The search for natural ways to ease inflammation and pain is universal.
Whether your pain is caused by athletic endeavors, aging or a medical condition, you want relief. And if your pain is chronic, you are concerned about taking too many NSAIDs as these pharmaceutical substances can tax your organs and may even lead to problems in the future.
According to integrative medicine expert David C. Leopold, MD, director of integrative medical education at the Scripps Center for Integrative Medicine in San Diego, CA, supplements can be the cornerstone of good pain management. “People are also looking to supplements more and more. They have less tolerance for the side effects of traditional pain medications. They want something different.”
The questions for the natural supplement industry are, “What ingredients and products are most effective?” “How is this category of supplements is evolving?” “What is the consumer profile for these products?” “What is the most exciting research currently underway in this category?”
How Natural Ingredients Help With Pain
A key aspect of natural pain relief as compared to prescription medications is the fact that specific natural ingredients target specific kinds of pain.
According to David Winston, RH(AHG), and president of New Jersey-based Herbalist & Alchemist, while most herbs are milder than prescription medications, they are more specific in their action against pain.
He explained that herbs can be divided primarily into the categories of analgesics and anti-inflammatories and that they are specific to certain kinds of pain and to certain parts of the body. Some examples he cited included St. John’s wort, which when used as a tincture or orally is good for shingles, sciatica and most kinds of nerve pain. Winston described sweet melilot with its blood-thinning properties as useful for sharp, stabbing pain in the optic and sciatica area. He said it is specifically helpful with the kind of pain that feels like a knife stabbing.
Winston described horse chestnut as helpful in encouraging good blood circulation in the legs, and in alleviating dull, throbbing pain. He said kava relieves vascular skeletal pain or urinary tract/kidney stone pain and cited turmeric and ginger as anti-nociceptors, meaning they silence the nerves that send pain signals to the brain and spinal cord. Both substances increase pain thresholds, reduce pain sensation and help people tolerate pain better. Both are specifically helpful for those suffering from fibromyaligia.
Lou Paradise, president and chief of research for Topical BioMedics, Inc. in New York, described the products his company has available for pain relief. “Our Topricin and new MyPainAway healing cream formulas have taken a leadership role in this area. These products are examples of our company’s efforts to get to platforms for sustainable health care modeling and at the same time remain sensitive to reducing pain and suffering for the millions of people looking for safer ways of relieving their pain issues.”
According to Cheryl Myers, chief of scientific affairs with Wisconsin-based EuroPharma, Inc., the company has a line of products solely focused on headache pain relief. Some of these products include Curamin, Curamin Extra Strength and Curamin Headache.
Myers explained that while most over-the-counter options for pain relief are anti-inflammatory in nature, liver and stomach damage are often a consequence to their use. Therefore consumers are increasingly seeking effective nutritional supplements, which are free of these side effects, but still effective.
She pointed out that while turmeric and its active compound, curcumin, are effective, they are not easily absorbed by the body.
Curamin and Curamin Extra Strength, (and new the Curamin Headache Formula) feature a curcumin known for its naturally enhanced absorption—BCM-95 Curcumin. This curcumin formulation is blended with turmeric oils to significantly increase absorption compared to standard curcumin extracts. This strong botanical is also paired with another unique herbal component, BosPure Boswellia. Boswellia, which unlike many inflammation-reducing ingredients, is a specific inhibitor of 5-LOX, an enzyme that activates inflammation-inducing leukotrienes. These beta-boswellic acids are therefore reduced to less than five percent so absorption is good while inflammation is held down.
The other two ingredients in these formulas are DLPA (also known as d,l-phenylalanine) and nattokinase.
According to Myers, “DLPA contains two forms of the amino acid phenylalanine. These substances appear to block a nervous system enzyme (enzyme carboxypeptidase A) that intensifies pain signals. Combined they also may prevent the breakdown of one of the brain’s natural pain-killing substances, enkephalins (like endorphins). So it reduces pain and improves mood—a bigger factor than we often admit to—for dealing with pain.”
