The document discusses the effectiveness of curcumin, the active component in turmeric, in managing chronic pain and inflammation, comparing it to NSAIDs like ibuprofen and diclofenac. It highlights research showing curcumin's strong anti-inflammatory and antioxidant properties, along with its potential to improve symptoms in conditions like rheumatoid arthritis and knee osteoarthritis. Curcumin is deemed safe for use, even in elderly patients, and may serve as a beneficial alternative or adjunct to conventional pain management strategies.

1. «La Curcumina nel dolore cronico»
Dott. Andrea Piccozzi
Specialista in Medica Fisica e Riabilitazione
YAP researcher – Young Against Pain
Medico Sportivo
Team Doctor U.S. Triestina Calcio

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Chronic and degenerative illness
express high grade of inflammation
Cardiovascular diseases MSK pain
INFLAMMATION
Cancer
Auto-immune
diseases
Neuro degenerative
diseases
Type II diabetes High grade or Low grade

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Paradigm Shift in Inflammation

5. CGRP:Calcitonin gene related peptide; NMDA-R, N-methyl-D-aspartic acid receptor , EGF, epidermal growth factor; HIF, hypoxia
inducible factor; MMP, matrix metalloproteinase; PDGF, platelet-derived growth factor; TIMP, tissue inhibitor of metalloproteinase;
VEGF, vascular endothelial growth factor.
Iceberg Theory (2009, Fredberg et al.)

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Drugs used for pain management

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 Precautions in patients >70 years
 GI side effects
 Risks of gastic ulcers
 Attention in patients treated with
anti-coagulatns
 Risk of kidney impairment
Side effects and risks of NSAID’s
“Gli utilizzatori di FANS hanno
ulcere sintomatiche complicate 3-4
volte più frequentemente rispetto
ai non utilizzatori” 2
“Disturbi gastrici e intestinali
compaiono nel 10 - 30%
degli utilizzatori di FANS” 1
1-2Nederlandse Huisartsen Genootschap – pijnbestrijding: farmacotherapeutische richtlijn
3Cannon 2006, Chan 2006, Helin-Salmivaara 2006, Kearney 2006, McGettigan 2006

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 Curcuma longa
 Boswellia serrata
• Omega 3 (EPA and DHA)
 Zingiber officinale
Natural substances with anti-inflammatory activity

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• Rhizomatous, herbaceous,
perennial, plant
• Family Zingiberaceae
• Lives well with mild temperatures
(20°-30° C. and high rains
• Reach 1 m in hight
• Nice hermafrodite flowers in 20cm
inflorescence (August)
• Active sustances are concentrated
in rhizomes
Turmeric, the plant (Curcuma longa)

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Curcumin: THE active principle of turmeric
(1,7-bis (4-hydroxy-3-méthoxy-phényl) hepta-1,6-diène-3,5-dione)
Turmeric powder
contains 3-7% of Curcuminoids
essential oils and fibers

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8.770 studies shows pleiotroitropic effects
of curcumin (Pubmed)

12. Pubmed 18/11/2015
2367 publications
Curcumin anti-oxidant power is 10 time higher than Vit. E
- Direct activity on ROS
- Induction of NRF2
- Induce mitocondrial biogenesis
Curcumin is a powerful anti-oxidant

13. Epigenetic activity of Curcumin

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Epigenetic activity of curcumin
Molecular targets Activity Epigenetic and
anti-cancer
activity under
evaluation
DNA methylation,
HAT activities
Histone acetylation
(Acetil transferase/histone
deacetilase
HDAC isoenzymes (HDAC 1,3,4,5,8)
miRNA’s
miRNA’s target genes
Decrease
Decrease
Rebalance
Reduce
expression
Modulation
Regulation
Anti-oxidant,
anti-angiogenic,
antiproliferative
pro-apoptotic

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23
24
25
26
27
28
29
0
5
10
15
20
0
5
10
15
20
“Randomized, single blind study on efficacy and tolerability of
curcumin in patients with reumatoid poliarthritis “
Chandran et al. A Randomized, Pilot Study to Assess the Efficacy and Safety of Curcumin in Patients with Active Rheumatoid Arthritis. Phytother. Res. 2012;26:1719–
1725.
° n = 45 : curcumin n =15 ; diclofenac n = 15 ; curcumin and diclofenac n = 15
° 8 weeks , 1000 mg curcumin (BCM-95) e 100 mg diclofenac
Curcumin vs. NSAID’ (diclofenac )
Tassodisedimentazioneeritrocitaria(ESR)
- 11% - 8%
Significative reduction of
Disease Activity Score (DAS)
Significative reduction of
Joints pain
- 83%
- 69%
- 97% - 89%
Significative reduction of
Joints swelling
%Incidenza
%Incidenza
Curcumin
extract Diclofenac
1000 mg 100 mg
p < 0.05 p < 0.05 p < 0.05
Curcumin
extract Diclofenac
1000 mg 100 mg
Curcumin
extract Diclofenac
1000 mg 100 mg

