After a close friend credited Boswellia and targeted exercise for complete relief of his severe acute back pain, I was inspired to blog about this amazing pain-relieving extract.
Boswellia serrata extract is widely appreciated for its therapeutic effects on inflammation, arthritis and pain.
Also known as frankincense oil or olibanum, the Boswellia serrata extract is produced from gum resin (a.k.a. oleogum resin) obtained via incisions in the trunk of the Boswellia serrata tree that commonly grows in India.
Most people are familiar with the story of the three wise men bearing gifts of gold, frankincense and myrrh for the Baby Jesus on the eve of his birth in Bethlehem.
In addition to Christianity, frankincense is also highly regarded by other religions and cultures including by Jewish, Muslims, Indians, Egyptians and Greeks.
But did you know that the Boswellia serrata extract can also offer significant pain relief? Specifically, the resin from the Boswellia serrata tree may be effective in treating chronic pain including osteoarthritis, soft tissue rheumatism, low back pain, gout, rheumatoid arthritis and inflammatory bowel disease.
Boswellia treatment can lead to enhanced movement and mobility as well as reduced inflammation. Reduced leucocyte infiltration in the knee joint and decreased release of pro-inflammatory mediators occurs following daily Boswellia intake.
Boswellia serrata extract may be a viable alternative to non-steroidal anti-inflammatory drugs (NSAIDs), with fewer severe side effects (Abdel-Tawab et al, 2011; Pawar et al, 2011).
CASE STUDIES
(1) A Study Involving Boswellia-Treated Knee Osteoarthritis Patients
A study involving 70 knee osteoarthritis patients was done to evaluate the effectiveness and safety of a Boswellia serrata extract called 5-Loxin®. Specifically, 5-Loxin® (100 mg or 250 mg) or a placebo was offered daily for 90 days. Pain and physical function assessments were made on Days 0 (baseline), 7, 30, 60 and 90.
Pain levels and physical function were significantly improved in treated patients regardless whether 100 mg or 250 mg 5-Loxin® was offered. It is noteworthy that patients who received the higher dosage enjoyed substantial pain relief and other benefits within only 7 days of treatment.
Boswellia serrata-treated patients also had decreased levels of the cartilage-degrading enzyme, matrix metalloproteinase-3. Reduced pro-inflammatory mediators in the synovial fluid may lead to improved knee joint health including less cartilage damage in osteoarthritis patients (Sengupta et al, 2008).
(2) A Second Study Involving Boswellia-Treated Knee Osteoarthritis Patients
An Indian study involving 30 knee osteoarthritis patients was done to ascertain the efficacy, side effects and safety of Boswellia serrata extract. Specifically, 15 patients were offered Boswellia serrata while the remaining 15 patients were given placebo treatment for 8 weeks. The second half of the study involved switching the 30 patients to the opposite intervention for a further 8 weeks.
All Boswellia serrata-treated patients enjoyed decreased knee pain, reduced knee joint swelling, enhanced knee flexion and increased walking distance.
While minor gastrointestinal side effects may arise in some patients, Boswellia serrata extract may be an effective treatment option for knee osteoarthritis and other arthritic conditions (Kimmatkar et al, 2003).
(3) An Indian Study Involving Boswellia For Osteoarthritis
An Indian trial led by Raychaudhuri and her colleagues evaluated the efficacy of the Boswellia serrata extract enriched with a form of boswellic acid in osteoarthritis patients. The researchers concluded that Boswellia serrata can reduce pain and improve knee joint function in as little as 7 days (per Indian newspaper article).
SUMMARY
Boswellia serrata extract may be effective in treating chronic pain, arthritis and osteoarthritis. Its therapeutic effects are achieved via dampening of the inflammatory response.
Boswellia serrata extract may be a viable alternative to NSAIDs, with fewer severe side effects.
What could be better than this??
Sabina Walker
Blogger, Pain Matters (in WordPress)
PS Please feel free to share your personal experience with Boswellia serrata extract via this blog.
