The Therapeutic Effects of Black Pepper Essential Oil on the Muscular/Skeletal System

About the Author: Nina Miller
B.Sc. Physiotherapy C.A.H.P.

Abstract 

This paper will address the pathology of Pain & Inflammation as it pertains to the Musculoskeletal system in Aromatherapy. Black Pepper Essential oil -Piper nigrum, is the essential oil selected for the purpose of demonstrating its multiple therapeutic effects on pain & inflammation in the Musculoskeletal system. The analgesic and anti -inflammatory properties of the Black Pepper Essential oil , used in the right dilutions, can serve to offer alternative  , non-invasive , therapeutic  outcomes in treating the individual who is experiencing pain & inflammatory conditions of  the Musculoskeletal system. 
As an aromatherapy student with a background in Orthopaedic physiotherapy, I have chosen to address the  pathology of pain and inflammation as client’s  most dominant and prevailing complaints  pertaining to conditions of the Musculoskeletal system. 

Pain
Musculoskeletal pain is pain that affects bones, joints, ligaments, muscles, and tendons. Muscular/skeletal pain can be acute, which could be sudden and intense, or pain can be chronic or long lasting. 
Pain in the Musculoskeletal system is recognized as soreness. Soreness leads to tension (in the muscular and tendons, fascia) which elicits inflammation and aching. When pain is untreated or treated unsuccessfully, a repetitive pain cycle is established.
Simultaneously, the mind signals its own form of stress by presenting as insomnia which leads to frustrations, leading to panic/fear that left unresolved, causes anxiety which may develop into depression. This stressful pattern is then repeated[1]

Types of Musculoskeletal pain include: 

• Bone pain – bone fracture or other injuries causing bone pain 
• Joint pain – Joint stiffness and inflammation 
• Muscle pain – Muscle spasms, cramps, and injuries causing muscle pain 
• Tendon and ligament pain – sprains and strain, overuse injuries.  

Pain is an unpleasant sensation conveyed to the brain by sensory neurons. The discomfort signals actual or potential injury to the body. Pain can be a physiological and or psychological sensation, which includes the subjective interpretation, the perception of that sensation. Perception indicates the pain’s location, nature, and intensity. There is also an emotional response to pain. [2]
The burden of chronic pain to society is enormous. It is estimated that 11.5% - .55 .2%. of individuals worldwide are defines as suffering from chronic, widespread pain. [3]

Inflammation: 
Signs of inflammation are heat, redness, pain, and swelling. Galen coined the fifth inflammatory sign, loss of function. Inflammation is the result of complex interactions between immune and inflammatory cells, their mediators, as well as regulators. All these components are part of an innate immune response. Insuring an inflammatory healthy state, the response is self-limited to a specific stimulus, programmed to minimize tissue damage. In a disease state, inflammatory cells and pathways continue to perpetuate inflammatory cycles. [4] When referring to the Musculoskeletal system, inflammation can be divided into acute inflammation & chronic inflammation. [5]

Acute Inflammation:

• Short term 
• Immune response is non-specific 
• Immune response is stereotyped 
• Part of the response is fluid production 
• Vascular response 
• Cells found are mainly neutrophils and basophils 
• Occasional tissue breakdown muscle/joint. ‘necrosis’ 

In acute inflammation, chemical and inflammatory mediators are triggered, eliciting an acute phase response leading to the recruitment of immune cells which then end stimulus and healing occurs – a protective response.  

Chronic Inflammation:

• Longer term 
• Immune response is non-specific 
• Immune response is variable 
• Part of response is fibrous tissue production 
• Cells found are mainly macrophages and fibroblasts 
• Always evidence of tissue breakdown, ‘necrosis’ 

Chronic inflammation triggers adaptive immunity which then elicits an ongoing stimulus, recruiting more immune cells which in-turn secrete more inflammatory mediators. This causes an abundance of inflammatory markers   which overtime lead to various inflammatory associated diseases and disorders. [6]

Osteoarthritis
Osteoarthritis (OA) is a common inflammatory degenerative joint disease seen with growing prevalence due to an aging population. Inflammatory mediators increase cytokines and matrix metalloproteinase (MMP) activity which leads to cartilage disruption, mainly due to an imbalance between synthesis and degradation of the extracellular matrix (ECM), in favor of degradation.[7] This leads to joint degeneration and compromised function and disability in activities of daily living. [8]

