A RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED, PARALLEL GROUP CLINICAL STUDY TO EVALUATE THE ANALGESIC EFFECT OF AQUEOUS EXTRACT OF TERMINALIA CHEBULA, A PROPRIETARY CHROMIUM COMPLEX, AND THEIR COMBINATION IN SUBJECTS WITH JOINT DISCOMFORT

Authors

  • Chandrasekhar Nutalapati Senior Resident, Department of Clinical Pharmacology and Therapeutics, Nizam's Institute of Medical Sciences, Panjagutta, Hyderabad 500082
  • Uday Kumar Chiranjeevi Senior Resident, Department of Clinical Pharmacology and Therapeutics, Nizam's Institute of Medical Sciences, Panjagutta, Hyderabad 500082
  • Kishan P V Senior Resident, Department of Clinical Pharmacology and Therapeutics, Nizam's Institute of Medical Sciences, Panjagutta, Hyderabad 500082
  • Kiran Kishore K Senior Resident, Department of Clinical Pharmacology and Therapeutics, Nizam's Institute of Medical Sciences, Panjagutta, Hyderabad 500082
  • Usharani Pingali

Abstract

Objective: To evaluate the analgesic effect of an aqueous extract of Terminalia chebula (TCE), a proprietary chromium complex (PCC), and their
combination in subjects with joint discomfort.
Methods: A total of 100 patients with knee joint discomfort were randomized into five treatment groups - TCE 500 mg BID, TCE 500 mg BID+PCC
400 µg OD, PCC 400 µg OD alone, placebo, and TCE 250 mg BID, for 12 weeks in a double-blinded manner. Assessment of symptoms of knee joint pain
and discomfort was done by modified Western Ontario and McMaster Universities Arthritis Index (mWOMAC) and knee swelling index (KSI); visual
analog scale (VAS) was used for subjective assessment of pain, stiffness, and disability. Statistical analysis was done with GraphPad Prism 6.
Results: Absolute reduction in mWOMAC score in TCE 500 mg (19.82±8.35), TCE 500 mg+PCC 400 µg (13.10±5.69), PCC 400 µg (8.30±3.81), placebo
(2.45±3.07), and TCE 250 mg (10.47±4.43), respectively, at the end of 12 weeks as compared to the baseline values. Absolute reduction in KSI in
TCE 500 mg (28.95±16.82), TCE 500 mg+PCC 400 µg (19.14±9.50), PCC 400 µg (12.7±4.86), placebo (10.03±3.8), and TCE 250 mg (18.24±6.86),
respectively, at the end of 12 weeks as compared to the baseline values (p<0.001). Similar results were seen with VAS assessments for pain, stiffness,
and disability. All the treatments were well tolerated.
Conclusion: TCE and PCC reduce joint discomfort.
Keywords: Terminalia chebula extract, Proprietary chromium complex, Western Ontario and McMaster Universities Arthritis Index.

Downloads

Download data is not yet available.

References

Gerwin N, Hops C, Lucke A. Intra-articular drug delivery in

osteoarthritis. Adv Drug Deliv Rev 2006;58(1):226-42.

Fransen M, Bridgett L, March L, Hoy D, Penserga E, Brooks P.

The epidemiology of osteoarthritis in Asia. Int J Rheum Dis

;14(2):113-21.

Mahajan A, Verma S, Tandon V. Osteoarthritis. J Assoc Physicians

India 2005;53:634-41.

Peat G, McCarney R, Croft P. Knee pain and osteoarthritis in older

adults: A review of community burden and current use of primary

health care. Ann Rheum Dis 2001;60(2):91-7.

Laine L. GI risk and risk factors of NSAIDs. J Cardiovasc Pharmacol

;47 Suppl 1:S60-6.

Larkai EN, Smith JL, Lidsky MD, Graham DY. Gastroduodenal mucosa

and dyspeptic symptoms in arthritic patients during chronic nonsteroidal

anti-inflammatory drug use. Am J Gastroenterol 1987;82(11):1153-8.

Laine L. Gastrointestinal effects of NSAIDs and coxibs. J Pain

Symptom Manage 2003;25 Suppl 2: S32-40.

Surya Prakash DV, Sree Satya N, Avanigadda S, Vangalapati M.

Pharmacological review on Terminalia chebula. Int J Res Pharm

Biomed Sci 2012;3(2):679-83.

