“As long as you feel pain, you’re still alive.”
As a doctor, I’ve listened to many patients tell me that pain is a normal part of life. Some may even call it essential. Even if you disagree with that sentiment, the fact is that many people suffer from chronic pain for various reasons. But while we cannot stop all sources of chronic pain, we can change the way it is managed.
Painkillers like ibuprofen, acetaminophen, and in increasing numbers, opioids, have become our go-to solutions for pain management. Opioids, in particular, are often hailed as the holy grail in pain relief and management. But they’ve come with significant costs — addiction, abuse, overdose, and death — and without the promised benefits. One 2018 study found that opioids were not more effective at treating moderate to severe chronic pain than non-opioids.1 Furthermore, they may raise risks for serious infections.2
Non-opioid treatments like NSAIDs also have adverse reactions. So what can you do? Thankfully, there are many alternatives to prescription painkillers, many of which are much safer and gentler on your body.
Natural Pain Relievers
Many herbs, essential oils, and spices have anti-inflammatory properties that can provide pain relief. We’ll discuss a few options here.
Turmeric for Pain Relief
Turmeric (Curcuma longa) is a commonly used spice in many ethnic cuisines, especially in Southeast Asian countries like India and Pakistan. It gives curry its characteristic yellow color, which is produced by a family of bioactive compounds in turmeric called curcuminoids.
The most well-known curcuminoid is curcumin, which research has shown to have powerful anti-inflammatory and antioxidant properties. In fact, some studies have indicated that curcumin may be a more potent than some anti-inflammatory drugs like ibuprofen and aspirin.3 The greatest advantage of curcumin is its high tolerability.4 Some clinical studies have shown that high doses (8–12 g) of curcumin cause some side effects like nausea and diarrhea, but it is not necessary to consume such high doses to experience the benefits of curcumin. Results from one 2016 study indicated that osteoarthritis symptoms improved with a dosage of less than 2 g/day of curcumin.5
In addition to pain relief, turmeric has received much attention from the scientific and medical community for its potential as a therapeutic agent for:
- Wound healing
- Alzheimer’s disease
- Parkinson’s disease
- Cardiovascular disease
- Pulmonary disease
- Various types of cancer
- Irritable bowel syndrome
Despite having such huge potential, curcumin has poor bioavailability, which refers to the proportion of an unchanged substance that is absorbed into the bloodstream, ready for use by the body. Curcumin degrades into various metabolites within 30 minutes at physiological pH. However, some research studies have shown that these metabolites — which are found in high concentrations in circulation after curcumin consumption — are responsible for the anti-inflammatory and antioxidant activities associated with curcumin.67
Some people recommend taking curcumin with piperine, a compound found in black pepper, to increase bioavailability. But extensive studies have shown that activate curcumin is absorbed earlier and is retained longer than the curcumin-piperine combination.8 For my patients, I recommend Activated Curcumin, which features BCM-95® CG, a formulation that provides optimal bioavailability of curcumin and other curcuminoids.
Boswellia for Pain Relief
Boswellia is an extract of Boswellia serrata, a moderate to large sized branching tree that grows in mountainous regions of India, Northern Africa, and the Middle East. It is often referred to as Indian frankincense, and is one of the most valued Ayurvedic herbs. In traditional Ayurvedic and Unani texts, Boswellia is named as an effective remedy for a long list of conditions from diarrhea to sore throat to ringworm.9 In Western medicine, this gummy resin is known for its use as an:
- Antihyperlipidemic (reduces lipid levels in blood)
- Antiatheroscloertic (prevents or counteracts the buildup of fatty substances in and on artery walls)
- Analgesic (relieves pain)
- Hepatoprotective (protects the liver)
Lab and animal studies have shown that boswellia blocks the synthesis of 5-lipoxygenase (5-LO), an enzyme that generates inflammatory compounds called leukotrienes. Furthermore, while NSAIDs can accelerate arthritic conditions by disrupting glycosaminoglycan synthesis in tissues, boswellic acids reduce glycosaminoglycan degradation.9
A clinical trial conducted in 2008 found that boswellia significantly improved arthritic pain and joint function in as little as seven days.10 Other studies have shown similar results, with some suggesting that the anti-inflammatory effect of boswellia is comparable to that of ibuprofen.1112
In general, boswellia can be taken as an oral supplement. Because products vary greatly, it has been difficult to come to a consensus on the optimal dose for safety and efficacy. The Arthritis Foundation recommends 300 mg to 400 mg three times a day of products that contain 60% boswellic acids. I recommend Boswellia by Pure Encapsulations for my patients.