Stacey Littlefield, lead product formulator with Illinois-based Redd Remedies said the company offers Pain T4, which goes beyond the conventional focus of anti-inflammatory agents and combines support for other contributing factors to pain, such as stress and brain function to give the consumer a comprehensive platform for pain management.
She said, “The key ingredients—corydalis, ashwagandha, huang bai and cang zhu—work synergistically to reduce the pain-intensifying effects of stress and quiet the brain’s response to pain signals. These ingredients, combined with turmeric extract Curcumin C3, target multiple factors surrounding pain, including liver function, blood flow and cytokines that induce inflammation.”
Missouri-based Hyalogic specializes in making hyaluronic acid (HA) based products. Hyalogic President Darren Landis explained, “HA helps create the cushiony fluid for the joints. We don’t drive our cars without engine oil, we should not operate our joints without joint fluid.”
Dean Mosca, president, Proprietary Nutritionals Inc., an ingredient supplier, said the company produces Celadrin, a branded proprietary esterified fatty ester. He explained how it can be used as a topical cream directly on the affected area or in supplement form. According to Mosca, “Celadrin works much like essential fatty acids EPA and DHA which are made from omega-3 fish oils. But Celadrin produces a much more dramatic result because it causes changes at the body’s cellular level. Clinical studies show it works by supporting healthy inflammatory response and lubricates cell membranes throughout the body, promoting flexibility and mobility, without any side effects.”
Advances on the Horizon?
As far as new advances in natural pain relief, Winston noted, “There is not much new in terms of substances, although cannabis is stealing headlines. But I am most excited about some of the new extracts that continue to be found in turmeric. In the past 15 years, roughly 15-20 new extracts have been isolated from this herb.“
He explained that these new extracts generally are most effective when used as tinctures as opposed to pills or other ingestible forms.
Paradise offered a different approach. “There is a significant role for our industry to become leaders in education and innovators of robust product solutions to truly help and guide the pain sufferer to know and understand all their options. This is versus using a ‘popular’ ingredient as a marketing ploy simply to sell a product.
“There are a number of serious issues that need to be addressed, including the epidemic of prescription opioid addiction that is destroying lives and unfortunately is now found in every community, he continued. “We have an obligation to bring a central message to the public, thereby earning trust and respect by demonstrating we truly care about people and are responsibly serving them.”
Myers said the change she sees in this product category is an evolution toward specific types of relief for specific situations. She believes this mirrors the developments of categories seen in over-the-counter (OTC) products—specific pain-related health concerns being called out on packaging and ingredient lists.
She added that she believes the future will hold a wider variety of delivery systems, especially for those who have a difficult time swallowing tablets or capsules. “We’ve seen a quite a bit of that so far with chewable and drink mix supplements becoming more prevalent—and even expected—when they would have been considered a novelty just a few years ago,” she explained.
When it comes to developments in the product category, Littlefield said the most recent developments she has seen are focused on reducing inflammation as the key pathway to reducing pain. She cited recent scientific studies on traditional Chinese medicines, including corydalis, and the effects of stress on pain which have shed light on the human multi-faceted response to pain and its relationship to stress—factors that Pain T4 takes into consideration.
According to Landis, the most recent changes/developments affect joint health. He said the new emphasis in this area involve “chondroprotective fluids,” which are related to cartilage. These efforts seek to return cushiony fluids back to the joints so that the cartilage and bone structures are gliding across one another with limited friction.
In addition, the category is evolving to answer the needs of athletes and younger consumers who are highly fitness-oriented. Mosca noted, “A few short years ago, supplements that support joint comfort and mobility were always aimed at the ‘senior’ market. Many companies and suppliers have realized that there is a real need for the active populations—including individuals whose jobs are physically oriented—for supplements aimed at providing natural-source comfort, as opposed to those OTCs or prescriptions with nefarious side effects.”
The Consumer Profile
With these developments in mind, the primary users of these products appear to be evolving.
