# Ginger: Panacea or Consumer's Hype?
## 2 Pharmacology of Ginger
### Biological Activity
#### 2.3.1. Anti-Inflammatory and Analgesic Activities  
The anti-inflammatory activity of ginger was demonstrated in a clinical trial monitoring pro-inflammatory enzymes such as cyclo-oxygenase (COX) and lipo-oxygenases (LOX-5, LOX-12 and LOX-15). Following the daily intake of 2 g of ginger powder for 28 days, the lower activity of these enzymes was confirmed by reductions in the levels of the pro-inflammatory substances they produce, particularly eicosanoids and prostaglandin E2 (PGE2) [27].  
In clinical terms, the effect of ginger is more of a long-term one than an immediate one (as observed with non-steroid anti-inflammatory APIs). A clinical study measured the effect of ginger reduction of pain, swelling and mobility on 24 healthy male volunteers subject to eccentric muscle exercise to generate acute inflammation and muscle pain. 24 h and 48 h after the strong exercise, volunteers were given 2 g of ginger or a placebo. The pain and swelling, measured 45 min after the intake, were similar in the ginger group and the placebo group; interestingly, the same measurements were repeated 24 h after ginger ingestion and improvements were observed. This study suggests ginger may attenuate the day-to-day progression of muscle inflammation and the associated pain [34]. Another study compared the effect of 2 g of either raw or heat-treated ginger on two groups of volunteers (34 and 40 men, respectively) and again reduction of pain was observed three days after the exercise, with values of 25% for the raw ginger group and 23% for the heat-treated ginger group [35]. As mentioned in Section 1.2., gingerols are sensitive to heat, and thus the lower activity observed in this study for the second group is due to the lower content in gingerols. This study confirms that, in humans, gingerols are involved in the anti-inflammatory and analgesic actions. For pure 6-gingerol, both activities are already demonstrated in mice models [36].  
Clinical trials investigating osteoarthritis (OA) pain management also show incoherent results for ginger, which may be associated with the different composition of the tested formulations. A trial employing an unknown composition of ginger hydroxymethoxyphenols at a daily dose of 170 mg for three weeks showed no improvement in motion-derived joint pain (test group with \(n=56\)) [37]. In turn, another study with 40 patients taking, over a month, a daily dose of 30 mg of ginger extract (by cold ethanol percolation, 30 mg of extract corresponding to 1 g of dry ginger powder) showed a significant reduction (\(>\)50%) in the pain associated with motion of the affected joints [38]. Another study with a larger number of patients (\(n=103\)) taking capsules with whole ginger powder at daily doses of 0.25 g for six weeks also showed reduction of knee pain (average of c.a. 30%), which was more significant in patients having OA for less than three years [39].  
The use of ginger as an anti-inflammatory and analgesic agent in migraine was reported in 1990, in a single-patient case study. The patient consumed 1.5 to 2 g of powdered ginger per day (doses of 500 mg at four-hour intervals) and reported the abortion of migraine 30 min after the first dose of 500 mg [40]. The anti-neuroinflammatory activity of ginger was confirmed by in vitro studies on microglia cells [41] and it is associated mainly with the component 10-gingerol, rather than 6-gingerol [42].