White Willow Bark for Pain Relief
The use of willow bark extract dates back to 400 BC13 when people chewed on the bark as an anti-inflammatory, antipyretic, and a pain reliever. It continues to be used today for the treatment of various conditions, such as:
- Low back pain
- Inflammation (ex: bursitis, tendinitis)
Willow bark contains salicin which converts to salicylic acid in the stomach. Salicylic acid is a chemical similar to aspirin or acetylsalicylic acid. For this reason, many refer to willow bark as the “original aspirin.” However, willow species only contain a small amount of salicylic acid, and the dose is insufficient to produce pain relief. Fortunately, there are other components of the willow bark, such as flavonoids and polyphenols, that also contribute to the antioxidant, analgesic, and anti-inflammatory effects. This multi-component active principle allows willow bark to have a much broader mechanism of action and lower risk of adverse effects than aspirin.
Few research studies have been done on the safety and efficacy of white willow bark. Of those available, results suggest that white willow bark (standardized to 120 mg or 240 mg salicin) produce at least short-term pain relief.14
One study used a supplement formulated with a combination of white willow bark extract, ginger root concentrate, glucosamine sulfate, methylsulfonylmethane (MSM), boswellia serrata extract, turmeric root extract, cayenne, and hyaluronic acid. In this randomized, double-blind study, this combination significantly reduced joint pain severity of middle-aged and older adults.15
There are several precautions to be aware of before you consume white willow bark supplements. Because salicin is similar to aspirin, it is possible for people who are allergic to aspirin to also be sensitive to salicin. White willow bark can also interact with other medications like blood thinners and beta-blockers. If you take any of these medications, consult your doctor before taking willow bark. Children, adolescents under the age of 16, and pregnant and breastfeeding women are also discouraged from taking willow bark supplements.
For a high-quality white willow bark supplement, I recommend White Willow Forte from Nutra Biogenesis. This unique formula combines the potent powers of white willow bark, boswellia, turmeric, ginger, enzymes, and other nutritional factors to reduce inflammation and provide antioxidant support.
Other Herbs for Pain Relief
Another supplement I recommend is ReJoint™, a science-backed herbal formula that works on 9 different pain pathways at once, thereby stopping occasional pain before it even starts. ReJoint™ is a combination of 5 carefully-selected herbs:
- Boswellia serrata extract
- Horsetail leaf powder
- Nettle leaf powder
- Odorless garlic bulb powder
- Celery seed powder
In clinical trials, ReJoint™ was found to deliver an average of 66.67% improvement in pain with little to no side effects.
