Pain in your back, joints, and muscles – musculoskeletal pain – is caused by a range of lifestyle and genetic factors. Treatments for that pain must be personalized for every patient, based on your level of inflammation, how you experience pain, other health conditions, and current medications.
Creating personalized treatment plans can be simultaneously the most rewarding and challenging aspect of my physical medicine and rehabilitation (PM&R) practice. Several natural, medicinal, and procedural pain treatments are available, and patients respond differently to all of them.
In the U.S., musculoskeletal pain management is beginning to incorporate more Eastern and Ayurvedic medicine, which focus on natural mind and body treatments using exercise, foods, or herbs, as a complement to Western medicine, which treats physical symptoms with medication or surgery.
While anti-inflammatory drugs such as ibuprofen or naproxen can be effective for acute pain, long-term use can cause harmful side effects, including kidney and gastrointestinal damage. Some natural supplements can be highly effective for certain conditions, and some have fewer side effects. However, not all supplements are effective or safe for everyone.
Natural medicinal approaches, commonly referred to as complementary medicine, continue to grow in popularity. Americans spend more than $30 billion each year on complementary health products and practices. Unfortunately, the U.S. Food and Drug Administration (FDA) does not regulate all supplements, so it can be difficult to know exactly what you’re buying and whether the product might benefit you.
In PM&R, we recognize that you know your body, and we want to help you find a treatment plan that relieves your pain without increasing other health risks. Following are seven natural supplements that our patients have said help them manage inflammatory musculoskeletal pain.
Safety (and efficacy) first
Before trying a complementary treatment, talk with your doctor to ensure it won’t interfere with your other medications or health conditions.
The next step is to look for evidence of efficacy and safety. Less research exists for natural substances than for chemicals or pharmaceuticals, but it’s growing. This is largely because of studies and trials funded and conducted by the National Center for Complementary and Integrative Health (NCCIH).
Check the NCCIH website to learn more about the success of certain complementary approaches. It also offers a mobile app that provides unbiased, research-based information about the effectiveness of more than 50 herbal products. As a general rule, purchase a name-brand capsule tablet, which will lessen the chances of it containing lead or mercury.
Keep in mind that what works for one person might not work for you. While some supplements can complement treatments such as surgery or acupuncture, they should not be combined with each other or anti-inflammatory drugs. Otherwise, we can’t tell which treatment, if any, is reducing your pain.
Natural supplements to consider
A plant from the ginger family, turmeric is often used in South Asian cuisine, such as curry. It contains curcumin, the key ingredient that can help decrease inflammation. To be effective as either a supplement or food – and not simply metabolized and excreted – turmeric should be absorbed with fatty oils, such as avocado or olive oil, and black pepper, which most supplements contain.
I recommend making turmeric a part of your daily diet for three to six months to gauge any benefits. Turmeric supplements can be expensive, and inflammation can be treated in other ways. So, if your pain hasn’t decreased after this amount of time, we can try something else
2. Cherry juice extract
Anthocyanin supplies both the red coloring and anti-inflammatory benefits in cherries and other red fruits and vegetables. Most of my patients who say cherry juice helps relieve their pain drink about one glass a day, but you can eat a handful of cherries daily or take supplements that contain the pure juice extract – cherries are high in anthocyanin. However, because of its high sugar content, I do not recommend cherry juice for diabetic patients.
3. Omega-3 fatty acids (fish oil)
Many studies have evaluated the effectiveness and safety of omega-3 supplements for several inflammatory conditions, including rheumatoid arthritis. For example, a small study showed that taking omega-3 fatty acids, which occur mostly in fish oils, can significantly decrease joint swelling and tenderness in patients with rheumatoid arthritis.
Most patients I see have taken these supplements before without good results. For better absorption I recommend incorporating omega-3s into your diet through foods such as tuna, salmon, sardines, tofu, walnuts, and flaxseeds.
