pain – Dr. Danenberg

Dr. Al Danenberg ● Nutritional Periodontist

March 28, 2021

Pain is very subjective. What is painful for one may be only slightly uncomfortable for another.

I live with pain all the time. But I now have a new solution that can help me deal with it.

I have bone pain from multiple myeloma as well as leftover pain from my pathological fractures of both my femurs, my right humerus, several ribs, and 2 vertebrae. Most of the time, Pulsed Electromagnetic Field (PEMF) Therapy (part of my Unconventional Cancer Protocols) has reduced this pain to tolerable levels. However, some pain gets to me, and I need something additional for relief.

Usually when I need pain medication, I go for ibuprofen 600mg as needed. I have tried CBD oil, but I have not had success with it. I do not take narcotics.

Now I found a new substance that works well for me – Boswellic Acids. It works better than ibuprofen with minimal side effects. And when I discussed it with my conventional oncologist, he was impressed and was interested in the medical journal reports I shared with him.

Also, since I need to take a small dose of dexamethasone (a corticosteroid) along with my monthly immunotherapy, Boswellic Acids may be a perfect substitute for that steroid. There is evidence that Boswellic Acids may replace this steroid while providing the same results with little to no side effects.

If I still were treating patients in my office, I would not hesitate to recommend this medicine as an anti-inflammatory and pain reliever.

What are Boswellic Acids?

Boswellia, also known as Indian frankincense, is an herbal extract taken from the Boswellia serrata tree. It is a series of pentacyclic triterpene molecules. Boswellia resin made from boswellia extract has been used traditionally for thousands of years. In Ayurvedic medicine, it is one of the most prized medicinal herbs for the treatment of arthritis and inflammatory disorders. Today, research is discovering Boswellia’s efficacy in treating a number of health problems, which I list later in this post.

Boswellic Acids from the resin are responsible for the herb’s anti-inflammatory properties. These acids are reported to have expectorant, antiseptic, anxiolytic, anti-neurotic, analgesic, tranquilizing, and antibacterial effects. The strength of Boswellia products is generally rated on its concentration of Boswellic Acids in the product. I look for at least 65% Boswellic Acids in the capsule or softgel. These medicaments are available as a resin, pill, or cream.

Based on the research I have read and my personal experience, Boswellic Acids appear to be a healthier alternative to steroids and nonsteroidal anti-inflammatory drugs (NASIDS) for pain and inflammation.

CAVEAT: If you have gastritis or gastroesophageal reflux disease (GERD), you may not be able to take Boswellia. If you are taking blood thinners or on prescription steroids, you must consult with your doctor before you try Boswellic Acids.

Problems with NSAIDS Like Ibuprofen[1],[2],[3]

NSAIDS are the go-to, over-the-counter drugs of choice for pain. However, ibuprofen and other NSAIDS can cause bleeding, increased blood pressure, heart attack, stroke, and renal damage. They may be the culprit in heartburn, stomach pain, nausea, vomiting, and diarrhea or constipation. NSAIDS can also damage the gut microbiome, decrease the diversity of species in the gut, and damage the gut epithelial barrier.

Problems with Steroids Like Dexamethasone[4],[5],[6]

Dexamethasone is a strong, anti-inflammatory, corticosteroid drug. It is used to treat conditions such as arthritis, blood and hormone disorders, allergic reactions, skin diseases, eye problems, breathing problems, bowel disorders, cancer, and immune system disorders. It relieves pain and inflammation.

Unfortunately, dexamethasone has significant adverse side effects such as water retention, weight gain and puffiness, suppression of the immune system, increase in blood sugar, weakness in arms and legs, insomnia, osteoporosis, and damage to the adrenal glands. Also, steroids damage the mucous layer in the gut.

However, this drug is widely used and considered a necessary evil in patient management for various diseases.