Also feel free to share this post on Facebook and other social media.
REFERENCES
ARTICLES
(1) Schultz, Colin. There’s More to Frankincense and Myrrh Than Meets the Eye. Smithsonian.com (24 Dec 2014).
(1) Sengupta et al. A double blind, randomized, placebo controlled study of the efficacy and safety of 5-Loxin for treatment of osteoarthritis of the knee. Arthritis Res Ther. (2008); 10: R85.
(2) Kimmatkar et al. Efficacy and tolerability of Boswellia serrata extract in treatment of osteoarthritis of knee–a randomized double blind placebo controlled trial. Phytomedicine (Jan 2003); 10(1): 3-7.
(A) Kizhakkedath et al. Clinical Evaluation of an Herbal Formulation, Rhulief®, in the Management of Knee Osteoarthritis. Osteoarthritis and Cartilage; 19 (Supplement 1): S145-S146.
(B) Kizhakkedath et al. Clinical evaluation of a formulation containing Curcuma longa and Boswellia serrata extracts in the management of knee osteoarthritis. Mol Med Rep. (Nov 2013); 8(5): 1542-8.
(1) Pawar et al. Physico-chemical standardization and development of HPTLC method for the determination of β-boswellic acid from Boswellia serrata Roxb. (exudate). Int J App Pharm (2011); 3(1): 8–13.
(2) Hamidpour et al. Frankincense (乳香 Rǔ Xiāng; Boswellia Species): From the Selection of Traditional Applications to the Novel Phytotherapy for the Prevention and Treatment of Serious Diseases. Journal of Traditional and Complementary Medicine (2013); 3(4): 221-226.
(5) Abdel-Tawab et al. Boswellia serrata: an overall assessment of in vitro, preclinical, pharmacokinetic and clinical data. Clin Pharmacokinet. (June 2011); 50(6): 349-69.
Hyperbaric oxygen therapy (HBOT) involves the delivery of 100% oxygen at increased atmospheric pressures inside a pressure chamber.
Pressures greater than normal air pressure (i.e. 1 Atmosphere Absolute, or 1 ATA) may be offered by trained personnel. Many patients are exposed to 2 to 2.4 ATA per session. Each session may last 1.5 to 2 hours and patients may complete a total of 20 to 30 HBOT sessions.
For those of you who have scuba dived, free dived or snorkelled, 2 ATA is the pressure that one would feel 10 meters (33 feet) under the ocean. Thus, every 10 meters (33 feet) of sea water is equivalent to an increase of 1 ATA of pressure.
Also called hyperbaric medicine or hyperbaric treatment, HBOT can increase oxygen concentration, reduce inflammation and decrease the number and sensitivity of tender and painful points.
This is a cute 2-minute video of a dog inside a pressure chamber (with great background music):
Hyperbaric oxygen therapy can alleviate chronic pain in:
Complex regional pain syndrome;
Fibromyalgia;
Myofascial pain syndrome;
Idiopathic trigeminal neuralgia;
Migraines and cluster headaches; and
Other pain conditions (Yildiz et al, 2006; Yildiz et al, 2006; Efrati et al, 2015)
as well as reduce pain following crush injuries.
PAINFUL CONDITIONS TREATED BY HYPERBARIC OXYGEN THERAPY
A 41-year old man, ‘G.G.’, suffered from Complex Regional Pain Syndrome Type 2 (CRPS Type 2), left foot, caused by a traumatic ‘Weber B’ left ankle fracture that occurred more than a year ago on 21 February 2014. Specifically, G.G. slipped and fell on ice in a parking lot at the end of a working day. He immediately suffered severe pain in his left ankle and foot.
Two days later, on 23 February 2014, G.G. had surgery involving open reduction internal fixation of his ankle. Complications set in including a cellulitis infection that was treated with antibiotics.
Post-surgery, G.G. endured ongoing and severe pain including intermittent shooting pains and severe electric shocks in his left ankle and foot. Other symptoms included allodynia, swelling, temperature changes and discoloured skin in the left lower limb.