Winston stated simply that the largest growing audience for this kind of substance is primarily Baby Boomers. While he noted they are generally in better shape than their parents, they are using natural herbs for arthritis and anti-inflammatories for knee, back and neck pain.
He also cited active younger people as a growing market for these products as they are generally interested in using them as long-term treatments to ward off pain from exercise and stress.
He pointed to prescription narcotics as a gateway to drug abuse. According to Winston, “These natural substances are important alternatives to prescriptions. Prescription drug abuse (opiates) has led to the current heroin epidemic people (because people) get addicted to pain meds and turn to heroin which is cheaper.”
And he cited OTC medications, such as ibuprofen, as dangerous to consumers’ overall health. “People seek out herbs because of their relative safety. For example, willow bark is much safer than aspirin although it is weaker. Combining other herbs with willow bark makes it more effective.”
Paradise pointed out that because pain does not discriminate according to age or culture and at any one time there are more than 100 million people in the U.S. suffering from chronic pain conditions. He noted that, in general, pain affects women at a higher percentage than men. The population of 25- to 40-year-old men and women is becoming more proactive in using natural products, as they are engaging in a more active lifestyle, including such endeavors as the massive appeal of obstacle course racing, such as the Spartan Race.
EuroPharma has heard from a wide-ranging audience regarding how their supplements have stopped pain, improved lives, and helped their customers return to levels of activity they hadn’t expected to experience again. Meyers said, “We expect that many older adults and Baby Boomers are experiencing some level of daily pain to be interested in alternatives in the natural products channel. But, we also have many active younger people who are very aware of the limitations and risks of OTC and prescription drugs.”
Myers explained, “ I would say that educating customers is key in this area as it is in any other. Let people know that there are effective options available, and they’ll try them (and keep using them) when they experience the effects.”
Agreeing with Myers, Littlefield said, “Consumers who choose to take natural pain relief products are looking to avoid the common side effects associated with NSAIDS, such as gastrointestinal complaints.”
She added, “These consumers also include people who have not been able to find the relief they need with traditional anti-inflammatory pain products.”
Landis took a more generalized approach to the question and explained, “Anyone who has joint health concerns is looking for hyaluronic acid supplements. This could be the young 20-year old athlete or a 65-year old male who still likes to stay active.”
Mosca reiterated his earlier observation that this category is evolving to answer the needs of athletes and younger consumers who are highly fitness-oriented. “The supplements that support joint comfort and mobility are no longer always aimed at the ‘senior’ market,” he said.
Herb Combinations and Ascendency of Curcumin
Looking into the future of natural pain relief, experts offered their predictions of what research will be the most valuable for consumers and manufacturers.
Winston said that curcumin will continue to be proven more effective than turmeric, and that combination is a watchword. “Herbs are best and most effective when used in combinations,” he added. These combinations greatly enhance the effectiveness of each individual ingredient, like a one plus one equals three-effect, although there is no scientific study done to prove this.”
He cited corydalis as an effective pain relief substance useful in avoiding bruising and inflammation especially when combined with angelica, a close relative of the carrot, parsley, celery, fennel and dill.
In the longrun, Winston said products containing a combination of anti-inflammatories such as corydalis, St. John’s wort and Jamaican dogwood (Jamaica dogwood is well-known as a traditional remedy for treating migraine and neuralgia severe stabbing nerve pain) work better than each herb by itself.
“Intelligently combining herbs are more effective than using single herbs alone,” Winston surmised.
Paradise explained how the need to build trust and create real solutions to pain guides his company’s research and development.
“There needs to be far more research then there is today and a number of companies—including our company, Topical BioMedics—are proactive in this area because people and their health providers deserve our very best continued evolving efforts. There is a lot of distrust in the mind of the consumer, especially the pain sufferers looking for safer alternatives to painkillers. So doing the real work of developing and providing real product solutions will build credibility and integrity and (enable us to) earn the necessary trust so people want to turn to our industry as a real resource and a responsible part of helping them solve significant problems.”