Black Pepper Essential Oil
Botanical name: Piper Nigrum 
Family: Piperaceae 
Source: Fruit, dried, crushed, almost ripe; steam distilled essential oil. 
Origin: India 
Odour: Fresh, dry, woody, spice 
Perfume: Considered a spicy middle note, fairly high evaporation rate [9]

Key Constituents: [10]

Main actions: Anti-inflammatory, Analgesic, Anti-nociceptive (any substance that inhibits perception of pain) Anti-oxidant, Rubefacient, warming activating. [11]

Indications: Musculoskeletal aches and pains, muscles tension, Arthritis, Rheumatism. Improves sluggish circulation, as well as provides a positive feeling of wellbeing, energizing, and eases anxiety.[12]
For the purpose of this paper, Beta-Caryophyllene the key constituent found in

Black Pepper essential oil , will be addressed as its contribution to the anti-inflammatory effect pertaining to the Musculoskeletal System. 
Beta-Caryophyllene is known to contribute to the rubefacient, warming properties of the oil assisting reduction in inflammation and pain [13]
Beta-Caryophyllene relives anxiety and depression [14]
It was found to Inhibit 5-Lox (inflammatory marker), thus relieving pain and inflammation [15]
Beta-Caryophyllene binds to CBI receptors ( the brain and nervous system) – and CB2 (receptors mainly found in the rest of the body) to reduce inflammation  [16]
Beta-Caryophyllene – local analgesic properties [17] 

Black pepper essential oil  consists of 40-50% monoterpenes-
limonene.  Absorbed into skin and via inhalation.

Alpha-Pinene [19]– Absorbed into the body through inhalation and skin within 20 minutes. Calms the nervous system. Analgesic, Anti-fungal. Increased dopamine and  helps motivation. Skin irritant when oxidized.

35-50% sesquiterpenes – Beta-caryophyllene – contributes to spicy note anti-inflammatory local analgesic, anti-carcinogenic, relives anxiety and depression, potential skin lightening agent. Antimicrobial, anti-inflammatory, vulnerary and balancing.[20]

4% Aldehydes – anti-fungal, sedative, skin irritant, sensitizer. [21]
Great variations in percentages of the Black pepper essential oil constituents could be attributed to difference in environmental factors, plant variety, cultivation, harvesting stage, and extraction method. [22]

Benefits of Black Pepper Essential Oil 

• Reduces muscle injuries, tendonitis, and symptoms of arthritis, and rheumatism[23]
• Rubefacient – warming properties improve circulation and heart health when topically applied[24]
• Provides relief from spasms and cramps – antispasmodic properties[25]
• Anti inflammatory  on joints due to Beta-caryophyllene (BCP).
• BCP actives CB2 receptors which assist in a calming of the Nervous System and contribute to an anti-inflammatory effect.

An in-vitro experiment on human chondrocytes, BCP caused marked reduction of inflammatory markers [26]  BCP preserves articular cartilage – histological adverse joint alterations were significantly reduced in BCP treated mice. Particularly noticed in the reduction of a) Inflammatory infiltrate b) presence of the joint cartilage [27]  BCP reduced the severity of arthritis. BCP attenuatedthe severity of arthritic induced antigen in mice but did not fully revert the security of adults. [28]

Black Pepper Essential Oil Recommendations 

• Chose dilution suitable for pathology 
• Dilution 1-2% depending on area and age of individual.
• Change oils every 2-weeks 
• Do not massage swollen/inflamed muscles [29]
• Not recommended in a bath[30]

Applications for Musculoskeletal pain and inflammation 

• Local compress 
• Gel/oil/ointment 
• Carrier oil:  Almond, Grapeseed, Sunflower seed - 1-100% 
• Sesame, St. John’s wort, Arnica infused, Calendula Infused 10-20%
• Salts: Epsom, Magnesium, Himalayan dilute with carrier oil [31]

Safety of Black Pepper Essential Oil: 
Black Pepper Essential Oil  is considered to be a safe essential oil when used in correct dilutions provided the oil is not old or oxidized. 
BCP, one of its main constituents is considered a weak skin allergen. BCP is non-toxic, non-mutagenic, and anti-tumor.  The oxidation of BCP does not increase skin sensitization further. 
The additional key constituents in Black pepper essential oil such as D-Limonene, alpha Pinene, and gamma-3-Carene can be volatile and therefore can easily be oxidized, causing skin sensitization. To avoid oxidation, it is recommended to store Black pepper essential oil in a dark, air tight container in the refrigerator. Adding an additional antioxidant when preparing formulations will delay oxidation.[32]

