Efficacy of Boswellia serrata Extract and/or an Omega-3-Based Product for Improving Pain and Function in People Older Than 40 Years with Persistent Knee Pain: A Randomized Double-Blind Controlled Clinical Trial

A single-center, randomized, double-blind, controlled clinical trial with four arms was conducted in healthy subjects with persistent knee discomfort (pain intensity on 1–10 cm visual analog scale (VAS) > 3) aged 40 years and older treated with a dietary supplement for 8 weeks. The study groups were Boswellia serrata extract (n = 29), an omega-3-based product (AvailOm® 50 High EPA) (n = 31), Boswellia + AvailOm® (n = 30), and placebo (n = 30). The intake of Boswellia + AvailOm® improved the quality of life (QoL) (WOMAC index) and some variables of muscle strength. Statistically significant differences between the AvailOm® and the placebo groups in the decrease of pain intensity were found. Weekly VAS scores showed a significant decrease in pain perception when comparing the AvailOm® product to the placebo, with the lowest VAS scores at week 8. Consumption of Boswellia improved sleep latency. The time to perform the Up and Go test decreased after the intake of AvailOm®. There was an increase in the omega-3 fatty acids, with the greatest increase in the Boswellia + AvailOm® group. AvailOm® was safe and effective in reducing pain and improving the QoL and functionality of subjects over 40 years with persistent knee pain.

[1]  O. Werz,et al.  Allosteric Activation of 15‐Lipoxygenase‐1 by Boswellic Acid Induces the Lipid Mediator Class Switch to Promote Resolution of Inflammation , 2022, Advanced science.

[2]  F. Rodríguez‐Artalejo,et al.  Fish consumption, omega-3 fatty acid intake, and risk of pain: the Seniors-ENRICA-1 cohort. , 2022, Clinical nutrition.

[3]  S. Cornish,et al.  Omega-3 Fatty Acids for the Management of Osteoarthritis: A Narrative Review , 2022, Nutrients.

[4]  S. Cornish,et al.  Effects of Omega-3 Supplementation Alone and Combined with Resistance Exercise on Skeletal Muscle in Older Adults: A Systematic Review and Meta-Analysis , 2022, Nutrients.

[5]  Y. Boirie,et al.  A Meta-Analysis of the Impact of Nutritional Supplementation on Osteoarthritis Symptoms , 2022, Nutrients.

[6]  Qiang Liu,et al.  Prevalence Trends of Site‐Specific Osteoarthritis From 1990 to 2019: Findings From the Global Burden of Disease Study 2019 , 2022, Arthritis & rheumatology.

[7]  K. V. Sarma,et al.  Efficacy and Safety of Aflapin®, a Novel Boswellia Serrata Extract, in the Treatment of Osteoarthritis of the Knee: A Short-Term 30-Day Randomized, Double-Blind, Placebo-Controlled Clinical Study. , 2022, Journal of the American Nutrition Association.

[8]  F. J. López-Román,et al.  Effect of Dietary Supplementation with a Natural Extract of Sclerocarya birrea on Glycemic Metabolism in Subjects with Prediabetes: A Randomized Double-Blind Placebo-Controlled Study , 2021, Nutrients.

[9]  G. Moncada,et al.  Effect of omega-3 on painful symptoms of patients with osteoarthritis of the synovial joints. Systematic review and meta-analysis. , 2021, Oral surgery, oral medicine, oral pathology and oral radiology.

[10]  Xiaochun Wei,et al.  The global state of research in pain management of osteoarthritis (2000–2019) , 2021, Medicine.

[11]  F. Suhr,et al.  Omega-3 Supplementation Improves Isometric Strength But Not Muscle Anabolic and Catabolic Signaling in Response to Resistance Exercise in Healthy Older Adults , 2020, The journals of gerontology. Series A, Biological sciences and medical sciences.

[12]  W. Chiu,et al.  Effects of Omega-3 Fatty Acids on Muscle Mass, Muscle Strength and Muscle Performance among the Elderly: A Meta-Analysis , 2020, Nutrients.

[13]  Junlong Zhong,et al.  Global, regional prevalence, incidence and risk factors of knee osteoarthritis in population-based studies , 2020, EClinicalMedicine.

[14]  J. C. Domingo,et al.  Oxidative Stress in Endurance Cycling Is Reduced Dose-Dependently after One Month of Re-Esterified DHA Supplementation , 2020, Antioxidants.

[15]  É. A. Silveira,et al.  Effects of Nutritional Interventions in the Control of Musculoskeletal Pain: An Integrative Review , 2020, Nutrients.

[16]  Peter R C Howe,et al.  Fish oil supplementation reduces osteoarthritis-specific pain in older adults with overweight/obesity , 2020, Rheumatology advances in practice.

