roughly 40 studies have evaluated the efficacy of SAM-e in depression. Multiple studies showed that SAM-e may be effective in treating depression.

However, these studies have been short in duration, only lasting a few weeks.

Additionally, only a small number of subjects have been included, and the studies were not well-controlled or of great quality.

Osteoarthritis

SAM-e has shown mixed results in osteoarthritis studies. Some research has compared SAM-e to NSAIDs in terms of pain relief.

Results have demonstrated that SAM-e and NSAIDs are similar in terms of increasing pain relief and joint function.

Other studies that compared SAM-e to placebo had mixed results, and no definitive conclusions could be made.

Liver diseases

SAM-e has been studied in liver conditions such as cholestasis, alcoholic liver cirrhosis hepatitis C, and nonalcoholic steatohepatitis, and liver cancer. Overall, results are inconclusive.

Is SAM-e safe?

SAM-e may lower the effects of a drug called levodopa (L-dopa), which is used in Parkinson’s disease.

Additionally, SAM-e may interact with other drugs that affect a chemical in our body called serotonin.

These drugs include antidepressants and St. John’s wort.

Conclusion

Some evidence exists that supports the use of certain herbal medicines in treating pain and inflammatory conditions.

However, as with any medication, these substances run the risk of side effects and drug interactions.

It is important that if you take these supplements, you always let your doctor and pharmacist know.