Caution
May irritate sensitive skin. Do not use in pregnancy. Keep away from children. Shelf-life is 2-years. Most individuals who experience chronic pain are typically on some form of pain and ant-depressant medication. It is recommended to start with low dilutions to avoid essential oil interacting with the medication. Gradually progress the essential oil dilution according to the individual’s response. [33]

Aromatherapy has a simultaneous reaction on the mind, body, and emotions. Holistic treatments are therefore incorporated when treating conditions pertaining to the Musculoskeletal system.  The Aromatherapist approach to treating conditions pertaining to the Musculoskeletal system must consider an analgesic, anti-inflammatory, and anxiolytic therapies.

Current treatment addressing conditions of arthritis includes the use of steroidal and non-steroidal drugs which do have anti-inflammatory effects. These drugs however continue to display adverse effects on the viability of the cell.[34] Sara Pluta , education director for Emerald Health BioCeuticals  explained that the most effective way for treating inflammation is with the support of the Endo  Cannabinoid System (ECS)– “the most critical biological system in the body that promotes homeostasis in every cell, tissue, and organ. It is intrinsically involved in balancing the neurotransmitters, that influence pain and inflammation, which is significant because when inflammation becomes out of control, it can cause severe tissue damage and disrupt your health on a deeper cellular level, leading to chronic disease.”[35]

Mini Clinical  Case Study-Nina Miller Aromatherapy student
Four individuals, all over 50 years, 1 male, 3 females, were treated with a formulation containing 0.5% Black Pepper Essential Oil – Piper Nigrum, addressing subacute (more than 4 weeks) and chronic complaints of knee pain and inflammation.
Black Pepper Essential Oil was selected as a choice in addressing pain and inflammation due to it’s main constituent, BCP.   Additional essential oils were added were added to the formulation to form a synergy of essential oils that included therapeutic properties such as analgesic, anti-inflammatory and anxiolytic properties.  A 3-4% dilution of the synergy was used in Aloe vera gel/oil formulation on the affected area 2-3 times a day.

Synergies of essential oils that included the Black pepper essential oil addressed treating the individual’s pain and inflammation addressing the following therapeutics;

Outcome – After 1 week, all four individuals experienced significant reductions in pain and inflammation based on the pain analogue scale. 

This demonstrates that using Black Pepper Essential Oil in combination  with other Analgesic, Anti -inflammatory and Anxiolytic Essential Oils  in treating pain, inflammation, and nervous tension, is an effective treatment when applied to conditions of the muscular/skeletal system.

To enhance the therapeutic effect of Black pepper essential oil, consider blending with other Essential Oils that offer Analgesic, Anti-inflammatory and improved Circulatory, rubefacient benefits such as true Lavender, Basil Linalool type, Clary Sage, Rosemary, Sweet Marjoram, Peppermint, Geranium, Juniper Berry, Coriander Seed, Nutmeg, Galbanum, Rose, Citrus (Bergamot, Lemon, Yuzu).  BPEO blends well with cinnamon, clove, and other spices. [37]

Recommendation Mini case study:
In order to assist Aromatherapists in treating individuals experiencing joint pain and inflammation, it is recommended that a larger study utilizing Black pepper essential oil as part of a synergy be performed  and its outcomes analyzed. 
This will help refine and establish various synergies  at optimum dilutions, which may prove beneficial to the Aromatherapist’s data base ,the  individual, the community, and to health care in general when addressing Aromatherapy treatment of  pain & inflammation  in  the
Musculoskeletal System.  This will provide the individual with supported human research related to conditions of similar nature. This non-invasive and non-intimidating form of treatment would encourage and support the individual to embark on a healthier journey in recovery as opposed to relying solely on medical drugs as the preferred solution. 

Conclusion: 
Black Pepper essential oil is a good choice for the Aromatherapist when treating pain & inflammation of the Musculoskeletal system. Black pepper essential oil has been stated to have a calming effect on the Nervous system. This choice of essential oil therefore incorporates a true holistic approach in treating the individual’s body & mind. This approach assists the individual in further reducing stress, tension, fear and anxiety which enhances overall treatment outcome.

