Article - Fast pain relief in exercise-induced acute musculoskeletal pain by turmeric-boswellia formulation: A randomized placebo-controlled double-blinded multicentre study.

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Take home message

Exercise induced MSK can result in significant injuries and limit training and performance of athletes.
Commonly prescribed over-the-counter analgesics may affect some of the positive post-exercise benefits and have known side effects.
The supplementation of TBF may be a fast acting alternative treatment for exercise induced MSK pain.

Evidence category

A: Meta-analyses, position-stands, randomized-controlled trials (RCTs)

Summary review

Introduction

Exercise-induced musculoskeletal (MSK) pain is a common occurrence but can be limiting and lead to injuries or inflammation.
Analgesics are commonly used over-the-counter medications; however, it is unclear as to their benefit for exercise-induced pain management as they may be detrimental to recovery.
Alternative treatments may have merit and turmeric and boswellia have been shown to have anti-inflammatory properties. These compounds have been growing in popularity for their use as an adjunct to MSK pain medications.
This study aimed to evaluate the efficacy of a turmeric-boswellia formulation (TBF) on acute MSK pain.

Methods

This was a randomised placebo-controlled double-blind multi-centre trial of 232 individuals with exercise induced MSK pain.
Participants were split into two groups TBF (Rhuleave-K 1000mg/d) or placebo (1000mg/d).
The trial ran for 7 days.
Exercise induced pain included lower back, shoulder, knees, lower body and other types of pain.

Results

Pain intensity was reduced with TBF when at rest, when moving and when pressure was applied compared to placebo (P=<0.001).
TBF was more effective at obtaining pain relief than placebo according to the Total Pain Relief scale (P=<0.0001).
Pain relief was fast following TBF, with meaningful pain relief achieved within 191.6 minutes compared to 358.1 minutes in the placebo group.
39% of participants given TBF reported noticeable pain relief as early as 30 minutes, whereas only 1.7% reported noticeable pain relief after 30 minutes in the placebo group.
Symptom resolution was much more likely in those given TBF than placebo (P=<0.001).

Conclusion

TBF is effective at relieving exercise induced MSK within 3 hours.

Clinical practice applications

TBF in the form of Rhuleave-K (1000mg/day) may provide a natural, fast and effective alternative to analgesics in treating exercise induced MSK.

Considerations for future research

Research on the use of TBF for the management of other sources of pain should be considered.

Abstract

BACKGROUND

Plant extracts with analgesic properties are seldom considered for treatment of acute musculoskeletal pain due to delay in onset of analgesia. Turmeric (Curcuma longa) and boswellia (Boswellia serrata) extracts are well-studied anti-inflammatory compounds gaining in popularity and used as an alternative to conventional treatments for musculoskeletal pain. This study analyzed the analgesic effect of a formulation of turmeric and boswellia extracts in sesame oil (Rhuleave-K, TBF) in reducing exercise-induced acute musculoskeletal pain in healthy participants.

METHODS

In this randomized double-blinded placebo-controlled, single-dose, single-day, multicentre study, a total of 232 participants (TBF n = 116; placebo n = 116) having moderate-to-severe exercise-induced acute musculoskeletal pain were randomized in an allocation concealed 1:1 ratio to receive a single dose of 1000 mg of TBF or placebo. The outcome measures were numerical rating scale (NRS), categorical pain relief scale (PRS), onset of analgesia, and short form of McGill questionnaire (SF-MPQ). NRS and PRS were measured from predose to every 30 minutes interval of postdose up to 6 hours at rest, with movement and applying pressure on the affected part. The onset of analgesia was measured from the time of dosage and censored at 6 hours of postdose. The sum of pain intensity difference (SPID6) and total pain relief (TOTPAR6) at 6 hours was, respectively, analyzed from NRS and PRS scores.

RESULTS

TBF showed a significant reduction in pain intensity (SPID6rest) with 97.85% improvement in cumulative responder analysis compared with 2.46% in placebo. The onset of pain relief was fast and highly significant in the TBF group with 99% of participants having a mean perceptible pain relief at 68.5 minutes (95% confidence interval, 59.5-77.4) and 96% of participants having a mean meaningful pain relief at 191.6 minutes (95% confidence interval, 176.7-206.4) compared to the placebo group. Highly significant and continuous improvement in pain relief was observed in the TBF group with 93% of participants having ≥ 50% of maximum TOTPAR6 with a number needed to treat of 1.1 at rest.

CONCLUSION

Exercise-induced acute musculoskeletal pain can be effectively relieved by TBF (Rhuleave-K) in about 3 hours signifying its strong analgesic activity.