on May 22, 2026
Chronic pain, defined by the World Health Organization as persistent or recurrent pain lasting more than three months, represents one of the major challenges of modern medicine. It affects approximately 20–30% of the adult population, with higher prevalence in older adults, and is associated with a significant impact on quality of life, functionality, and mental health.
The main causes include musculoskeletal conditions (osteoarthritis, arthritis), neuropathic pain, traumatic sequelae, and primary chronic conditions such as fibromyalgia and migraine. Management requires an integrated and personalized approach.
Integrated approach and the role of phytotherapy
In the treatment of chronic pain, especially forms resistant to conventional therapies, a multidisciplinary approach is indicated, including:
Pharmacological therapy (NSAIDs, antidepressants, gabapentinoids)
Nutritional and nutraceutical support
Physiotherapy and physical techniques (TENS, laser, TECAR)
Psychological and behavioral interventions
Phytotherapy and phytotherapy with plant buds
In this context, phytotherapy represents a valuable support for modulating inflammatory processes and improving pain symptoms.
Boswellia serrata: pharmacological properties and mechanisms of action
Boswellia serrata is a plant native to India, from whose bark a gum-oleoresin rich in boswellic acids is extracted, pentacyclic triterpenic compounds responsible for biological activity.
Molecular mechanisms
Numerous in vitro and animal model studies have shown that boswellic acids:
Inhibit 5-lipoxygenase (5-LOX) → ↓ pro-inflammatory leukotrienes
Modulate COX-1 and COX-2 → ↓ prostaglandins (PGE2)
Inhibit leukocyte elastase → tissue protection
Interfere with cathepsin G → ↓ neutrophil-mediated damage
These effects result in a significant reduction of the inflammatory cascade, with a different but complementary mechanism compared to NSAIDs.
Clinical evidence in musculoskeletal pain
The use of Boswellia is supported by clinical studies and systematic reviews, particularly in the treatment of:
Osteoarthritis (osteoarthritis)
Arthralgia and rheumatism
Tendinitis
Chronic low back pain
Several randomized controlled trials have shown that standardized Boswellia extracts (≥65% boswellic acids) can:
Reduce joint pain
Improve functionality and mobility
Decrease joint stiffness
Some studies report clinically significant improvement after 4–8 weeks of treatment.
Systematic review
A review published in Phytomedicine highlighted that Boswellia is effective and well tolerated in the treatment of osteoarthritis, with effects comparable to some NSAIDs but with a better gastrointestinal safety profile.
Clinical applications and topical use
In addition to systemic use, Boswellia is also used in:
Analgesic creams and gels
Combined phytotherapeutic preparations
Formulations for local use in joint pain
Dosage and method of use
Standardized dry extract (≥65% boswellic acids)
500 mg daily
Preferably taken with meals
The duration of treatment varies depending on the clinical condition, generally for cycles of at least 8–12 weeks.
Safety, contraindications, and interactions
Boswellia is generally well tolerated.
Possible side effects
Mild gastrointestinal disorders
Rare skin reactions
Warnings
Not recommended during pregnancy (potential uterotonic effect)
Caution in patients taking:
Leukotriene inhibitors (possible synergistic effect)
Anti-inflammatory drugs
Role in integrated pain management
Boswellia serrata fits effectively into an integrated medicine model, contributing to:
Modulation of chronic inflammation
Pain reduction
Improved quality of life
The combination with other strategies (anti-inflammatory nutrition, physical exercise, stress management) allows for a more complete and sustainable approach in the long term.
Boswellia serrata represents one of the main phytotherapeutic resources in the treatment of chronic pain of inflammatory origin. Scientific evidence supports its use as a complement to conventional therapy, with a good safety and efficacy profile.
Essential bibliographic references
- Sengupta K. et al. A double blind, randomized, placebo controlled study of the efficacy and safety of 5-Loxin for treatment of osteoarthritis. Arthritis Research & Therapy.
- Vishal A.A. et al. A double blind, randomized, placebo controlled clinical study evaluates the early efficacy of Aflapin in subjects with osteoarthritis. Int J Med Sci.
- Ernst E. Frankincense: systematic review. BMJ.
- Ammon H.P.T. Boswellic acids in chronic inflammatory diseases. Planta Medica.
- Henrotin Y. et al. Nutraceuticals in osteoarthritis: Boswellia serrata. Phytomedicine.
