An antioxidant that is abundant in some mushrooms has shown promise for easing period pain. A daily dose of a supplement containing L-ergothioneine, which is also in fermented foods, seems to limit the extent of this pain by targeting cells within the uterus, rather than just blocking discomfort that has already taken hold.

“Instead of treating the symptom acutely when the pain is already severe, EGT [L-ergothioneine] acts as a nutritional foundational support, potentially reducing the reliance on strong medications and giving women a safer way to reclaim their well-being,” says Guohua Xiao at Gene III Biotechnology Co. in Nanjing, China.

Period pain, or dysmenorrhea, is considered one of the most common gynaecological-related issues, but , from 16 per cent to 91 per cent. It is thought to be caused by the uterus producing higher levels of inflammatory chemicals called prostaglandins, which result in it contracting strongly to shed its lining. This can make the uterus press against nearby blood vessels, briefly cutting off the oxygen supply to muscle tissue, which causes pain.

Dysmenorrhea . This occurs when there is an imbalance between molecules called free radicals and antioxidants in the body, which causes cell damage.

Current advice recommends using painkillers such as ibuprofen, which reduces inflammation and blocks the production of prostaglandins. Xiao and his team wondered if L-ergothioneine could have a protective effect in the uterus.

To put it to the test, Xiao and his colleagues recruited 40 women, aged between 18 and 30, who had been diagnosed with primary dysmenorrhea – period pain that isn’t caused by a particular condition, such as endometriosis. None of them had attempted to treat their dysmenorrhea, such as through painkillers or traditional Chinese medicine, within the past month.

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Half of the women were given 120 milligrams of L-ergothioneine to take every day across three menstrual cycles, while the others were given a placebo.

Those taking the supplement reported experiencing a pain score of 4.8 out of 10, on average, at the start of the study, which decreased to 4.1, 3.6 and 2.3 during their subsequent three menstrual cycles. L-ergothioneine may become more effective over time because it accumulates in cells, says Xiao. There was no significant reduction in pain in the placebo group.

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The researchers also found no difference in inflammation levels between the groups, which supports the idea that L-ergothioneine works through a more novel pathway than many existing painkillers, says Xiao. “During menstruation, discomfort is heavily driven by localised oxidative stress in the uterine tissue. Since we saw no systemic anti-inflammatory signal, the evidence points toward a localised antioxidant effect. EGT likely neutralises free radicals directly at the source of the cellular stress before the systemic inflammatory cascade is even triggered.”

at the University of Melbourne in Australia says this is biologically plausible, but needs to be confirmed in a larger study. “That is worth pursuing,” she says. Xiao says his team is planning a larger trial at multiple centres.

That will also give us a better idea of L-ergothioneine’s safety, although the researchers reported no side effects in either group. Long-term use of painkillers like ibuprofen has been , . The way that L-ergothioneine is transported into cells means it is excreted by the kidneys once levels have reached a saturation point, says Xiao.

A drug derived from cannabis eases chronic lower back pain without serious side effects or signs of addiction, making it a potentially powerful alternative to existing pain medications.

There are currently few treatment options for patients experiencing chronic pain, with many having to take opioids that come with a high risk of addiction.

The experimental drug VER-01 is an extract from the cannabis plant containing 5 per cent tetrahydrocannabinol (THC), the principal active ingredient.

In a clinical trial, 820 people with chronic lower back pain were randomly assigned to take VER-01 or a placebo for 12 weeks. At the end of this period, people taking the drug had a reduction in their pain scores of 1.9 on average on a scale of 0 to 10, while those taking a placebo had a 1.4-point reduction. There were no adverse events indicating a risk of withdrawal or abuse with the medication.

The study is the most rigorous to date to show clinically proven and non-addictive cannabis-based treatment of chronic pain, reinforcing a growing interest in cannabis as a pain treatment.

“It’s one of the first really high-quality studies for medical cannabis which many people, both researchers and patients, have been waiting for,” says at Jena University Hospital in Germany, a researcher on the study. “So far evidence is poor, past studies are of lower quality, fewer patients.”