Despite undergoing a rehabilitation program and taking pain medication including pregabalin (75 mg twice daily), acetaminophen and NSAIDs (as needed), multivitamins, calcium, magnesium and glucosamine, G.G.’s severe pain persisted.
A diagnosis of CRPS, left foot, was made in April 2014.
On 5 February 2015, almost one year after his injury, G.G. had surgery to remove the plateau in his left lower limb in an effort to relieve his pain. Sadly, G.G.’s symptoms including pain and allodynia, swelling, purple discolouration, lower skin temperature as well as muscle weakness in his left lower leg and ankle continued. With average pain levels at 6 that often rose to 8, G.G. described his pain as (quoting) ‘constant, dull, aching pain with intermittent shooting sensations’.
Desperate for some pain relief, G.G. decided to try HBOT for his CRPS in his left foot.
After 15 HBOT sessions over 3 weeks, G.G. had significantly less pain and allodynia, reduced swelling, enhanced skin colour and improved range of motion in his left foot. Following 3 weeks of HBOT, G.G. was able to return to work after more than a year off due to severe left foot pain.
Hyperbaric oxygen therapy may be a valuable therapeutic option for treating chronic CRPS (Katznelson, 2016).
A 44-year old woman had CRPS, left foot and ankle. Her foot and ankle had restricted range of motion, appeared cyanotic and was tender and cool upon touch.
Within only 15 minutes of her first HBOT treatment, she enjoyed complete pain relief in her foot! Furthermore, her foot felt warm on palpation and (quoting her) ‘pinker than it’s been in years’. The foot remained pink and warm for 8 hours. Best of all, she enjoyed nil pain for 18 hours after her first HBOT treatment!
Following amendments to her second HBOT session on the following day, her foot became pink and warm for 1 hour as well as painless for 2 hours.
Further adjustments made to her third HBOT protocol in the following week resulted inher foot remaining painless, warm and pink for 30 hours (!) (Peach, 1995).
COMPLEX REGIONAL PAIN SYNDROME
A double-blind, randomized, placebo-controlled study compared 37 CRPS patients who had HBOT treatment against 34 CRPS patients who received normal air (Control Group). All 71 CRPS patients underwent 15 sessions inside a hyperbaric chamber.
The HBOT-treated patients enjoyed significantly less pain and edema as well as enhanced range of motion of the wrist.
Hyperbaric oxygen therapy may offer pain relief, decreased swelling and improved range of motion in CRPS patients (Kiralp et al, 2004).
FIBROMYALGIA
A study involving 60 women aged 21 to 67 who suffered fibromyalgia for more than 2 years underwent 40 HBOT sessions. These 90-minute sessions were offered 5 days a week and each session involved 100% oxygen at 2 ATA. Hyperbaric oxygen therapy led to significant improvement in all fibromyalgia symptoms including improved quality of life (Efrati et al, 2015).
MYOFASCIAL PAIN SYNDROME
A study evaluated the effects of HBOT on 20 patients with myofascial pain syndrome (MPS) compared to 10 patients in the control group. The patients in the HBOT group were offered 10 HBOT sessions over 2 weeks.
There were no complications following hyperbaric oxygen therapy. The pain threshold was significantly improved as were visual analogue scale (VAS) scores in patients in the HBOT group.
The researchers concluded that HBOT may offer benefits for patients with MPS (Kiralp et al, 2009).
IDIOPATHIC TRIGEMINAL NEURALGIA
Patients with severe nerve facial pain (i.e. idiopathic trigeminal neuralgia) were offered HBOT sessions for 10 consecutive days. Specifically, 42 patients aged 40 to 70 (8 men, 34 women) who suffered trigeminal neuralgia for 2 to 20 years were selected for this study.
The researchers concluded that HBOT treatment offered quick, dose-dependent and lasting pain relief. Thus, HBOT may be an effective treatment for some nerve pain conditions including trigeminal neuralgia (Gu et al, 2012).
