Landmark Study: Topical Frankincense Relieves Knee Osteoarthritis Pain and Stiffness

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Can a centuries-old natural remedy from traditional medicine offer new hope for those suffering from the pain and stiffness of knee osteoarthritis?

Osteoarthritis (OA), a degenerative joint disorder characterized by pain, inflammation, and reduced mobility, affects millions worldwide, with the knee being one of the most commonly impacted sites.1 Current pharmacological treatments often come with serious side effects, leaving patients seeking safer, natural alternatives.1,2 Now, an exciting study published in BMC Research Notes offers new evidence that frankincense, an aromatic resin used in traditional medicine for centuries, may be a viable treatment option for this prevalent condition.3

In the randomized, double-blind, placebo-controlled clinical trial led by researchers at Isfahan University of Medical Sciences in Iran, 70 patients with knee OA were divided into two groups.3 The treatment group applied an oily solution containing enriched frankincense extract, also known as boswellic acids, to their affected knee three times daily for four weeks, while the control group received a placebo solution.3 Researchers evaluated several outcome measures, including the WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) score, VAS (Visual Analogue Scale) for pain severity, and PGA (Patient Global Assessment) score.3

Remarkably, the frankincense group experienced significant improvements in all measures compared to placebo.3 Total WOMAC scores, which assess pain, stiffness, and physical function, decreased from a median of 67 to 24 in the treatment group versus 70 to 52 in the placebo group.3 Pain severity, as measured by VAS, dropped from 9 to 4 with frankincense compared to only 9 to 6 with placebo.3 Patients' overall assessment of their condition (PGA score) also showed greater improvement with frankincense.3

The therapeutic effects of frankincense are attributed to boswellic acids, particularly AKBA (3-O-acetyl-11-keto-β-boswellic acid).3 These compounds are known to inhibit 5-lipoxygenase and other inflammatory pathways implicated in OA.4,5 Previous studies have demonstrated the benefits of oral Boswellia serrata for knee OA, but this is the first clinical trial to investigate a topical frankincense preparation, which offers the advantage of localized effects with fewer systemic side effects.3,6,7

While the study's findings are highly promising, the authors acknowledge some limitations, including the small sample size and short follow-up period. Larger, longer-term trials are needed to confirm the efficacy and safety of topical frankincense for knee OA. However, given the favorable tolerability profile observed in this study, with no serious adverse effects reported, frankincense oil represents an attractive option for those seeking natural remedies for arthritic knees.3

As the global burden of OA continues to rise with an aging population, identifying safe and effective treatments is crucial. By harnessing the power of nature, frankincense extract may offer renewed hope for improving quality of life in those affected by this debilitating condition. As integrative medicine gains traction, further research into traditional plant-based therapies like frankincense will be key to expanding our arsenal of tools for managing chronic diseases naturally.

To learn more about the benefits of boswellia (frankincense) visit our database here.

For other natural solutions to osteoarthritis visit our extensive database on the subject here.


1. Primorac D, Molnar V, Rod E, et al. Knee Osteoarthritis: A Review of Pathogenesis and State-Of-The-Art Non-Operative Therapeutic Considerations. Genes. 2020;11(8):854. doi:[10.3390/genes11080854](  

2. D'Arcy Y, Mantyh P, Yaksh T, Donevan S, Hall J, Sadrarhami M. Treating osteoarthritis pain: mechanisms of action of acetaminophen, nonsteroidal anti-inflammatory drugs, opioids, and nerve growth factor antibodies. Postgrad Med. 2021;133(8):875-888. doi:[10.1080/00325481.2021.1949199](

3. Mohsenzadeh A, Karimifar M, Soltani R, Hajhashemi V. Evaluation of the effectiveness of topical oily solution containing frankincense extract in the treatment of knee osteoarthritis: a randomized, double-blind, placebo-controlled clinical trial. BMC Res Notes. 2023;16(1):28. doi:[10.1186/s13104-023-06291-5](

4. Houssen ME, Ragab A, Mesbah A, et al. Natural anti-inflammatory products and leukotriene inhibitors as complementary therapy for bronchial asthma. Clin Biochem. 2010;43(10-11):887-890. doi:[10.1016/j.clinbiochem.2010.04.061](

5. Ammon HP. Modulation of the immune system by Boswellia serrata extracts and boswellic acids. Phytomedicine. 2010;17(11):862-867. doi:[10.1016/j.phymed.2010.03.003](

6. Kimmatkar N, Thawani V, Hingorani L, Khiyani R. Efficacy and tolerability of Boswellia serrata extract in treatment of osteoarthritis of knee--a randomized double blind placebo controlled trial. Phytomedicine. 2003;10(1):3-7. doi:[10.1078/094471103321648593](

7. Majeed M, Majeed S, Narayanan NK, Nagabhushanam K. A pilot, randomized, double-blind, placebo-controlled trial to assess the safety and efficacy of a novel Boswellia serrata extract in the management of osteoarthritis of the knee. Phytother Res. 2019;33(5):1457-1468. doi:[10.1002/ptr.6338](

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