References

[1] Healing fragrances School of Aromatherapy-Clinical Aromatherapy, Pain management, Danielle Sade B.sc &CAHP
[2] Medical Dictionary-Pain By Farlex (2009)https://medical.dictionary.the free dictionary.com/pain
[3] Tracey I, Dunckley P. Importance of anti- and pro-nociceptive mechanisms in human disease. Gut. 2004 Nov;53(11):1553-5. doi: 10.1136/gut.2004.046110. PMID: 15479668; PMCID: PMC1774272. https://www.webmd.com/arthritis/about-inflammation
[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5541893/
[5]https://www.ncbi.n/m.nih.gov>books-chapter 2 Historical Perspectives Inflammation and the microcirculation-NCBI Bookshelf
[6] Arulselvan P, Fard MT, Tan WS, Gothai S, Fakurazi S, Norhaizan ME, Kumar SS. Role of Antioxidants and Natural Products in Inflammation. Oxid Med Cell Longev. 2016;2016:5276130. doi: 10.1155/2016/5276130. Epub 2016 Oct 10. PMID: 27803
[7]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6723248/#:~:text=%CE%B2%2Dcaryophyllene%20(BCP)%20is,activation%20exerts%20anti%2Darthritic%20effects.
[8]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6723248/#:~:text=%CE%B2%2Dcaryophyllene%20(BCP)%20is,activation%20exerts%20anti%2Darthritic%20effects.
[9] Healing Fragrances A Practioners Guide To Aromatherapy -Danielle Sade B.sc & CAHP Black Pepper page 120
[11] Aromatherapy Blending Essential Oils in Synergy, second addition, Jennifer Peace Rhind, page 84
[12] LabAroma.com Black Pepper essential oil.
[13] Aromatherapy Blending Essential Oils In Synergy, second addition page 84,Jennifer Peace Rhind.
[14] Bahi A, Al Mansouri S, Al Memari E, Al Ameri M, Nurulain SM, Ojha S. β-Caryophyllene, a CB2 receptor agonist produces multiple behavioral changes relevant to anxiety and depression in mice. Physiol  Behav. 2014 Aug;135:119-24. doi: 10.1016/j.physbeh.2014.06.003. Epub 2014 Jun 13. PMID: 24930711.
[15] Essential Oil Safety ,2^nd edition, Robert Tisserand/Rodney Young, page 520-521
[16] Ceccarelli I, Fiorenzani P, Pessina F, Pinassi J, Aglianò M, Miragliotta V, Aloisi AM. The CB2 Agonist β-Caryophyllene in Male and Female Rats Exposed to a Model of Persistent Inflammatory Pain. Front Neurosci. 2020 Aug 18;14:850. doi: 10.3389/fnins.2020.00850. PMID: 33013287; PMCID: PMC7461959.
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[18] Essential Oil Safety , 2^nd edition, Robert Tisserand/Rodney Young , page 384-385
[19] Healing Fragrances, A Practitioners Guide To Aromatherapy-Danielle Sade B.sc & CAHP, Black Pepper page 120
[20] Healing Fragrances ,A Practitioners Guide To Aromatherapy-Danielle Sade B.sc & CAHP Black Pepper page 120
[21] Essential Oil Safety , 2^nd edition, Robert Tisserand/Rodney Young , page 384-385
[22] Dosoky,  Noura S et al. “Volatiles of Black Pepper Fruits (Piper nigrum L.).” Molecules (Basel, Switzerland) vol. 24,23 4244. 21 Nov. 2019, doi:10.3390/molecules24234244
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[24] LAB Aroma.com
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[35] Pepper Oil Extract/ Beta-Caryophyllene: A Non-cannabis Phytocannabinoid for Pain and Inflammation
Prof. Gene Bruno, MS, MHS, RH(AHG)—Huntington University of Health Sciences | December 31, 2020
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[37] Aromatherapeutic Blending Essential Oils In Synergy, second addition, page 84, Jennifer Peace Rhind.

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The information contained in this educational service is not intended nor is it implied to be a substitute for professional medical advice, diagnosis or treatment. Healing Fragrances School of Aromatherapy does not accept responsibility for any problematic situations experienced by you or anyone to whom you give treatment.

Always seek the advice of your physician or other qualified health providers prior to starting any new treatment or with any questions you may have regarding a medical condition. Nothing contained in the course is intended to provide a medical diagnosis or offer a treatment.