Natural Topical Pain Relievers
If you’re reluctant to pop another pill, you can consider a topical pain reliever like CRYODERM. The ingredients in CRYODERM include:
- Menthol (derived from peppermint oil)
- Arnica (a homeopathic remedy for pain)
- Boswellia serrata
- Eucalyptus oil
- Ilex paraguariensis leaf extract (an herb used in southern Latin American countries for its analgesic properties)16
The ingredients in CRYODERM act to restore tissue homeostasis. That is, when tissues are inflamed and blood vessels are over-dilated, CRYODERM makes them contract, reducing swelling, redness, pain, and discomfort. On the other hand, when your muscles are in spasm, your blood vessels are constricted, which reduces the blood flow to the affected tissue. In this case, CRYODERM relaxes and dilates the blood vessels, improving microcirculation and tissue oxygen supply to promote healing.17
Special Proresolving Mediators for Pain Relief
Inflammation is a host response to an infection or tissue damage and has the purpose of restoring homeostasis to the affected tissue. Inadequate or insufficient resolution of inflammation can lead to:
- Chronic inflammation
- Severe and irreversible tissue damage
- Dysregulation of tissue healing and fibrosis
- Development of autoimmunity and other disease states
Resolution of acute inflammation was once thought of as a passive process — once the stimulus was removed, proinflammatory proteins like cytokines and other signaling molecules would simply decline over time. We now know that it is not only highly complex, but that it is an active process that requires the synthesis of specialized pro-resolving mediators (SPMs). This collective term refers to a large class of signaling molecules derived from polyunsaturated fatty acids like eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). SPMs have important roles in resolving inflammation, and unlike NSAIDs that compromise the immune response, SPMs allow the inflammation to carry out naturally. Once the immune response has served its purpose, SPMs help promote the return to homeostasis by shutting down the immune response, inhibiting additional inflammation, and aiding tissue remodeling.1819 Once SPMs are done with their jobs, the body naturally breaks them down.
The production of SPMs in your body is highly dependent on a healthy lifestyle and genetics. There are many factors that limit SPM production, a few of which include:
- Exposure to environmental toxins
- Lack of exercise or overexertion
- High intake of processed carbohydrates
- High intake of low-quality dietary fats
Simply changing your lifestyle does not do enough to increase the level of SPMs, and neither does taking fish oil supplements. A better, more direct way is to take SPM supplements like SPM Active, which is made from fractionated fish oils to deliver a concentrated SPM product. Studies have found that SPM supplementation reduced blood markers of inflammation in as little as six weeks and had no obvious side effects. With their active roles in inflammation resolution, I believe that SPM supplements can make a big difference for patients who continue to experience pain and discomfort during the slow process of healing.
Systemic Enzyme Therapy for Pain
Tissue repair is a protective response after injury. It is a dynamic process, involving the recruitment of various inflammatory cells, proliferation of cells, scar deposition, and tissue regeneration. In many cases, proper tissue repair occurs when the injury is transient and the inflammation is resolved quickly.
However, chronic inflammation due to severe, repetitive, or prolonged injury can lead to pain and fibrosis, an immune response characterized by the development, hardening, and/or scarring of fibrous connective tissue. This simply means that the normal tissue is replaced by permanent scar tissue. In some cases such as liver cirrhosis and cardiovascular fibrosis, extensive tissue remodeling and fibrosis can lead to organ failure and death.
Therefore, the current standard of care for inflammation is to treat it using anti-inflammatory drugs like NSAIDs. There are several problems with this approach though, one of which is the fact that while preventing inflammation may protect tissues from further injury,20 doing so also hinders recovery.2122 This dilemma suggests that the current treatment options may not be effective or safe.
There’s a need for a therapeutic option that allows the tissue repair processes to occur naturally. And that’s where systemic enzyme therapy comes in.
Systemic enzyme therapy involves the use of primarily proteolytic enzymes (also called protease, proteinase, or peptidase) along with the flavonoid rutin. Enzymes are administered orally and are mainly absorbed in the small intestine. Although their mechanism of action is not yet fully understood, it is believed that they act in an anti-inflammatory manner upon absorption into the bloodstream. Specifically, it is known that they act in two main ways:
- As their name suggests, they break down proteins into smaller units called amino acids. This activity not only helps in digestion, but also acts as markers of cell destruction and inflammation.23
- The enzymes irreversibly bind to antiproteinases such as ɑ-1-antitrypsin and ɑ-2-macroglobulin. This allows the levels of anti-proteinases to increase, which inactivates other proteinases that are thought to play a role in uncontrolled protein degradation as well as tumor development and metastasis.24
When the enzymes bind ɑ-2-macroglobulins, they form ɑ-2-macroglobulin-proteinase complexes. These complexes can bind to cytokines, some of which are known for promoting immunosuppression and inflammation.