Nair V, Singh S, Gupta YK. Anti-arthritic and disease modifying

activity of Terminalia chebula Retz. in experimental models. J Pharm

Pharmacol 2010;62(12):1801-6.

Reddy DB, Reddy TC, Jyotsna G, Sharan S, Priya N, Lakshmipathi V,

et al. Chebulagic acid, a COX-LOX dual inhibitor isolated from the

fruits of Terminalia chebula Retz. induces apoptosis in COLO-205 cell

Asian J Pharm Clin Res, Vol 9, Issue 3, 2016, 264-269

Nutalapati et al.

line. J Ethnopharmacol 2009;124(3):506-12.

Kumar CU, Pokuri VK, Pingali U. Evaluation of the analgesic activity

of standardized aqueous extract of Terminalia chebula in healthy human

participants using hot air pain model. J Clin Diagn Res 2015;9(5):01-04.

Pratibha N, Saxena VS, Amit A, D’Souza P, Bagchi M, Bagchi D. Antiinflammatory

activities

of Aller-7,

a novel polyherbal

formulation

for

allergic

rhinitis. Int J Tissue

React 2004;26(1-2):43-51.

Fleck A, Gupta RC, Goad JT, Lasher MA, Canerdy TD, Kalidindi SR.

Anti-arthritic efficacy and safety of crominex 3

(Trivalent chromium,

Phyllanthus emblica extract, and Shilajit) in moderately arthritic dogs.

J Vet Sci Anim Husbandry 2014;19(4):1-7.

+

Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis.

Ann Rheum Dis 1957;16(4):494-502.

Available from: http://www.copcord.org/images/WOMAC.pdf.

Juang LJ, Sheu SJ. Chemical identification of the sources of commercial

Fructus Chebulae. Phytochem Anal 2005;16(4):246-51.

Seo JB, Jeong JY, Park JY, Jun EM, Lee SI, Choe SS, et al.

Anti-arthritic and analgesic effect of NDI10218, a standardized extract

of Terminalia chebula, on arthritis and pain model. Biomol Ther (Seoul)

;20(1):104-12.

Bag A, Bhattacharyya SK, Chattopadhyay RR. The development of

Terminalia chebula Retz. (Combretaceae) in clinical research. Asian

Pac J Trop Biomed 2013;3(3):244-52.

Muhammad S, Khan BA, Akhtar N, Mahmood T, Rasul A, Hussain I.

The morphology, extractions, chemical constituents and uses of

Terminalia chebula: A review. J Med Plants Res 2012;6(33):4772-5.

Reddy DB, Reddanna P. Chebulagic acid (CA) attenuates LPS-induced

inflammation by suppressing NF-kappaB and MAPK activation

in RAW 264.7 macrophages. Biochem Biophys Res Commun

;381(1):112-7.

Jagetia GC, Rao SK, Baliga MS, S Babu K. The evaluation of nitric

oxide scavenging activity of certain herbal formulations in vitro: A

preliminary study. Phytother Res 2004;18(7):561-5.

Sumantran VN, Kulkarni AA, Harsulkar A, Wele A, Koppikar SJ,

Chandwaskar R, et al. Hyaluronidase and collagenase inhibitory

activities of the herbal formulation Triphala guggulu. J Biosci

;32(4):755-61.

Karmakar S, Kay J, Gravallese EM. Bone damage in rheumatoid

arthritis: Mechanistic insights and approaches to prevention. Rheum

Dis Clin North Am 2010;36(2):385-404.

Sabina EP, Rasool M. Therapeutic efficacy of Indian ayurvedic herbal

formulation triphala on lipid peroxidation, antioxidant status and

inflammatory mediator TNF-α in adjuvant induced arthritic mice. Int J

Biol Chem 2007;1(3):149-55.

Published

01-05-2016

How to Cite

Nutalapati, C., U. K. Chiranjeevi, K. P V, K. K. K, and U. Pingali. “A RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED, PARALLEL GROUP CLINICAL STUDY TO EVALUATE THE ANALGESIC EFFECT OF AQUEOUS EXTRACT OF TERMINALIA CHEBULA, A PROPRIETARY CHROMIUM COMPLEX, AND THEIR COMBINATION IN SUBJECTS WITH JOINT DISCOMFORT”. Asian Journal of Pharmaceutical and Clinical Research, vol. 9, no. 3, May 2016, pp. 264-9, https://journals.innovareacademics.in/index.php/ajpcr/article/view/11217.

Issue

Section

Original Article(s)