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Edibles, vapes and joints all contain the same psychoactive compounds, but the effects they have on the body vary

Those who took VER-01 also had significant improvements in sleep quality and physical function and most of the side effects were mild, including dizziness, fatigue, dry mouth and nausea. Patients gradually increased their dosage during the treatment period, taking up to 13 doses per day.

The treatment was especially effective for back pain caused by nerve damage, known as neuropathic pain. Meissner says patients with chronic pain should always be treated first with physical therapy, but painkillers can help those who are unable to move. “Even a relatively small pain reduction might help [patients] go to exercise,” he says.

Although the reduction in pain wasn’t massive, it is rare to see huge reductions in chronic pain, says at King’s College London, who wasn’t involved in the study. “The fact people can sleep better, which is a secondary outcome of the study, will have an immense impact on the ability to function,” she says. “When you look at chronic pain you don’t look at giant effects.”

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Di Forti says it was striking the trial showed no signs of patients becoming dependent on the drug, and she hopes it will lead to it being prescribed. She often hears from patients who say cannabis helps their pain and buy the plant from a drug dealer, which she finds concerning. There is huge variability in THC levels in cannabis joints and patients can end up smoking cannabis all day, heightening risks of the drug, she says.

“In a world where there are claims of cannabis treating everything, at least here we have a randomised control trial testing it,” she says. “The fact it works for pain is wonderful news in my view.”

Knee braces and water-based exercise appear to be two of the most effective ways to ease the pain and stiffness caused by knee osteoarthritis. That is according to a review of 12 non-drug therapies, but higher-quality evidence is needed before this guides clinical practice.

The condition is caused by the wear and tear of cartilage that cushions the ends of bones, leading to inflammation, pain and stiffness. Painkillers and anti-inflammatory drugs can relieve these symptoms, but can also have side effects, so clinicians typically recommend physical therapies, such as shoe insoles to relieve knee pressure, supporting the joint with tape or using laser therapy to promote cartilage healing.

However, it is unclear how these methods compare. “A lot of reviews of treatments only look at how well a single therapy works,” says at the University of Leeds in the UK, who wasn’t involved in the latest research.

To fill this gap, at the First People’s Hospital of Neijiang in China and colleagues analysed data from 139 randomised controlled trials that collectively assessed 12 approved or experimental physical therapies for knee osteoarthritis. Those trials together involved more than 9600 adults with the condition.

Some of them compared two or three physical therapies, while others tested one therapy against a placebo or no treatment. The participants generally received some form of therapy for several weeks before completing surveys on their symptoms.

Based on this, the researchers found that knee braces appeared to be the most effective at reducing pain and stiffness and improving mobility. This was followed by water-based exercise. “If you walk in a pool, you’re using your muscles, but you’re not putting force [that wears down cartilage] through your joint in the same way as if you were walking down the park,” says Kingsbury.

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The order of effectiveness for the remaining tested treatments was: land-based exercise; high-energy laser therapy; firing high-energy sound waves at the knee; low-energy laser therapy; two ways of electrically stimulating nerves in the knee; taping the knee; stimulating the knee with electromagnetic waves; stimulating the knee with ultrasound waves; and wearing insoles.

For various reasons, the results aren’t strong enough that they should influence clinical practice, says Kingsbury. One reason for this is that many of the studies involved fewer than 50 participants and small samples can limit confidence in any findings. What’s more, the treatment period in each study ranged from less than a week to several months, meaning that some therapies may only appear more effective than others because they tended to be used for longer.

Another limitation is that the studies didn’t compare the physical therapies with drug treatments, or test the effectiveness of combining drug and non-drug therapies, says Kingsbury.

Still, ahead of further research, the review offers clues as to what works best, she says. “It is useful and important to have that ranking – maybe we can discount the bottom six or 10 [therapies] and really focus our efforts on improving the evidence around the top few.”