MIGRAINES
Female migraine sufferers were offered either:
100% oxygen and nil pressure (control group); or
Hyperbaric oxygen therapy comprising 100% oxygen and pressure.
The HBOT-treated migraineurs enjoyed some pain relief. Pain levels remained unchanged in the control group.
Hyperbaric oxygen therapy may reduce the intensity of migraines and headaches (Wilson et al, 1998).
CRUSH INJURY
Due to their traumatic nature, crush injuries can result in severe injury and pain to various body regions. Crush injuries can range from minor contusions to limbs facing amputation due to tissue necrosis.
Crush injuries may affect different tissue regions including skin, subcutaneous layers, muscle, tendons, ligaments, cartilage, vasculature including capilliaries, nerves, bones and joints. Physical trauma can lead to prolonged swelling and edema, stasis and/or internal bleeding including bleeding within myofascial envelopes. The latter may lead to increased tissue fluid pressure in the skeletal muscle compartment.
Affected tissues may become ischemic due to hypoxia if the tissue fluid pressure (edema) exceeds the capillary perfusion pressure to the muscles and nerves inside the skeletal muscle compartment.
Ongoing edema may result in increased pressure as well as severely compromised microcirculation and limited or nil oxygen transfer across the capillary endothelium. This may ultimately lead to ischemia and hypoxia.
Complex regional pain syndrome, skeletal muscle compartment syndrome and other painful conditions may develop and/or limb amputation may occur if urgent and effective treatment to prevent hypoxia and ischemia following crush injury is not provided.
Thus, time is of the essence that appropriate treatments are undertaken to reduce localised inflammation and swelling.
Importantly, hyperbaric oxygen may be used as an adjunct treatment to reverse ischemic and hypoxic conditions in crush injuries.
Note: This section is written for scientifically-minded readers, and may be skipped altogether by others who may not be so inclined.
Animal research shows that HBOT blocks the production of tumor necrosis factor (TNF)-α in rats with chronic constriction injury. Reduced TNF-α levels may lead to decreased nerve pain (Li et al, 2011). Local overproduction of TNF-α, on the other hand, may play a role in promoting CRPS (Walker and Drummond, 2011).
Many chronic pain conditions include an inflammatory component that may lead to tissue hypoxia, ischemia and microvascular deficits (i.e. inflammatory hypoxia). Re-oxygenation of injured or diseased tissues is a prerequisite before regeneration can occur.Therapies such as HBOT may promote tissue re-oxygenation, reversal of inflammatory hypoxia and regeneration (Perdrizet, 2017) that may lead to pain relief.
Ten divers (9 males, 1 female) underwent pressures of 1, 2, 3 and 4 ATA in a supine position for 10 minutes per pressure in a hyperbaric chamber. The Spanish study found that as the pressure increased, heart rate (HR) decreased and heart rate variability (HRV) moved into the high frequency range, especially after 2, 3 and 4 ATA. Pressure-evoked increased HRV is indicative of enhanced parasympathetic (vagal) activity (Barbosa et al, 2010). Increased parasympathetic activity including enhanced vagal tone may lead to reduced pain, decreased inflammation and other medical benefits (Walker and Drummond, 2011).
Researchers recently suggested that nerve cells may actually communicate via mechanical pulses instead of electric pulses (Fox, 2018). If true, is it possible that increased atmospheric pressures via HBOT inside a pressure chamber may lead to increased mechanical pulses? If so, could this result in increased cutaneous sympathetic vasoconstrictor activity? If yes, could this induce tissue re-oxygenation and reversal of inflammatory hypoxia in some pain patients including CRPS patients? Research is warranted.
SUMMARY
Hyperbaric oxygen therapy may offer pain relief for some pain patients.
Please ensure that HBOT is done under medical supervision only and by trained personnel. Refer to References for complications that may arise from HBOT.
Sabina Walker
Blogger, Pain Matters (in WordPress)
PS Please feel free to share your personal experience with HBOT via this blog.
