Ease joint pain without blockbuster drugs

Ease joint pain without blockbuster drugs ·

By Seth D. Torregiani, D.O.

Originally published February 28, 2006 online at:
http://delawareonline.com/ in their Alternative Medicine Section
All Rights Reserved.

Osteoarthritis is the most common joint disease, affecting more than 20 million, mostly elderly, Americans. Also known as degenerative joint disease, the condition is caused by the breakdown of cartilage, the connective tissue that lines joints and cushions the ends of bones. Subsequent joint destruction and bony overgrowth cause severe pain, diminished mobility and decreased quality of life. Although osteoarthritis is not a deadly disease, it is a disabling one.

The mainstay of treatment of osteoarthritis is acetaminophen (Tylenol) and nonsteroidal anti-inflammatory medications, known as NSAIDs, such as ibuprofen and naprosyn. Though successful as pain relievers, these over-the-counter medications, particularly the NSAIDs, can have dangerous side effects, including gastric ulcers and kidney failure, if taken in high enough doses.

A newer generation of NSAIDs, known as Cox-2 inhibitors, appeared promising when first introduced. They provided effective pain control and protected against some of the nastier gastrointestinal side effects of the older NSAIDs. Unfortunately, these drugs -- known by the brand names Celebrex, Vioxx and Bextra -- increased the risk of heart attack and stroke in some studies. Vioxx is now off the market, and many patients and their physicians feel the risk of using these medications outweighs any benefits they may offer.

The good news for people with osteoarthritis is that new research shows there are complementary therapies available that may be effective as, and possibly safer than, conventional medicines.

Chief among these are glucosamine and chondroitin. These two popular dietary supplements are naturally found in cartilage and other connective tissues in the body. They appear to relieve symptoms in patients with osteoarthritis by stimulating cartilage growth and decreasing inflammation in affected joints.

Recently, the GAIT (Glucosamine/Chondroitin Arthritis Intervention Trial) study found that a glucosamine/chondroitin combination was effective in treating moderate to severe knee pain in patients with osteoarthritis. These findings were based on an analysis of a subset of patients from the entire study, however, so they must be viewed cautiously. Glucosamine and chondroitin showed no improvement overall in the total group, which included patients with mild pain, so further study is warranted.

Another trial, the European-based GUIDE study, found that 1,500 milligrams of glucosamine sulfate taken daily was effective in relieving osteoarthritis-associated pain.

Taken together, this new research suggests that glucosamine and chondroitin may be a good treatment option for osteoarthritis, particularly for those who do not get relief from acetaminophen or tolerate NSAIDs. These two supplements generally are well tolerated and safe to use.

Another well-known supplement, SAM-e, or S-adenosyl-L-methionine, also appears effective at treating osteoarthritis-related pain. SAM-e is found throughout the body and is a component in numerous biochemical reactions in humans. A number of studies have found that SAM-e works as well as NSAIDs in treating joint pain, though the effect takes longer to set in (30 days vs. 15 days, on average). Like glucosamine and chondroitin, SAM-e seems to stimulate cartilage growth and decrease inflammation. SAM-e also appears safe when taken appropriately.

Acupuncture is another therapy to consider if you suffer from joint pain. A 2004 study published in Annals of Internal Medicine demonstrated that a course of acupuncture for patients with osteoarthritis of the knee resulted in improved function and decreased pain when compared to a group that received sham, or fake, acupuncture.

In the hands of an experienced practitioner, acupuncture is an extremely safe therapy. Insurance coverage varies, so check with your health plan to see if acupuncture treatments are covered, otherwise you may have to pay out-of-pocket.

Finally, low-impact exercises such as walking, yoga, tai chi and qi gong help keep your joints lubricated and muscles limber, without increased stress on your body. I recommend these exercises highly; they'll benefit both your body and mind. Many of these therapies are offered throughout the community, including at Christiana Care's Preventive Medicine and Rehabilitation Institute.

As always, check with your physician before starting any new medications, supplements or therapies.

Dr. Seth Torregiani is a medicine/pediatric physician at Christiana Care Health System.