Dosage of Boswellic Acids[7],[8],[9]

One study has shown that the elimination half-life of Boswellic Acids is about six hours. This means that dosing every 6-8 hours orally may be important to maintain the proper blood level. Also, it took about thirty hours after the initial dose to reach a stable blood level. So, expected benefits may not be reached until the second day after the starting dose. In addition, absorption is better when taken with a meal that is high in fat. Since I eat a high-fat diet, I’m good to go!

Dosing guidelines are suggested by each of the product’s manufacturer. However, the general dosing guidelines suggest taking one capsule or softgel orally one to three times a day. Different medical conditions would require specific dosing concentrations of the active ingredients – Boswellic Acids.

Rare Side Effects from Boswellic Acids

In 2019, a double-blind study was reported where 48 patients with osteoarthritis were divided into 2 groups. Over the course of 4 continuous months, the control group took a placebo, and the experimental group took 87mg of Boswellic Acids in capsule form twice a day. The experimental group’s knee pain and function significantly improved. It is important to note over the course of 120 days, there were no statistically significant changes in the participants’ body weight, blood pressure, respiratory rate, or pulse rate. Also, there were no abnormal lab or diagnostic parameters recorded. In addition, Boswellic Acids significantly reduced the serum levels of high‐sensitive C‐reactive protein, a systemic inflammatory marker. And none of the individuals developed any serious side effects during the entire 4-month study.[10]

Although side effects are rare, you should be aware that Boswellic Acids …

May accelerate menstrual flow and may induce miscarriage in pregnant women
May increase bleeding
May cause nausea
May aggravate acid reflux
May cause diarrhea
May cause skin rashes
May interact with steroids, ibuprofen, aspirin, and other NSAIDs

Boswellic Acid Science[11],[12],[13],[14],[15]

Boswellic Acids have the ability to modulate multiple mediators involved in the pathogenesis of many diverse diseases. Currently, there are a number of research projects actively investigating the efficacy of using this medicine as a treatment modality. Here are a few of the chronic diseases that have been, and are being, studied:

Osteoarthritis (OA)
Rheumatoid Arthritis (RA)
Inflammatory Bowel Disease (IBD)
Asthma
Various Cancers
- Breast Cancer
- Bladder Cancer
- Brain Cancer
- Cervical Cancer
- Colon Cancer
- Leukemia
- Liver Cancer
- Lung Cancer
- Prostate Cancer
- Pancreatic Cancer
- Melanoma
Atherosclerosis
Renal Intestinal Fibrosis
Diabetes
Central Nervous System Disorders like Parkinson’s, Alzheimer’s, and Multiple Sclerosis
Ischemia-Reperfusion Injury (IRI)
Psoriasis

My Solution

I have read about, and experienced the benefits of, Boswellic Acids as a supplement in capsule or softgel form. There are many products on the market.

I selected a product that contains 65% Boswellic Acids in 500mg Boswellia Extract. Therefore, each softgel has 325mg of Boswellic Acids. The recommended dose is 1 softgel, 1-2 times per day. When needed, I take 1 softgel 3 times a day with food containing high fat.

For me, this is an excellent substitute for an anti-inflammatory pain medicine when I need it. It also might be considered as a promising alternative to corticosteroids in the treatment of diseases requiring steroids.

My oncologist has allowed me to experiment on myself. As you know, I don’t hesitate from being a study of N=1! But he will monitor me.

So, starting with my next monthly immunotherapy infusion, I will begin to replace my 3 declining doses of dexamethasone (4mg, 2mg, 1mg) with Boswellic Acids.

