When medical students learn about the best way to treat osteoarthritis pain and inflammation, they inevitably hear that NSAIDs (nonsteroidal anti-inflammatory drugs) are the go-to medications. That’s why drugs like celecoxib, diclofenac, ibuprofen, indomethacin, meloxicam and naproxen are prescribed in such huge numbers. And that doesn’t even include OTC sales of NSAIDs such as Advil, Aleve or Motrin IB. Most medical schools don’t mention turmeric or the active ingredient curcumin. Which is better and safer — curcumin or NSAIDs when it comes to osteoarthritis of the knee?
Effectiveness of Curcumin or NSAIDs?
Ask most physicians in the US about turmeric or curcumin and you will likely get a blank stare. They never learned about this Ayurvedic medicine that has been part of the Indian system of healing for thousands of years.
American medical education often promotes the idea that FDA-approved pharmaceuticals are safe and effective. After all, they are FDA approved!
Herbal or plant-based compounds are mostly considered unproven and possibly dangerous. Given a choice between curcumin or NSAIDs, most conventionally trained MDs would go with NSAIDs every time.
What About the Data?
A study published in BMC Complementary Medicine and Therapies (Oct. 19, 2022) actually reviews the research on curcuminoids (the active ingredients in turmeric) for knee osteoarthritis. They analyzed data from 15 randomized controlled trials (RCTs) involving 1,670 patients.
The Bottom Line on Effectiveness of Curcumin or NSAIDs:
Let’s let the authors speak for themselves:
“The principal finding of our study was that CURs [curcuminoids] were associated with better effectiveness than placebo and not inferior to NSAIDs in terms of pain reduction and functional promotion for knee OA [osteoarthritis]. The pooled analyses found that CURs were more effective than placebo in the improvement of VAS [visual analog scale] for pain, WOMAC [Western Ontario and McMaster Universities Osteoarthritis Index] total score, WOMAC pain score, WOMAC function score and WOMAC stiffness score, while there was no significant difference found between CURs and NSAIDs.”
OK, that’s a lot of doctorspeak. Here is our translation. Curcumin and related compounds were more effective than placebo for relieving pain and stiffness.
The WOMAC score is a validated way for rheumatologists to study symptoms surrounding osteoarthritis. Another key finding was that curcuminoids were just as good (“not inferior”) as NSAIDs at easing symptoms.
That’s impressive. This Ayurvedic medicine was just as good as nonsteroidal anti-inflammatory drugs for controlling pain and inflammation of the knee. We doubt that very many US-trained physicians are aware of that.
What About Side Effects When It Comes to Curcumin or NSAIDs?
Here is the BIG news!
Again, let’s allow the authors to state their findings:
“Among the included fifteen studies, two reported no AEs [adverse events] at the end of the trials. According to the data of the remaining thirteen studies (1569 patients), AEs were mainly concentrated in gastrointestinal symptoms including meteorism [bloating or gas], gastro-oesophageal reflux, dyspepsia, nausea, and stomach pain. There was no significant difference found between CURs and placebo group in the incidence of AEs, while a lower incidence of AEs was observed in CURs group when compared with NSAIDs group, but the pooled results were not statistically significant. Sensitivity analysis found that the difference between CURs and NSAIDs groups became statistically significant when the data of Gupte et al. were omitted.”
Curcumin Side Effects:
The bottom line appears to be that:
“Diarrhea and/or constipation and stomach pain (5.8% and 8.17%) were the most frequent mild AEs in CURs and control groups respectively.”
We have warned about other adverse effects of turmeric or curcumin at this link. Some people are allergic to turmeric. They can develop a serious skin rash. Liver enzyme elevations have also been reported with this natural remedy. And anyone taking anticoagulants should skip curcuminoids. This is especially true of the blood thinner warfarin!
