In an era where chronic pain affects millions worldwide, the search for effective and safe pain relief has never been greater.
PanaNatra is a line of herbal products from Haleon, the makers of Panadol. Haleon claims that PanaNatra’s three products, made from plant extracts, help manage and provide relief from mild joint pain, mild muscle pain and mild pain that affects sleep.
They contain different combinations of four plants:
- Boswellia serrata (contained in the products of joints and muscles)
- Curcuma longa (in joint and muscle products)
- Piper nigrum (only in the common product)
- Withania somnifera (only in the sleep product).
These products are “listed medicines” in Australia. This means that the ingredients are considered largely low risk, have been used in traditional medicine, and are manufactured to a high standard. But the manufacturer has not provided evidence to the government regulator that they are working.
So can herbal ingredients effectively and safely relieve different types of pain?
What does the evidence say?
Let’s look at the evidence for the four main ingredients.
Indian incense (Boswellia serrata) has been described in traditional Indian Ayurvedic texts since the 1st century AD. The key active compounds derived from the gum resin of the tree called boswellic acids are thought to have anti-inflammatory effects.
U Boswellia serrata The dry concentrate extract (Rhuleave K) used in the Muscle Pain product contains 50 mg of the herb per tablet, while the Joint Pain product includes 33.3 mg as a different formulation (Apresflex).
A review of different human clinical trials using a range of formulations of this herb supports its ability to reduce certain types of pain and improve function in osteoarthritis. But a key finding of the study was that improvement only begins when Boswellia serrata is used continuously for four weeks and at a dose of at least 100-250 mg per day.
In a clinical trial, 100 mg daily of a Boswellia serrata The gum-based product has been found to reduce pain and improve physical function for people with osteoarthritis.
Read more: 9 signs that you have inflammation in your body. Could an anti-inflammatory diet help?
turmeric (Curcuma longa) has been used in Chinese and Indian medicine for at least 2,000 years. It contains a well-known chemical called curcumin, a natural compound used for its anti-inflammatory properties, especially for osteoarthritis.
Turmeric compounds such as curcumin are often combined with Boswellia serrata compounds to improve their anti-inflammatory effects to reduce pain.
A review of 16 different clinical trials found turmeric extracts to be effective for knee osteoarthritis.
A similar conclusion was drawn from a review of 11 clinical trials that examined the use of curcuminoids (of which curcumin is one) for one to four months. It found that curcuminoids had analgesic qualities similar to non-steroidal anti-inflammatory drugs.
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black pepper (Piper nigrum) contains the chemical piperine, which has anti-inflammatory properties.
Piper nigrum it is often added to curcumin products to improve the absorption of curcumin, as is the case with the PanaNatra Joint Pain product.
For musculoskeletal pain, a preliminary human trial that examined the effects of a 1000 mg dose of Rhuleave K (the extract used in PanaNatra) found it to be as effective as paracetamol.
But the study was not placebo-controlled and the dose of paracetamol given (1,000 mg per day) was below the recommended daily intake for pain relief.
Read more: Knee pain: here’s why it happens and how to fix it
Withania somnifera (also called Ashwagandha) has been used in traditional Indian Ayurvedic medicine for thousands of years to reduce stress and ease inflammation.
One of the key chemicals appears to be with aferin A that interferes with the inflammatory signaling pathway.
PanaNatra’s Pain and Sleep product contains 300 mg per tablet of a Withania somnifera extract called KSM66.
A human trial found a dose of 600 mg daily Withania somnifera extract improves the quality of sleep and helps manage insomnia.
In a separate process, Withania somnifera was found to improve the quality of sleep, again when administered at a dose of 600 mg per day.
Read more: From Ayurveda to biomedicine: understanding the human body
So what does this mean?
Whether, and how well, a herbal medicine works is largely dependent on the formulation (how it is made and the extract used) and the dose provided. The same herb used in one formulation may result in a different result than a different formulation containing the same herb.
It is also important to note that effectiveness for one type of pain does not mean that a product will work for other types of pain.
In general, herbal extracts similar to those included in PanaNatra products have some evidence that they work for pain and sleep. Whether they work for you will depend on a number of factors including the effectiveness of the PanaNatra formulation, how much you take and the extent of your pain.
Are you sure?
PanaNatra should be used with caution by some patients.
In general, there is insufficient human data to recommend any of these plant ingredients during pregnancy or breastfeeding. In fact, there is some evidence that Withania somnifera may not be safe to use in pregnancy, and other than the amounts commonly found in food, turmeric and its compounds are not considered safe to use in pregnancy.
Herbs can also affect the effectiveness and safety of other medicines. For example, blood levels of the cancer drug tamoxifen can be reduced when taken concurrently with turmeric supplements.
Withania somnifera has been associated with drowsiness and cases of liver toxicity.
Curcuma longa Products, including formulations containing curcumin and piperine, are also associated with liver toxicity. Therefore, the Australian Therapeutics Administration has proposed adding warning labels to any products containing those ingredients. But this discussion is ongoing and a decision will not be made until next year.
While there is a long history of traditional use of herbs in PanaNatra products, there is limited high-quality scientific evidence for efficacy and safety for these specific products.
Pregnant and lactating women should not take these products, and should not exceed the daily dose recommended by the manufacturer.
If you have an underlying health condition, or take other medications, before trying, consult your doctor or pharmacist to check if these products are suitable for you.
Read more: Do you know what is in the herbal medicine you are taking?
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