These two mechanisms of action suggest that systemic enzymes support immune function and promote tissue healing and muscle recovery. Fortunately, these enzymes are present naturally in certain foods. Some examples of such foods are papaya and pineapples, which contain the enzymes papain and bromelain, respectively.
However, some people may benefit from taking systemic enzyme supplements. And with over 200 clinical studies and 100 million users25, Wobenzym N may be one of the world’s most well-researched joint-health supplements. It has been the subject of six human clinical studies with over 2,400 participants, and has a long history of safety and efficacy. Its unique blend of proteolytic enzymes have been used over several decades as an alternative treatment for other anti-inflammatory medications.
Safe, Effective Pain Management is Possible
A good pain management strategy involves a multi-pronged approach that often requires patients to make a commitment to lifestyle changes. Instead of reaching for potentially dangerous and addictive drugs that simply mask pain, employing a holistic mindset to pain management can help you enjoy a pain-free life.
Of course, we haven’t covered all types of natural pain management strategies in this blog post. While we will certainly discuss other methods in the future, I want to emphasize the importance of thinking long-term for your health. While opioids may be appropriate in certain situations, they are never permanent solutions, and the current opioid crisis in this country is proof of that.
In my practice, I have seen success with all of the products mentioned in this article. Other products I recommend for my patients can be found here. If you suffer from chronic pain, I also highly recommend consulting a qualified functional medicine physician to help you.
Now it’s time to hear from you. Do you suffer from chronic pain? What are your strategies for managing pain? Please share your story in the comments below!
* These statements have not been evaluated by the Food and Drug Administration. The product mentioned in this article are not intended to diagnose, treat, cure, or prevent any disease. The information in this article is not intended to replace any recommendations or relationship with your physician. Please review references sited at end of article for scientific support of any claims made.
I read with interest an older post about low dose naltrexone for pain. However, the idea that opiates for chronic pain are not more effective than NSAIDs is false. That idea came mostly from a survey of people in an emergency room setting. That is not at all the setting faced by most chronic pain patients. In situations like that people were offered one treatment or the other knowing what it was. Placebos should have been used and a much larger sample size used.
As a chronic pain patient with avascular necrosis, lupus, scoliosis, and vasculitis, I think it’s downright dangerous to stop opiate treatment for people like me, snd it’s already led to numerous suicides–all to prevent deaths from the “opiate crisis!” Opiates are (as you say) the “holy grail” of pain control because they work. Pain patients have been denied their needed medication –after years of responsible use– all because addicts will always want to get high (and because cheap fentanyl has arrived which kills).
I have tried most of the things you advocate, but to no avail. If low dose naltrexone works, I’d be happy–but don’t force people onto it if it doesn’t. There’s a reason opiates have been used for over 5 thousand years.
No one said that opioids are not effective for pain. They have an appropriate place in pain management but I believe its important to give people other options. I have no problem with appropriate use of opioid pain medications.😊
Thoughtful blog. Yes, I do have long term chronic nerve pain. I do follow as you suggest “a good pain management strategy involving a multi-pronged approach” …. there is a time & place for all types of modalities & strategies, The journey is challenging & few practitioners can truly appreciate the journey, rightly so, you must walk the shoes for that… What I have found, when a person takes full responsibility for their chronic pain, well being & quality of life, the many choices available to manage chronic pain both medical, holistic & lifestyle are numerous & there are so many amazing practitioners/resources available to assist us as we choice. When we hold no treatment in judgement, but truly engage a desire to live a full life with chronic pain, we often naturally migrate to a “mix of treatments” that allow us a full life.
lovely comment, Rhonda! I couldn’t agree with you more…
I too live with chronic pain. Mine appears to be from abdominal scar tissue from a number of previous surgeries. I also have IBS I have addressed the IBS pretty well with a functional medicine nurse practitioner through duet and supplements but have not found an answer to relieving the pain at night from the scar tissue. It seems to be positional. I have had to be an “inspector general” of my own health. I have worked with Craniosacral therapy, myofascisal release therapy, self massage and essential oils. It is stubborn. Any additional ideas would be welcome. This has gone on for over five years following a mastectomy.