NSAID Side Effects:
Contrast the side effects mentioned above with the potential adverse reactions associated with NSAIDs:
Ibuprofen Side Effects:
• Heartburn, abdominal pain, nausea, vomiting
• Ulcers, bleeding ulcers, perforated ulcers
• Headache, dizziness, drowsiness, disorientation
• Skin rash, sensitivity to sunlight, itching
• Fluid retention, high blood pressure
• Heart failure, heart attack, stroke
• Irregular heart rhythms (AFib)
• Ringing in ears, hearing changes
• Visual disturbances
• Liver damage, kidney damage
Remember, the FDA considers ibuprofen so safe that it can be sold without a prescription.
You can read more about ibuprofen side effects at this link.
Readers Report NSAID Complications:
Pat followed instructions and developed bleeding issues:
“I think even when you read the instructions carefully and follow them, you can still develop problems. When I took sodium naproxen for arthritis once a day, I developed bleeding in my digestive tract. It scared the heck out of me when I had a BM and out came bright red blood. My doctor said it’s more common than you would think.”
Susan’s husband developed a double whammy–liver damage and a stomach ulcer:
“My husband hurt his shoulder trying to get rid of a beaver dam. He used ibuprofen thinking it was a safe pain medication even at unrecommended doses. Long story short, he ended up being hospitalized and almost died due to hepatic encephalopathy and a gastric ulcer. The scary truth is ibuprofen is not safe if taken in larger doses, or even every day at recommended doses. My sister had increased liver enzymes from taking doses at recommended levels.”
Christine developed an irregular heart rate:
“My doctor had me taking ibuprofen for years after a car accident that damaged both my knees. Eventually my doctor advised me to up my dosage from 2 pills every 6 hours to 3 every six hours. I developed an arrhythmia in 2015 and had a mild stroke from which I have fully recovered.
“When i realized what caused the stroke, the doctors at the hospital did not believe me.”
Doctors Like Diclofenac and Meloxicam…But Watch Out for Side Effects:
Diclofenac and meloxicam are very popular NSAIDs. You can read more about their adverse reactions at these two links:
A Few More Comments:
Jay had a life-threatening bleeding ulcer:
“I was on meloxicam for one year. In May of this year I developed excruciating pain in my abdomen and was rushed to the ER. After many x-rays it was determined that I had a ruptured peptic ulcer and needed emergency surgery. I was told to stop taking meloxicam immediately because of the horrific side effects!
Steven developed ringing in the ears (tinnitus):
“I took meloxicam back in October 2018 for knee pain. After two weeks I had ringing in my ears. Called my Dr. and he told me to stop taking meloxicam, and the ringing would go away. Six months later I still have ringing in my ears all the time!”
Judi and high blood pressure:
“Last year my surgeon put me on naproxen before it became necessary for him to do neck surgery on me. On day 21 of taking Naproxen my blood pressure spiked to 234/180 and I went to the ER. I will never take NSAIDS again.”
Curcumin or NSAIDs for Knee Osteoarthritis?
We make no recommendations. That is between patients and their practitioners. We will leave you with a comment from Laverne, though:
Laverne offers this contrast between corticosteroids and curcuminoids:
“A few years ago I was getting a cortisone shot in my left knee every 5 months for pain. The knee had ‘advanced arthritis.’ After several shots, I started taking a good quality brand of curcumin with black pepper extract for greater absorption — 1330 mg of turmeric root extract a day, standardized to provide a minimum of 95% curcuminoids.
“The pain and swelling started decreasing almost immediately, and I haven’t had a shot since. I hope to continue to avoid knee surgery.”
Curcumin and Heart Health:
You likely noticed that NSAIDs have been associated with high blood pressure, heart attacks, heart failure and strokes. And yes, that does not sound good for the cardiovascular system.
What about curcumin? To our surprise, this dietary supplement actually lowers blood lipids like LDL and total cholesterol. Triglycerides were also reduced a bit.
The authors of this study (Archives of Physiology and Biochemistry, Dec. 2022) conclude:
“This study suggests that curcumin may reduce blood lipid levels and can be used as a hypolipidemic [lipid-lowering] agent.”
What Do You Think?
So, which is better, curcumin or NSAIDs? We would love to read about your experience with either and/or both in the comment section below. Which do you think is safer?