REFERENCES
TEXTBOOK
(1) Undersea and Hyperbaric Medical Society (UHMS). Hyperbaric Oxygen Therapy Indications, Thirteenth Edition (April 2014).
(2A) Katznelson. Successful Treatment of Lower Limb Complex Regional Pain Syndrome following Three Weeks of Hyperbaric Oxygen Therapy. Pain Research and Management (2016); Volume 2016, Article ID 3458371, 4 pages.
(2C) Kiralp et al. Effectiveness of hyperbaric oxygen therapy in the treatment of complex regional pain syndrome. J Int Med Res. (May-June 2004); 32(3): 258-62.
(2) Perdrizet. Chronic Diseases as Barriers to Oxygen Delivery: A Unifying Hypothesis of Tissue Reoxygenation Therapy. Adv Exp Med Biol. (2017); 977: 15-20.
(3) Barbosa et al. Effect of hyperbaric pressure during scuba diving on autonomic modulation of the cardiac response: application of the continuous wavelet transform to the analysis of heart rate variability. Mil Med. (Jan 2010); 175(1): 61-4.
(4) Sabina Walker, Peter D. Drummond; Implications of a Local Overproduction of Tumor Necrosis Factor-α in Complex Regional Pain Syndrome [Review Paper, 24 pages]; Pain Medicine (Dec 2011), 12 (12), 1784–1807.
A couple of years ago, I sat next to an elderly lady in her 80’s during a flight between Los Angeles and San Francisco. The woman told me that she used to have severe pain in both knees.
Then one day, the woman heard about serrapeptase for chronic pain. After taking serrapeptase on a daily basis, she no longer has knee pain. Because there were no side effects, she intended to take serrapeptase for the rest of her life. Since no prescription was required, serrapeptase can be purchased online or in specialty health shops.
Struggling to keep up with her as I said goodbye (and I jog daily!), I took notice of her fast stride as she quickly walked out of the airport terminal. She said she was in a big hurry as her friends were waiting for her at the cruise ship terminal!
After listening to her amazing story about serrapeptase’s beneficial effects on her knee pain and after watching her race out of the airport terminal, I decided to dedicate a blog post to her favourite pain medicine, serrapeptase.
BACKGROUND
So what exactly is serrapeptase?
The saliva of silkworms contains an enzyme called serrapeptase. This enzyme is secreted by friendly bacteria called Serratia sp. E-15 that live in the intestines of silkworm.
The serrapeptase enzyme is sometimes called the silkworm-butterfly enzyme, silkworm enzyme or (my personal favourite) butterfly enzyme. Scientifically, it may also be called serrapeptidase, serratiopeptidase, serratiapeptase, serralysin and serratia E-15 protease (the latter named after the bacteria from which it was first isolated).
Serrapeptase’s principal function is to break down and dissolve dead cocoon tissue during the silkworm’s transformation into a butterfly. Serrapeptase plays a significant role in dissolving the non-living (‘avital’) proteins that make up the strong silk threads of the dead cocoon.
Serrapeptase’s strong protein-dissolving capabilities enables the silkworm-turned-butterfly to finally break loose from its old cocoon tissue (instead of remaining stuck in there forever).
ANTI-INFLAMMATORY AND ANTI-EDEMIC EFFECTS OF SERRAPEPTASE
Researchers found that when taken orally on an empty stomach, serrapeptase is absorbed by the small intestine where it enters the bloodstream.
Serrapeptase facilitates the breakdown of cellular debris and dead proteins within the bodily fluid and certain biofilms (via proteolysis). It can dissolve proteins including fibrin in blood clots, arterial plaques and scar tissue. Excess scar tissue near injury sites can often lead to pain, limited range of motion and nerve blockages.
NB Research is warranted whether serrapeptase’s deleterious effects on fibrin could alleviate certain painful conditions including endometriosis.
Serrapeptase reduces swelling, inflammation and pain as well as enhances tissue repair and regeneration.
