Bromelain for Acute Knee Pain

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Re: Bromelain for Acute Knee Pain

http://www.herbalgram.org/iherb/herbclip/review.asp?i=43700

 

Walker A, Bundy R, Hicks S, Middleton R. Bromelain reduces mild

acute knee pain and improves well-being in a dose-dependent fashion

in an open study of otherwise healthy adults. Phytomedicine.

2002;9:681-686.

 

Non-steroidal anti-inflammatory drugs are often prescribed to reduce

the swelling and pain associated with knee pain. However, because

adverse side effects have been attributed to the use of these drugs,

natural and safe alternatives to alleviate knee pain are being

sought. Results from animal and in vitro studies indicate that

bromelain has anti-inflammatory and analgesic properties. Bromelain

is a crude aqueous extract from the stem and fruit of the pineapple

plant (Ananas comosus Merr.). The main active components of this

extract are several enzymes that have proteolytic activity. The

mechanism of action for bromelain's anti-inflammatory effects is its

ability to increase serum fibrinolytic activity and decrease

prostaglandin E2 and thromboxane A2 concentrations. Its analgesic

action is thought to result from both its direct effect on pain

mediators (e.g., bradykinin) and its secondary effect on pain-

inducing factors such as edema, debris, and immune complexes.

 

In an open, parallel, dose-ranging study, the authors investigated

the effect of bromelain supplementation on acute, mild knee pain in

otherwise healthy adults aged 25–50 years. The subjects were

randomly assigned to receive either 200 or 400 mg bromelain/day

(Bromelin™; Lichtwer Pharma UK Ltd, Marlow United Kingdom) as one or

two tablets, respectively. Two validated self-assessment

questionnaires were completed by the subjects at baseline (before

the study began) and at the end of the 30-day intervention. The

primary outcome questionnaire was the Western Ontario and McMaster

Universities Osteoarthritis Index (WOMAC), which covers three

dimensions: pain, stiffness, and physical function. The secondary

outcome questionnaire was the Psychological General Well-Being Index

(PGWB), which covers six dimensions: anxiety, depressed mood,

positive well-being, self-control, general health, and vitality.

 

Seventy-seven subjects completed the study: 43 in the 200-mg group

and 34 in the 400-mg group. No significant differences in the WOMAC

or PGWB index scores were observed between the two groups at

baseline. However, both groups of subjects reported significant

reductions in all three WOMAC dimension scores compared to baseline

after the 30-day intervention. Pain decreased by 44.6% and 58.2% (P

< 0.0001) in the 200-mg and 400-mg groups, respectively. Stiffness

and physical function improved significantly more in the 200-mg than

in the 400-mg group (P = 0.026 and 0.021, respectively) after the 30-

day intervention. Overall PGWB scores increased significantly after

treatment in both the 200-mg and 400-mg groups (P = 0.016 and

0.0003, respectively). In addition, all six PGWB dimension scores

were significantly greater than baseline in the 400-mg group (P =

0.023), and three of the dimension scores (anxiety, well-being, and

general health) were significantly greater than baseline in the 200-

mg group (P = 0.017, 0.013, and 0.009, respectively). After

adjustment for baseline, self-control and vitality were

significantly improved from baseline in the 400-mg group compared

with the 200-mg group (P = 0.004 and 0.026, respectively). No

serious side effects of supplementation were reported.

 

This open study showed a " significant effect of bromelain on

reducing symptoms of knee pain and improving well-being in otherwise

healthy adults. " Furthermore, " improvements were significantly

higher in a number of physical and well-being dimensions in the

group receiving the higher dose. " Given these findings, the authors

suggest that " a larger placebo-controlled trial is justified to

further strengthen these findings. "

 

—Brenda Milot, ELS