Yes, this is a difficult situation 😊 I have found physical therapists trained in scar adhesion and visceral work may be helpful to relieve chronic pain. Sounds like you are doing all the right things
With respect, there really isn’t an alternative to opioids and some of these suggestions makes me think you’re not really aware of what a lot of us are dealing with. A lot of us chronic pain patients who experience high levels of pain on a regular basis would be dead without our medication – I was strongly considering suicide before I found a doctor who was willing to properly treat my pain. Opioids are certainly risky medication, but you can manage that risk by taking them under the supervision of an attentive doctor.
The current response to the “opioid crisis” is dangerous and is not only pushing many pain to suicide, but also pushing them to illicit drugs. I don’t need to point out how much more dangerous taking heroin or illegally produced fentanyl is than taking prescription opioids with the help of a doctor, not to mention these people are being made to put themselves at risk of being incarcerated.
Feeding into this rhetoric is harmful and irresponsible – please consider what damage you’re doing to vulnerable people when you post these kinds of things.
There is no judgement for those who need opioids. However, I am providing alternatives to those who would like other options. Although you may be in pain and legitimately need opioids, there are thousands of others who become addicted due to poor physician discretion= and no good alternatives. Providing alternatives does not mean that I feel opiods are inappropriate in all situations.
Hi. I have had severe scoliosis for most of my 50 years of life. I can’t take pain meds because they make me very sick. I have taken Aleve twice a day for most of my life because that’s what the doctors always say will help most. I loved your article and I’m going to look into stating some of these supplements. I am very low income and do the best that I can to care for my two daughters that struggle with health issues as well. POTS, mast cell activation, hypothyroidism, too many to list. Thank you for the great article!
Great article! Thank you! When I herniated a disc in my back I did a little research and I found an article that suggested vitamin D could decrease pain and on my experience it did seem helpful (and likely helpful in healing too).
I’m curious what you think about full spectrum CBD for acute or chronic pain?
yes, excellent idea!
People with chronic severe pain who are considering the use of opioids have likely already realized that NSAIDS and topicals don’t touch their pain. I don’t think that nutritional supplements are able to relieve that level of pain either. I have had severe acute pain and cannot imagine what it would be like to have that level of pain every day. Identifying the cause(s) of pain is the key. I use a low-histamine diet, MSM and LDN, and topicals like arnica, but severe pain has required steroids and prolotherapy. I have an amazing osteopath that thinks outside the box. Even he wouldn’t tell me to use arnica when I am in so much pain that breathing hurts.
I have great compassion for those in chronic pain and I do believe opioids have an important place in treatment…I just want people to know there are other options
Dr Jill, thanks for your many great tips. We benefit from your excellent help through your posts even if we cannot get your help in person. My pain is no where near that of the others who have left messages here, but it is hurtful and depressing. If one is lucky they find a knowledgeable integrative or Functional Medicine person to help. Otherwise, it is a journey of spending a lot of money going to various specialists to find out if they are selling “snake oil” or providing an actual solution. Please know your help is appreciated. Thank you
thank you for your kind words, Tom!
I have had surprisingly good results with Cat’s Claw for medium inflammation. It could be because I have had ongoing Lyme infection for many years, but it has also helped my husband who supposedly doesn’t have Lyme. Also, Pycnogenol, pine bark extract has helped. I rotate some of the ones you have mentioned as well as these with the thought that I might build tolerance to them. Dr Jill can a person build tolerance to any of the aforementioned?
Thank you for the great tip, Jessica! I do like cat’s claw for borrelia and viral infections like EBV but it also has an anti-inflammatory effect
I am interested in the answer to Jessica Hull’s question. Can you build a tolerance to Cat’s Claw and/or Pycnogenol?
In general, I do not see tolerance to these develop
I have neuropathic pain from shingles in my right flank for over 10 years. Will these be helpful to try?
Neuropathic pain is difficult to treat with herbal supplements but they may help. I suggest trying the SPM Active 2 caps 3X daily