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Heather Anderson, MD Kathleen Bennett, MS Laura Bystrom, PhD
Mariann Garner-Wizard Shari Henson Amy Keller, PhD Heather S Oliff, PhD
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File: Black Cumin (Nigella sativa, Ranunculaceae)

Knee Osteoarthritis

HC 051734-577

Date: September 29, 2017

RE: Black Cumin Oil Is More Effective than Acetaminophen in Reducing Pain in
Elderly Patients with Knee Osteoarthritis

Kooshki A, Forouzan R, Rakhshani MH, Mohammadi M. Effect of topical application of

Nigella sativa oil and oral acetaminophen on pain in elderly with knee osteoarthritis: a
crossover clinical trial. Electron Physician. 2016;8(11):3193-3197.

Knee osteoarthritis (KO) is a common disabling condition in the elderly. Its treatment
includes medications, surgery, and complementary therapies. Nonsteroidal anti-
inflammatory drugs, which are often used, are not completely effective and are
associated with adverse effects. Black cumin (Nigella sativa, Ranunculaceae) oil and its
active components, especially thymoquinone, have antioxidant, anti-inflammatory, and
analgesic properties. These authors conducted a crossover, clinical trial to evaluate the
topical application of black cumin oil (Barij-e-Kashan; Kashan, Iran) and oral
acetaminophen on KO in elderly patients living in a nursing home in Sabzevar City, Iran.
The study was conducted from November 21, 2014, to January 20, 2015.

Patients were eligible for the study if they were older than 65 years and had been
diagnosed with KO using the American College of Rheumatology criteria, which included
knee pain on most days of the preceding month, crepitus on active motion, morning
stiffness for less than 30 minutes, and bony enlargement found on physical examination
of the knee. Forty-two patients with a mean age of 75.66 8.9 years were enrolled in the
study. Two patients did not comply with the study protocol and were excluded from the
final analysis.

During phase 1 of the study, the patients in group 1 applied 1 mL black cumin oil to the
knee 3 times daily every 8 hours for 3 weeks, massaging the knee for 5 minutes with the
palm of the hand in a clockwise direction at the front and sides of the joint. [Note: The
Intervention section of the article says 1 week; however, the Discussion section and
abstract say 3 weeks.] The patients in group 2 were instructed to take 1 tablet of 325 mg
acetaminophen 3 times daily every 8 hours for 3 weeks. Following a 1-month washout
period, each group then followed the alternate treatment protocol.

Pain intensity was measured using a visual analogue scale before and after the 2
phases of the study, with 0-3 indicating mild pain; 4-5, moderate pain; and 8-10, severe
 pain. The authors report that significant improvements in knee pain were seen after both
treatments (P = 0.0001). The improvement in pain intensity was significantly greater in
the black cumin oil group compared with the acetaminophen group (P = 0.01).

Thymoquinone in black cumin is reported to inhibit oxidative stress and exhibit an

analgesic effect on the central nervous system of study rats with experimental allergic
encephalomyelitis.1 In another cited animal study, the analgesic and anti-inflammatory
effects of black cumin were attributed to its polyphenols.2

"This study showed that topical use of Nigella sativa oil can be more effective in reducing
knee pain in elderly patients than acetaminophen, which is typically used as a safe
supplement for the elderly," conclude the authors. The mechanisms involved should be
explored further in studies of longer duration.

This study was funded by Sabzevar University of Medical Sciences (Sabzevar, Iran).

Shari Henson

References
1
Mohamed A, Shoker A, Bendjelloul F, et al. Improvement of experimental allergic encephalomyelitis (EAE)
by thymoquinone; an oxidative stress inhibitor. Biomed Sci Instrum. 2003;39:440-445.
2
Ghannadi A, Hajhashemi V, Jafarabadi H. An investigation of the analgesic and anti-inflammatory effects of
Nigella sativa seed polyphenols. J Med Food. 2005;8(4):488-493.

Referenced article can be accessed at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5358924/.

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