The skin elasticity benefits of collagen, a protein made up of amino acids, have long been touted. Less research exists for its anti-inflammatory benefits: Some studies suggest it can improve joint pain, while others suggest it can decrease muscle soreness but not inflammation.
Collagen is widely available as a capsule as well as a powder or liquid you can mix into food or drinks. Or you can increase your body’s natural collagen level by eating more foods containing protein and vitamin C, such as chicken, fish, eggs, and citrus fruits.
After discussing collagen with several patients and reviewing existing research, I decided to take it myself, in powder form, for about six months and noticed improvement in a hamstring injury. This doesn’t prove anything, and more conclusive research is needed. However, collagen is worth looking into if you’re interested.
5. Chondroitin and glucosamine
Chondroitin and glucosamine are two natural substances within your cartilage, which tends to decrease around your joints as you age. Supplements containing these components have been found to reduce pain caused by cartilage loss, with chondroitin improving function and glucosamine improving stiffness. Talk to your doctor to determine which of these two supplements is best for you.
6. Boswellia (Indian frankincense)
Several studies have shown that the extract from the bark of the Boswellia tree, which is native to India, can improve pain and physical dysfunction caused by chronic diseases such as osteoarthritis or inflammatory bowel disease. Boswellic acid might prevent musculoskeletal pain by interfering with cell-level functions that cause both pain and inflammation.
7. Cannabidiol (CBD) oil
More patients are asking about the benefits of CBD oil, and the research is just beginning. Studies show that CBD can help activate the endocannabinoid system within your central nervous system, which helps your body regulate critical functions such as pain, mood, temperature, memory, and appetite.
However, the FDA has not approved any over-the-counter CBD products for pain, though some have been marketed as such. I strongly recommend paying close attention to ongoing research and safety reports.
Don’t count out creams
I tell all my patients to approach their pain with a toolbox of options, depending on the type and location. Sometimes, alternating ice and heat is effective. For other ailments, medication is best. Topical pain-relief creams can be another great option.
For example, capsaicin cream, made from hot chili peppers, can significantly reduce joint pain. It decreases levels of substance P in your body, a natural chemical secreted by nerves and inflammatory cells that sends pain signals to your brain. The benefits of capsaicin cream have been studied extensively, showing a 50% reduction in pain after regular use.
Because creams are not systemically absorbed like oral supplements, only a small amount of the substance enters your body. This is especially beneficial to patients who experience side effects from certain supplements. Consistent use is key to reducing pain with creams over the long term; they’re not an immediate fix.
‘Motion is lotion’
Physical activity is one of the best “tools” in your toolbox. If you’re not moving regularly, your muscle tissues stiffen and harden, so exercise is always recommended for inflammation. I often say that “motion is lotion” because moving keeps your musculoskeletal system lubricated by bringing blood to the areas of the body that haven’t been getting enough.
The U.S. Preventive Services Task Force recommends that adults get at least 150 minutes of moderate aerobic physical activity per week – in addition to at least two strengthening activities. This can be difficult for many people, but if yoga on a mat is too challenging, for example, you can do chair yoga.
One of my favorite exercises to recommend is Tai Chi, which incorporates slow, steady movements and meditation. Qigong is a similar practice that focuses on the mind and body to help improve breathing, posture, stress, and strength. If you have limited motion, discuss any new exercise program with your primary care doctor before starting to prevent injury.
Related reading: Got a bad back? Exercise could be the key to relieving pain
Learning and healing together
I love continually learning about natural ways to heal the body and mind. Patients from many different cultures and nationalities teach me their perspectives on herbs or remedies they grew up with, which I research further to determine whether the treatments are safe for other patients or even myself.
The NCCIH recently funded three new research networks that will focus on the science of how emotional well-being correlates to physical health, so we can expect many more years of discovering how complementary and modern medicine can improve the mind-body connection.
If you are curious about a complementary treatment, talk with your doctor. We can help you safely and effectively incorporate new options into your care plan.