Considering the unpleasant and sometimes harmful side-effects of commonly prescribed pharmaceutical drugs, healthcare professionals are constantly on the lookout for natural products that may deliver similar benefits, but without the adverse consequences. With the FDA having strengthened its warnings of increased risk for heart attack and stroke due to NSAID use—not to mention the already strong warnings about the effects of NSAIDs on the gastrointestinal system—finding effective alternatives to these medications may help millions of people who experience chronic pain and stiffness.

One such natural substance is boswellia (Boswellia serrata), an herb that has been employed in Ayurvedic medicine for a variety of ailments. (Boswellia also goes by its more common name, frankincense.) Boswellia is particularly recognized for its efficacy in ameliorating the pain and stiffness associated with inflammatory conditions, such as osteo- and rheumatoid arthritis. Moreover, rather than potentially damaging the GI tract, evidence suggests boswellia improves inflammatory conditions of the gastrointestinal tract, such as Crohn’s disease and ulcerative colitis.        

It had long been believed that boswellia’s efficacy was due to inhibition of 5-lipoxygenase (LOX), an inflammatory prostaglandin. That may, indeed, be part of the mechanism, but research indicates the mechanisms of action go beyond LOX inhibition. Boswellic acids inhibit activation of NF-ĸB and downregulate TNF-alpha, as well as decrease synthesis of several other pro-inflammatory cytokines, and they may be particularly helpful for autoimmune conditions.

A randomized, double-blind, placebo-controlled crossover study showed boswellia to be more effective than placebo at reducing knee pain and swelling, and increasing knee flexion and walking distance in patients with osteoarthritis (OA) of the knee. Interestingly, the study authors noted that there were no observable radiological changes, but being that the subjects nevertheless experienced noticeable symptom improvement, boswellia is well worth considering for patients with OA.

The use of boswellia for increasing pain threshold and tolerance has been demonstrated in healthy subjects as well. This may not automatically translate to patients with longstanding conditions involving pain and inflammation, but the findings are still noteworthy. A double-blind, placebo-controlled crossover study involving a single oral dose of boswellia showed that, compared to placebo, boswellia significantly increased the pain threshold, pain tolerance force and time. Testing was administered at 1, 2 and 3 hours after administration of the supplement, and the pain threshold was increased above baseline at each interval. Obviously, in this study, the effects were acute, but longer-term regular supplementation—perhaps as a kind of “maintenance strategy”—could potentially be beneficial for conditions involving chronic pain. Supplementation in this manner has shown boswellia—either on its own or in combination formulas—to have similar analgesic efficacy to the NSAID celecoxib.

Another promising area for boswellia is in ameliorating the symptoms of colitis and other inflammatory bowel diseases (IBD). In a murine model of colitis, boswellia compounds demonstrated similar efficacy to the frequently used drug, dexamethasone, in terms of symptom suppression. Moreover, the boswellia compounds actively protected the integrity of the colonic mucosal lining and microvasculature, as observed via intestinal biopsy. And just as the use of boswellia as an anti-inflammatory mediator sidesteps some of the undesirable side-effects of NSAIDs, boswellia may be beneficial for IBD patients without the potential risks that come with long-term use of synthetic corticosteroid medications. Fortunately, we don’t need to rely exclusively on mouse data and hope for the best in humans. A small study involving 30 patients with chronic colitis showed that supplementation with a boswellia preparation (900mg daily, divided in three doses for 6 weeks) resulted in complete remission in 14 out of 20 subjects (70%), compared to 4 out of 10 subjects (40%) receiving sulfasalazine (3gm daily, divided in three doses for 6 weeks), who served as controls. This is a small sample size, but the findings are impressive nonetheless, particularly when combined with evidence that part of boswellia’s efficacy may be due to its protection of intestinal tight junctions against inflammatory and oxidative damage.

Many studies of boswellia leave a few things to be desired. They tend to have small sample sizes and incomplete reporting of data. Overall, though, boswellia has shown promise for bronchial asthma, Crohn’s, bursitis, rheumatoid arthritis, and other inflammatory conditions, largely without significant adverse side-effects even with long-term use. It may be a useful addition to the supplement regimen of patients living with these issues.