The vast majority of Americans using complementary therapies are those seeking relief from some kind of pain: arthritis, chronic back pain, and musculoskeletal pain. Arthritis pain alone has driven more Americans to seek complementary and alternative medicine (CAM) therapies than any other single affliction. And although most patients using CAM therapies for arthritis employ them as a supplement to rather than a replacement for mainstream medical care, they tell researchers they do so because their medications do not provide complete relief. In many cases, the use of CAM therapies corresponds to the severity of the pain.
Glucosamine and Chondroitin
The use of glucosamine sulfate with or without chondroitin sulfate is far and away the most popular supplement for the treatment of osteoarthritis.
Glucosamine is extracted from the shells of crustaceans and chondroitin is prepared from cow trachea or shark cartilage. Glucosamine has been reported to inhibit cartilage breakdown and stimulate regeneration of cartilage after damage. Chondroitin has been reported to block the enzymes that degrade cartilage.
Both supplements have been used for many years in Germany and other parts of Europe, and although their effects on joint damage are still being debated, most medical experts agree that glucosamine works as an anti-inflammatory, reduces pain, and is safe.
The best evidence available to date is a large three-year Belgian study that suggests that glucosamine slows the progression of osteoarthritis.1 A similar placebo-controlled trial is underway in the United States under the auspices of the National Institutes of Health (NIH) and will include chondroitin, glucosamine-chondroitin, and nonsteroidal anti-inflammatory (NSAID) arms.
The evidence in favor of chondroitin is less convincing and there have been no clinical trials published on the popular combination of the two supplements. It remains unclear whether patients get any additional benefits by taking glucosamine and chondroitin together.
The operative daily dose for the subjects of the Belgian study was 1,500 mg of glucosamine. It usually is divided into two or three doses—and it may take four to eight weeks for effects to become noticeable. Chondroitin usually is used in similar dosages. If neither has an effect within 12 weeks, patients usually are advised to discontinue use.
Because glucosamine may affect glucose metabolism, it is not recommended for patients with diabetes until further trials provide better information on its effects on blood glucose levels.
Massage
A 2001 survey shows that more than half of osteoarthritis sufferers use massage therapy.2 And a recent University of Miami (Florida) study of children with rheumatoid arthritis showed that subjects with mild-to-moderate forms of the disease who were massaged for 15 minutes daily by their parents for 20 days experienced immediate lowering of anxiety and stress as measured by cortisol levels, decreased pain, and increased joint mobility.3
The most effective massage techniques are stroking, called effleurage in traditional massage, and passive joint movement to increase mobility.
Patients can be taught simple self-massage techniques that can be very helpful, especially for arthritic conditions of the hands, wrists, and elbows.
Acupuncture and Acupressure
Acupuncture, an ancient Chinese treatment, and acupressure, its non-invasive cousin, have become widely accepted in the United States and for a variety of medical conditions.
Acupuncture treatments, as prescribed by traditional Chinese medicine, typically involve the insertion of hair-fine needles into the skin along defined tracts called meridians, where they help stimulate the flow of qi or chi, vital life energy.
Acupressure and shiatsu massage, a Japanese form of acupressure, use no needles, but stimulate the same meridians by applying pressure to certain points on the body. Qualified practitioners can teach patients acupressure techniques.
A Japanese animal study showed that electrically controlled acupuncture needles appear to delay the onset and reduce the severity of arthritis while reducing the collagen antibody levels. Researchers speculate that acupuncture may inhibit the production of endogenous interleukin-1 beta and prostaglandin by suppressing interleukin and COX-2 gene activations.4
After a 1998 Consensus Panel review of the available public data, the NIH concluded that acupuncture is a promising treatment for postoperative pain and for nausea and vomiting associated with chemotherapy. The NIH also approved the use of acupuncture as primary or adjunctive therapy for osteoarthritis, tennis elbow, fibromyalgia, myofascial pain, low back pain, and carpal tunnel syndrome.
Diet
Researchers have long believed that food sensitivities trigger the inflammation of rheumatoid arthritis and perhaps even exacerbate the symptoms of osteoarthritis.
Not all patients show food sensitivities, but for many, identifying food sensitivities can make an enormous difference. Some of these patients may have suffered with arthritis for years, never realizing that simple dietary changes might help.
The key is to put patients on a supervised elimination test for several days, eliminating suspect foods and then re-introducing them one at a time to identify specific triggers. The most common triggers, by far, are proteins in dairy products and eggs, followed by corn and peanuts.
The theory was tested by a Norwegian study published in the Lancet in 1991 in which common arthri tis food triggers were eliminated. Joint stiffness, swelling, and tenderness decreased and grip strength improved. The average pain score dropped from over 5 on a 10-point scale to below 3. Most importantly, when patients were checked a year later, the benefits were still there.5
A vegetarian diet appears to benefit about 50% of patients, including those without specifically identified food triggers.
Vitamins
The jury is still out, but the Framingham Heart Study suggests that vitamins D supplementation may be helpful alleviate symptoms of osteoarthritis and prevent deterioration.6
Patients should be advised not to exceed 400 IU of vitamin D daily because higher dosages have been shown to be toxic.
References
1. Reginster JY, et al. Long-term effects of glucosamine sulphate on osteoarthritis progression: A randomised, placebo-controlled clinical trial. Lancet 2001;357: 251-256.
2. Ramsey SD, et al. Use of alternative therapies by older adults with osteoarthritis. Arthritis Rheum 2001;45:222-227.
3. Field T, et al. Juvenile rheumatoid arthritis: Benefits from massage therapy. J Pediatr Psychol 1997;22: 607-617.
4. Fang JQ, et al. Inhibitory effect of electroacupuncture on murine collagen arthritis and its possible mechanisms. In Vivo 1999;13:311-318.
5. Kjeldsen-Kragh J, et al. Controlled trial of fasting and one-year vegetarian diet in rheumatoid arthritis. Lancet 1991;338:899-902.
6. McAlindon TE, et al. Relation of dietary intake and serum levels of vitamin D to progression of osteoarthritis of the knee among participants in the Framingham Study. Ann Intern Med 1996;125:353-359.
The vast majority of Americans using complementary therapies are those seeking relief from some kind of pain: arthritis, chronic back pain, and musculoskeletal pain. Arthritis pain alone has driven more Americans to seek complementary and alternative medicine (CAM) therapies than any other single affliction.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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