Even though I only take small doses of the steroid, I retain about 5 pounds of water weight as a result that lasts about one week. Also, this minimal dose of the steroid still gives me insomnia for about 5 days. I am looking forward to avoiding these steroid side effects if the Boswellic Acids work instead.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4809680/

[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7426480/

[3] https://onlinelibrary.wiley.com/doi/full/10.1111/apt.14451

[4] https://www.ncbi.nlm.nih.gov/books/NBK531462/

[5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4402247/

[6] https://www.ncbi.nlm.nih.gov/books/NBK279156/

[7] https://pubmed.ncbi.nlm.nih.gov/15643550/

[8] https://pubmed.ncbi.nlm.nih.gov/15070181/

[9] https://accp1.onlinelibrary.wiley.com/doi/abs/10.1177/0091270011422811

[10] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6681146/

[11] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7229515/

[12] http://www.koliskoinstitute.org/wp-content/uploads/2014/09/Therapeutic-Advantages-of-AKBAv2.pdf

[13] https://doi.org/10.1155/2019/3041438

[14] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6747466/

[15] https://www.lifeextension.com/magazine/2014/12/boswellia-new-studies-show-effective-pain-relief

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Dr. Al Danenberg ● Nutritional Periodontist
June 25, 2018

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Last week a friend of mine, whom I will call Craig, called me. He lives about 300 miles away from where I live. He told me about his dental problem. His story is a recurring concern I have about some dentists performing an inadequate dental exam. A lack of an in-depth exam can result in continued pain for the patient as well as expensive, unnecessary, and possibly harmful treatment.

Craig’s Problem

Craig told me that several weeks ago he had pain in his upper left molar area. He had so much pain that he could not sleep. Ibuprofen was not taking care of his pain. So, he went to his dentist, who took an x-ray.

Craig is a healthcare professional, but not a dentist. So, Craig understands medical terminology and the process of correctly diagnosing a problem.

His dentist explained that he saw an old filling in the last molar that could be causing the problem. The doctor recommended to remove the old filling and replace it with a new one. Craig accepted the dentist’s conclusion, and the dentist proceeded to remove the filling and place a new one at that appointment.

My friend believed that the dentist knew what he was talking about and left the office after the procedure. Craig thought his problem was solved. However, the pain was not gone. It just got worse.

He returned to his dentist the following week and explained the problem was getting worse. The dentist then suggested that the tooth probably had a crack and would require a root canal and crown to save the tooth. At that point, Craig was concerned about his dentist’s diagnosis. So, he called me for my opinion.

My Opinion

Craig emailed the digital x-ray to me, so I could explain what I saw. It was a standard, two-dimensional dental x-ray. When I looked at the x-ray, I noticed changes in the bone density around the roots of his molar teeth. These changes suggested the teeth were in trauma. The trauma was typical of a clenching or grinding habit. Tooth trauma like this could wiggle the teeth and damage the jawbone. This could cause pain in the tooth area, pain in the muscles of the jaw, and pain in the jaw joint.

After I explained to Craig what I saw in his x-ray, he told me that he clenches his teeth most of the time. My next question to my friend was, “Did your dentist ask if you were aware of clenching or grinding your teeth?” Craig told me his dentist never discussed it nor questioned him about it. He also said the dentist never explained what he saw in the x-ray other than the old filling.

I told Craig a 3D x-ray of the area might help identify if there was a cracked root or other damage around the tooth that could not be seen from a standard dental x-ray. I also suggested that he purchase a soft bite guard from the drug store to cushion his bite while he slept. If the pain was only from clenching or grinding, then the soft bite guard might be able to lessen the severe pressure and possibly relieve the pain.

Craig immediately went to his drugstore and purchased a soft bite guard for about $20. He called me the next day excited, “Last night was the first night in several weeks that I had no pain and could sleep all night long.”

Closing Thoughts

I know that diagnosing problems in dentistry can be difficult. But, a well-trained dentist should be able to look at an x-ray and see what I saw.

When there are obvious changes in the bone suggesting tooth trauma, then one of the first questions the dentist needs to ask the patient is, “Are you aware of any habits of clenching or grinding your teeth?”

Certainly, the first thing a dentist should not do is replace an old filling before a thorough evaluation is done. An inadequate dental exam often results in a misdiagnosis and continued pain as was the case for my friend Craig.

To completely correct Craig’s problem, he may need to have various chewing surfaces of his teeth smoothed and polished to “even out” his bite pressures. Also, Craig may need a customized bite guard.

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