Question

I have read several newspaper articles about the use of this natural plant-based treatment for pain relief, especially in arthritis and muscle soreness. But is there any evidence that it can help to reduce muscle pain in ME? Because none of the drug treatments that I have been prescribed by my GP have helped.

Answer

Bromelain is an interesting alternative approach to pain relief. The active ingredient in this dietary supplement is an enzyme found in pineapple juice and pineapple stem. And there is some evidence that this enzyme causes the body to make substances that reduce pain and swelling. So, it is sometimes recommended for pain management, especially by alternative and complementary practitioners. However, there is very little evidence from proper clinical trials to confirm that it is a safe and effective form of treatment for pain relief, and no such evidence in relation to ME/CFS.

As far as side-effects are concerned, bromelain can:

• cause stomach upsets, diarrhoea and vomiting, a rapid heartbeat, and heavy menstrual periods.
• trigger reactions in people with allergies to pineapples, certain pollens, carrots, celery, rye and wheat flour, latex, and bee venom.
• increase the risk of bleeding. So people should stop taking it at least two weeks before surgery

You should also check with your doctor before using bromelain if you:

• have any health conditions, such as a bleeding disorder, asthma, heart problems, liver or kidney disease, or stomach ulcers.
• take any drugs or supplements because it can interact with certain antibiotics, blood thinners, aspirin and NSAID painkillers, and cancer drugs. Eating potatoes or soybeans when you take bromelain could also make it less effective.

Given the lack of clinical trial evidence about both efficacy and safety, bromelain is not something that we would want to recommend in our current state of knowledge for pain relief in ME/CFS.

More information

• The ME Association has produced a series of leaflets on drugs that aim to help with pain management and can be prescribed by a GP:
  • Amitriptyline.
  • Duloxetine.
  • Gabapentin.
  • Pregabalin.
• Bromelain from the US National Institutes of Health: National Center for Complementary and Integrative Health.
• Please let us know if you have used bromelain and whether it was helpful: Feedback@meassociation.org.uk