If NSAIDs for arthritis pain make it worse, what’s the alternative?

Paul Varnas November 6, 2024

As explained in part 1 of this article series, taking NSAIDs for arthritis pain, or for pain associated with any condition, can do horrible damage to the body. Here are some safe and effective alternatives.

Pancreatic enzymes for inflammation

Taking enzymes with a meal will help digest the food, but they have been extensively studied and have also demonstrated an ability to reduce pain and inflammation and speed healing when taken on an empty stomach. They do so with few, if any, side effects. Studies have shown enzymes to be comparable to NSAIDs in their efficacy at relieving pain, easing joint stiffness and improving function.^1-10

Other studies have shown enzymes to be effective for managing arthritis, even in some studies to the point of outperforming drugs.^6-8 Enzymes have also been used to reduce pain and improve healing after surgery.^3,4 In one study involving patients who had undergone cosmetic surgery, the authors stated, “Systemic enzyme therapy with its pharmacological effects represents a preventive and curative option for inflammatory process including healing. Excellent results were presented, namely, in the treatment of secondary lymphoedema.”

Niacinamide

Niacinamide can reduce pain for your patients with arthritis and also improve function. In the 1990s, a pilot study looked at 72 patients with osteoarthritis (OA). They were given either a placebo or niacinamide for 12 weeks. Those receiving the supplement experienced a reduction in pain as well as improved function.¹¹

A more recent study looked at 2,375 patients with OA of the knee. The authors of that study stated, “The association between increased niacin intake and reduced pain and function scores, as well [as] improved quality of life in knee OA patients, is significant. Certain cohorts, according to a stratified analysis, could see more considerable benefits with increased niacin consumption.”¹²

For pain and swelling associated with OA, according to William Kaufman, MD, PhD, “in over several thousand patient years of high dose niacinamide therapy, no adverse side effects were reported.”

Both Wright and Kaufman indicated the dose required to achieve results with most patients is 1,000 mg three times per day. Some patients will experience upset stomach with an initial dose of more than 1,000 mg. Starting these patients out on 500 mg a day (one capsule) and working up to the required dose of 1,000 mg three times daily will ameliorate and ultimately overcome the digestive upset.  

MSM

MSM inhibits NF-κB and downregulates TNF-α, IL-1 and IL-6.^13-15 MSM may indirectly have an inhibitory role on mast cell mediation of inflammation. With the reduction in cytokines and vasodilating agents, flux and recruitment of immune cells to sites of local inflammation are inhibited.^16-18  Herschler patented MSM as an anti-inflammatory substance.^19-20

Noninvasive studies relying on questionnaires and joint function measuring have also been done on arthritic patients.  Clinical trials suggest MSM is effective in reducing pain, as indicated by the VAS pain scale and the WOMAC pain subscale.^21-23

MSM does more than reduce pain; it can improve function for patients with arthritis. Improvements in overall physical function have also been noted through the use of subjective measurements.

Final thoughts

Patients who regularly take NSAIDs usually have gastrointestinal complaints, such as epigastric burning or even symptoms of irritable bowel syndrome. If your arthritis patient has been taking NSAIDs, you may need to undo the damage. We will cover how to do that in part 3 of this article series.

References

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2. Roberts AD, Hart DM. Polyglycolic acid and catgut sutures, with and without oral proteolytic enzymes, in the healing of episiotomies. Br J Obstet Gynaecol. 1983;90(7):650-653. Pub Med. Accessed October 23, 2024.
3. Duskova M, Wald M. Orally administered proteases in aesthetic surgery. Aesthetic Plast Surg. 1999;23(1):41-44. PubMed. Accessed October 23, 2024.
4. Hoernecke R, Doenicke A. Perioperative enzyme therapy. A significant supplement to postoperative pain therapy? Anaesthesist. 1993;42(12):856-861. PubMed. Accessed October 23, 2024.
5. Tilscher H, et al. Results of a double-blind, randomized comparative study of Wobenzym-placebo in patients with cervical syndrome. Wien Med Wochenschr. 1996;146(5):91-95. PubMed. Accessed October 23, 2024.
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8. Shah D, Mital K. The Role of Trypsin:Chymotrypsin in Tissue Repair. Adv Ther. 2018;35(1):31-42. PubMed. Accessed October 23, 2024.
9. Beck TW, et al. Effects of a protease supplement on eccentric exercise-induced markers of delayed-onset muscle soreness and muscle damage. Journal of Strength and Conditioning Research. 2007;21(3):661-667. Accessed October 23, 2024.
10. Klein, et al. Efficacy and tolerance of an oral enzyme combination in painful osteoarthritis of the hip. A double-blind, randomised study comparing oral enzymes with non-steroidal anti-inflammatory drugs. Clinical Experimental Rheumatology. 2006;24(1):25-30. PubMed. Accessed October 23, 2024.
11. Jonas WB, et al. The effect of niacinamide on osteoarthritis: A pilot study. Inflamm Res. 1996;45(7):330-334. Pub Med. Accessed October 23, 2024.
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16. Tousoulis D, et al. The role of nitric oxide on endothelial function. Curr Vasc Pharmacol. 2012;10:4–18. PubMed. Accessed October 23, 2024.
17. Coleman JW. Nitric oxide: A regulator of mast cell activation and mast cell-mediated inflammation. Clin Exp Immunol. 2002;129:4–10. PubMed. Accessed October 23, 2024.
18. Use of Methylsulfonylmethane to Relieve Pain and Relieve Pain and Nocturnal Cramps and to Reduce Stress-Induced Deaths in Animals. 4,973,605. U.S. Patent. July 26, 1989.
19. Dietary Products and Uses Comprising Methylsulfonylmethane. 4,863,748. U.S. Patent. June 26, 1986.
20. Dietary and Pharmaceutical Uses of Methylsulfonylmethane and Compositions Comprising It. 4,514,421. U.S. Patent. Sept. 14, 1982. Cold Spring Harb Perspect Biol. 2009;1(6):a001651.
21. Debi R, et al. The role of msm in knee osteoarthritis: A double blind, randomized, prospective study. Osteoarthr Cartil. 2007;15:C231. Accessed October 23, 2024.
22. Kim LS, et al. Efficacy of methylsulfonylmethane (MSM) in osteoarthritis pain of the knee: A pilot clinical trial. Osteoarthr Cartil. 2006;14:286–294.PubMed. Accessed October 23, 2024.
23. Pagonis TA, et al. The effect of methylsulfonylmethane on osteoarthritic large joints and mobility. Int J Orthop. 2014;1(1):1-6. ResearchGate. Accessed October 24, 2024.