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280
290
300
310
320
330
340
350
360
Ibuprofen Curcumina
° n = 367 : curcumin extract n = 182 ; ibuprofen n = 185
° After 4 weeks 1500 mg curcumin (2 capsuls 3x/die) e 1200 mg
ibuprofen (2 capsuls 3x/die).
° Simple turmeric extract
Mobility
Distance covered in 6 minutes
(Time 0 and after 4 weeks)
p = 0,010
Meterswalkedin6minutes
Chronic Pain
(Time 0 and after 4
weeks)
0
1
2
3
4
5
6
Ibuprofen Curcumina
p = 0,018
%Incidence
1200 mg 1500 mg 1200 mg 1500 mg
)
- 41%
+ 14% + 11%
Curcumin vs. NSAID’ (ibuprofen)
“Efficacy and safety of curcumin vs. Ibuprofen in patients
with knee arthrosis : a multicentric study“
Kuptniratsaikul V et al. Efficacy and safety of Curcuma domestica extracts compared with ibuprofen in patients with knee
osteoarthritis: a multicenter study. Clin Interv Aging. 2014 Mar 20;9:451-8.
- 39%

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Combination of Curcumin an ginger is effective as well as NSAID’S (indometacine)
Objective: measure effective of a blend of curcumin and ginger on pain
in patients with rheumatoid arthritis
3 groups NSAID’S (Indometacine) vs. 200 mg (CG) vs. 400 mg (CG)
Results:
Arthritic score
14d
Arthritic score
28d
Nsaid’s
(Indometacine)
 39.6%  50%
200 mg  41.7% 58.3%
400 mg  52.1%  78.6%
0
4
8
12
16
7 giorni 14 giorni 28 giorni
Controllo (dopo trattamento) Indometacina
200 mg curcumina +zenzero 400 mg curcumina+zenzero
- 78,6%- 52%Arthriticscore

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21. Curcuma polvere
Curcumina principio attivo (1)
Fitosoma (1)
Oli (1)
Ciclodestrina(1)
Forma micellare o Solubilizzata (2)
X 9,5 – 51,1
X 57,7
X 335
X 1350
X 7,3
Source:
• (1) Jäger et al, Nutrition Journal 2014, 13:11, comparative absorption of curcumin formulations.
• (2) Schiborr et al, Mol. Nutr. Food Res. 2014, 58, 516-527.
X 1
Biodisponibilità vs. Curcuma
Bioavailability of IMPROVED Curcumins

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• Curcuma longa is GRASS in the USA
Turmeric tolerability
• Curcumin is not carcinogenic
• No concerns of genotoxicity.
• ADI* of 3 mg/kg bw/day based on the NOAEL of 250-320
mg/kg bw/day
• Intake of curcumin from the normal diet amounts to less than
7% of the ADI of 3 mg/kg bw/day
• Possible weak interference with anti-coagulant that normally
do not require dosage adjustments.
*ADI = Accettable daily Intake

23. Curcumin as a background supplement in
MSK Pain Management
 In chronic msk pain:
50mg every 12 hours together with oppiods until
rehabilitation protocol is completed with improved
functionality for at least 3 months.
 In acute msk pain:
To dismiss /diminuish the use(abuse) of NSAIDs:
100mg in acute phase every 12 hours until pain
reduction.(NSAID continued until VAS<4/5)
Maintainance with 50mg every 12 hours until pain
relief.

26. Acute sports injuries:
2 softgel x 2 day for acute sport
injuries until full recovery
Chronic Muscle Soreness (DOMS):
1 x 2 softgel daily.
1 tablet: 50 mg curcumin (micellar)

27. Take home messages
Curcumin is effective on chronic pain and inflammation
as NSAID’s providing additional benefits (recovery)
«Enhanced » curcumins have better bioavailability
Curcumin is safe, can be used with all patients

28. Grazie per l’attenzione!