Curcumin and boswellia, according to Myers, will continue to be the object of studies going forward. She said this is exciting since some of these studies use the same ingredients found in her company’s Curamin line of supplements, which include, Curamin Headache Formula that has additional targeted magnesium and vitamin B6.
“One is a clinical trial with patients suffering from osteoarthritis and compares the potency of two botanicals to a generic celecoxib (known under the brand name Celebrex), she noted. “In this case, 64 percent of those taking the herbal ingredients 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.’“
She continued, “Another study showed that BCM-95 Curcumin was superior to diclofenac sodium for rheumatoid arthritis, which has its own set of challenges for pain and joint health. The eight-week study, ‘A Randomized, Pilot Study to Assess the Efficacy and Safety of Curcumin in Patients with Active Rheumatoid Arthritis,’ followed 45 subjects, randomized to three groups. All study participants had been diagnosed with rheumatoid arthritis, functional class I or II.
“In the Disease Activity Score (known as “DAS”) 28 assessment, BCM-95 Curcumin had the highest impact for reducing disease symptoms,” cited Meyers. “This result was followed by the combination therapy of BCM-95 with diclofenac sodium. Interestingly, the diclofenac sodium-alone group scored in last place.”
Meyers also noted that magnesium has a long record in migraine research since it’s been estimated that about half of all migraine sufferers are magnesium deficient. She advised that pre-treatment with magnesium has reduced incidents of migraines in children and adults and the supplement EuroPharma offers is called Curamin Headache Formula which is chelated to the amino acid glycine for extra-efficient absorption since some people are prone to poor magnesium absorption, while others simply excrete more due to stress.
Vitamin B6 has been shown to help reduce the severity and duration of migraine headaches and EuroPharma’s Curamin Headache Formula is the pyridoxal-5-phosphate (P-5-P) form. This form of vitamin B6, unlike commonly used pyridoxine hydrochloride, is already in its active form and does not require conversion by the liver before it can be used by the body. This is beneficial because many people are not efficient converters of B vitamins, due to genetic markers that already put them at risk of deficiencies.
Meyers said these substances will continue to be studied and prove valuable in search for natural pain relief.
According to Littlefield, the most significant research on natural pain relief is related to the role stress plays in pain perception. “Managing stress and helping the body and mind adapt to stress, individuals can gain greater control over their pain,” she said, adding that she believes this is the area to watch in the future.
In addition, the prevention of joint degradation and the preservation of joint mobility is an area of research to watch, said Mosca. He described studies his company is conducting on reducing this kind of discomfort.
“Our studies on our product Celadrin show increased mobility and reduced discomfort.” For example, a double-blind, placebo-controlled study reported that after eight weeks of taking Celadrin capsules, (894 mg daily), average walking ability increased 45 percent, and participants claimed a 35 percent decrease in knee discomfort. These improvements were significantly better than the results seen in the placebo group, and no negative side effects were found throughout the entire study.
A previous study on the efficacy of Celadrin-based cream published in the Journal of Rheumatology in 2004, stated that participants reported significant relief in discomfort after only 30 minutes of application—benefits which continued to improve over time with daily use of the product.
In conclusion, experts agree that herbal and supplemental answers to the problems of chronic and acute pain will continue to be studied by researchers and sought out by educated consumers of all ages. Pain and inflammation is a part of the human condition regardless of age or activity level and there will continue to be an increasing demand for forms of relief that do not interfere with natural body processes and organ health. Different research studies are finding promise in the pain-relieving properties of herb combinations, curcumin, boswellia and vitamin B-6. VR
For More Information:
EuroPharma, (920) 593-6279
Herbalist & Alchemist, (908) 689-9020
Hyalogic, (913) 745-1116
Proprietary Nutritionals Inc., (800) 526-0609
Redd Remedies, (888) 453-5058
Topical BioMedics, Inc., (845) 871-4904
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