[17]  Liuting Zeng,et al.  Effectiveness of Boswellia and Boswellia extract for osteoarthritis patients: a systematic review and meta-analysis , 2020, BMC Complementary Medicine and Therapies.

[18]  L. Arendt-Nielsen,et al.  Pain inhibitory mechanisms and response to weak analgesics in patients with knee osteoarthritis , 2019, European journal of pain.

[19]  M. Majeed,et al.  A pilot, randomized, double‐blind, placebo‐controlled trial to assess the safety and efficacy of a novel Boswellia serrata extract in the management of osteoarthritis of the knee , 2019, Phytotherapy research : PTR.

[20]  D. Felson,et al.  Mechanisms of Osteoarthritis (OA) Pain , 2018, Current Osteoporosis Reports.

[21]  S. Lambova,et al.  Current Treatment Options for Osteoarthritis. , 2017, Current rheumatology reviews.

[22]  F. Rannou,et al.  Risk factors and burden of osteoarthritis. , 2016, Annals of physical and rehabilitation medicine.

[23]  T. Kroll,et al.  Prevalence of glucosamine and omega-3 fatty acid use and characteristics of users among mid-age women: Analysis of a nationally representative sample of 10,638 women , 2016, The journal of nutrition, health & aging.

[24]  N. Dautovich,et al.  Sleep Disturbance in Osteoarthritis: Linkages With Pain, Disability, and Depressive Symptoms , 2015, Arthritis care & research.

[25]  H. Hillstrom,et al.  State-of-the-Art management of knee osteoarthritis. , 2015, World journal of clinical cases.

[26]  S. Al Snih,et al.  Differences in health-related quality of life among subjects with frequent bilateral or unilateral knee pain: data from the Osteoarthritis Initiative study. , 2015, The Journal of orthopaedic and sports physical therapy.

[27]  S. Nakaji,et al.  Nocturnal Knee Pain Increases With the Severity of Knee Osteoarthritis, Disturbing Patient Sleep Quality , 2014, Arthritis care & research.

[28]  Deborah Schofield,et al.  The individual and socioeconomic impact of osteoarthritis , 2014, Nature Reviews Rheumatology.

[29]  A. Martínez-Amat,et al.  Reliability and validity of the Spanish version of the Pittsburgh Sleep Quality Index (PSQI) in patients with fibromyalgia , 2014, Rheumatology International.

[30]  Tom Fahey,et al.  Is the Timed Up and Go test a useful predictor of risk of falls in community dwelling older adults: a systematic review and meta- analysis , 2014, BMC Geriatrics.

[31]  P. Finan,et al.  See Blockindiscussions, Blockinstats, Blockinand Blockinauthor Blockinprofiles Blockinfor Blockinthis Blockinpublication the Blockinassociation Blockinof Blockinsleep Blockinand Blockinpain: Blockinan Blockinupdate and Blockina Blockinpath Blockinforward , 2022 .

[32]  Bernhard Haider,et al.  Long-term efficacy of Boswellia serrata in four patients with chronic cluster headache , 2012, Cephalalgia : an international journal of headache.

[33]  S. Goldring,et al.  Osteoarthritis: a disease of the joint as an organ. , 2012, Arthritis and rheumatism.

[34]  L. Cleland,et al.  Osteoarthritis: Omega-3 fatty acids and synovitis in osteoarthritic knees , 2012, Nature Reviews Rheumatology.

[35]  M. Z. Siddiqui.  Boswellia Serrata, A Potential Antiinflammatory Agent: An Overview , 2011, Indian journal of pharmaceutical sciences.

[36]  J. Jordan,et al.  Epidemiology of osteoarthritis. , 2010, Clinics in geriatric medicine.

[37]  Kenneth D Brandt,et al.  Etiopathogenesis of osteoarthritis. , 2008, Rheumatic diseases clinics of North America.

[38]  R. Goldberg,et al.  A meta-analysis of the analgesic effects of omega-3 polyunsaturated fatty acid supplementation for inflammatory joint pain , 2007, Pain.

[39]  H. Ammon.  Boswellic Acids in Chronic Inflammatory Diseases , 2006, Planta medica.

[40]  I. Otterness,et al.  Pathologic indicators of degradation and inflammation in human osteoarthritic cartilage are abrogated by exposure to n-3 fatty acids. , 2002, Arthritis and rheumatism.

[41]  M. Anazodo,et al.  Boswellic acids: novel, specific, nonredox inhibitors of 5-lipoxygenase. , 1992, The Journal of pharmacology and experimental therapeutics.

[42]  C. Dolea,et al.  World Health Organization , 1949, International Organization.

[43]  V. Thawani,et al.  Efficacy and tolerability of Boswellia serrata extract in treatment of osteoarthritis of knee--a randomized double blind placebo controlled trial. , 2003, Phytomedicine : international journal of phytotherapy and phytopharmacology.