The enzyme promotes the drainage of excess fluid including mucous via its anti-edemic effects hence improving sinusitis and other mucousal conditions. It can reduce or eliminate cysts (e.g. breast cysts, ovarian cysts).
Serrapeptase does not target proteins in living tissue. As such, it does not pose any risk to healthy tissue or cells.
There are no known side effects pertaining to serrapeptase intake (unlike non-steroidal anti-inflammatories that often causes gut wall damage and other adverse effects).
More details on serrapeptase are provided in the following video:
PAIN PATIENT STORIES
(1) Amba Carrington
Amba Carrington (28) suffered severe stabbing pain in her lower back following a motorbike accident 6 years earlier. One day, Amba’s doctor suggested that Amba try serrapeptase (SP-Zyme). Six (6) weeks later, Amba was completely pain-free. Quoting Amba:
‘For years, I took strong prescription painkillers and had injections to relax my back muscles, but nothing cut out the pain effectively … I was unable to drive, walk long distances or exercise. The pain was crippling and wiped me of energy. It was horrible – I felt like an old woman.’
‘… after a few days, I felt my back pain easing off, and after ten days, it had gone completely. I can barely believe it, but today I am free from chronic pain.’
A patient named Jann suffered ongoing pain and stiffness due to rheumatic arthritis (RA) diagnosed 2 years earlier.
Jann started taking Serraenzyme (250,000IU) 8 months ago. His dose during the first 2 months was 6×250,00IU daily. This was decreased to 4×250,000IU/day during the next 2 months, and further reduced to 2×250,000IU/day for the last 4 months.
Quoting Jann,
‘The change in me is nothing short of miraculous. Apart from a bit or morning stiffness, I have no pain what so ever. A fungal infection in both my big toenails, which [until now had] responded to nothing … , disappeared within the first month. My nails, which spent 80 years splitting, peeling and breaking, are now like steel tallons – well almost! I actually have to file them down every day.
I now have 5 friends on Serraenzyme and I’ll be on it for the rest of my life.’
Chronic Pain Relief – Serrapeptase Testimonial Video (3-minutes)
This patient’s back pain as well as neck and shoulders pain is now ‘dramatically reduced … feels better’ (quoting patient) after only 1 week of serrapeptase (refer to 1:14 minutes on).
Benefits of Serrapeptase – 3 Amazing Serrapeptase Testimonial Videos (3-minutes)
SUMMARY
Given its anti-inflammatory, anti-edemic, proteolytic and fibrinolytic effects, serrapeptase is increasingly being considered as a safer alternative than non-steroidal anti-inflammatories by patients suffering from pain and inflammation.
Serrapeptase can reduce swelling and fluid (edema) at wound and infection sites as well as decrease mucus and other secretions at mucosal membranes (e.g., ear, nose, throat).
Athletes often take serrapeptase as a supplement to treat injuries and prevent swelling after surgery.
Subject to medical supervision, pain patients including patients with arthritis and localised edema are encouraged to try serrapeptase for pain relief (given very little or nil side effects).
Could the silkworm become one of humankind’s new best friends??
Sabina Walker
Blogger, Pain Matters (in WordPress)
PS Please feel free to share your personal experience with serrapeptase via this blog.
REFERENCES
SCIENCE PAPERS
(1) Tiwari. The role of serratiopeptidase in the resolution of inflammation. Asian Journal of Pharmaceutical Sciences (May 2017); 12(3): 209-215.
(2) Al-Khateeb and Nusair. Effect of the proteolytic enzyme serrapeptase on swelling, pain and trismus after surgical extraction of mandibular third molars. Int J Oral Maxillofac Surg. (March 2008); 37(3): 264-8.
(3) Sannino et al. Combination therapy including serratiopeptidase improves outcomes of mechanical-antibiotic treatment of periimplantitis. Int J Immunopathol Pharmacol (2013); 26(3): 825-831.
(4) Mecikoglu et al. The effect of proteolytic enzyme serratiopeptidase in the treatment of experimental implant-related infection. J Bone Joint Surg Am (2006); 88(6): 1208-1214.
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