Chronic pain treatments lack scientific evidence
MSM and DMSO widely used for variety of pain
Back in the ’60s and ’70s, athletes suffering from injuries and muscle pain swore by dimethyl sulfoxide (DMSO), a sulfur-based solvent commonly used as a veterinary liniment that had patients rushing to the offices of alternative practitioners for a supplement that they swore relieved their pain.
As the word about DMSO got out, people began flocking to clinics dispensing DMSO, up to 100,000 of them seeking relief for arthritis, bursitis, tendinitis — benefits never clinically proven, but about which adherents of the treatment are adamant.
After DMSO was linked to ocular toxicity in experimental animals, the U.S. Food and Drug Administration (FDA) stopped human use and only permitted gradual resumption after clinical trials found ocular complaints were not present in humans. While DMSO is not commonly used in the United States, more than 30 million patients in Russia obtain prescriptions there each year to treat lupus, scleroderma, arthritis, and diabetic ulcerations, according to Stanley Jacob, MD, professor of surgery at Oregon Health Sciences University in Portland.
Jacob is the co-author of The Miracle of MSM (methylsulfonylmethane) with neurologist Ronald Lawrence, MD, PhD, a founding member of the International Association for the Study of Pain and the American Association for the Study of Headaches, and health writer Martin Zucker.1
As a topical application, DMSO is used as a carrier to reduce inflammation and carry medications quickly through the skin in trauma situations, says Jacob.
"DMSO is not really a drug. It’s more like a multifunctional therapeutic principle, an agent with hundreds of properties and applications in the body," says Jacob. "It’s safe, a substance of extraordinarily low toxicity, without a single documented death attributed to it."
DMSO does cause an unpleasant fish-like taste in the mouth, which sometimes causes patients to discontinue its use, and it has been associated with skin irritation.
Enter the new generation of pain relief: MSM, a chemical cousin of DMSO. When DMSO enters the body, Jacob says, 15% of it is converted into MSM — a substance that remains in the body four times as long as DMSO, possibly because of more extensive tissue binding, according to researchers who did lab analyses of both substances in the late 60s. Jacob theorizes that the benefits of DMSO are due to the long-lasting influences of its conversion into MSM — a substance for which he attributes these actions:
• It is an analgesic.
• It is anti-inflammatory.
• It’s a carrier — passing through the cellular membranes including the skin.
• It dilates blood vessels and increases blood flow.
• It’s a cholinesterase inhibitor, which Jacob says he has seen restore peristalsis, providing swift relief of constipation.
• It is anti-spasmodic, which creates a muscle-relaxing effect.
• It alters cross-linking processes in collagen, thus reducing scar tissue.
• It possesses antiparasitic properties, particularly for giardia, a protozoan parasite that causes diarrhea.
• It has an immune normalizing property as observed in its effectiveness against autoimmune diseases such as rheumatoid arthritis, lupus, and scleroderma.
"MSM offers a natural way to reduce pain and inflammation without serious side effects. It may even deliver as much or more relief as some of the standard painkillers. It just doesn’t work as fast, but patients often begin to experience noticeable easing of pain and discomfort within days," says Jacob.
He uses MSM for a wide variety of chronic pain conditions ranging from osteoarthritis to chronic back pain to chronic headaches, fibromyalgia, tendinitis, sinusitis, allergies, and heartburn.
Since 1978, Jacob has treated 18,000 patients with MSM at his clinic in Portland without serious side effects, but he’s the first to say, "You won’t find a good clinical study in the literature."
That’s the rub, according to Sharon Kolasinski, MD, assistant professor of medicine and chief of the clinical service in the division of rheumatology at the University of Pennsylvania School of Medicine in Philadelphia.
"The problem is we just don’t know how good MSM is. There just aren’t clinical studies," says Kolasinski, "So anecdote remains anecdote."
Kolasinski concluded in an article in Alternative Medicine Alert, a sister publication of Complementary Therapies in Chronic Care, in October:
"DMSO remains available worldwide and is approved for use for arthritis in a number of countries. However over-the-counter preparations in the U.S. are graded for industrial use and may contain impurities. A pharmacological grade solution is available by prescription and approved for intravesicular use for interstitial cystitis. Decades-old uncontrolled clinical observations suggest that topical application can be associated with analgesia for a number of musculoskeletal indications, but associated cutaneous side effects may be frequent.
"MSM is a popular substance for the treatment of numerous conditions, but recent interest has been for the treatment of musculoskeletal conditions. It is chemically related to DMSO, which enjoyed its own popularity as a cure-all in the 1960s, but has fallen into disuse. It is unclear how many chemical and biological properties MSM shares with DMSO. Scientifically acceptable data about the use of these substances in the treatment of human disease are lacking. Virtually no information is available regarding in vitro or clinical effects of MSM," she writes.
Kolasinski’s recommendations include:
• DMSO should be avoided since all nonprescription formulations are graded for other than human use.
• Prescription DMSO should be used under medical supervision, and patients should be aware that side effects are frequent.
• Since it is not known what effects MSM has in the body, whether it has efficacy in the treatment of human disease or what its short- or long-term side effects are, MSM cannot be recommended.
MSM is widely available in capsules and crystals for oral administration or as lotions, creams, and gels, to be used topically. Jacob recommends taking 2 g to 3 g a day for general health maintenance.
"For deep-seated conditions, patients may need higher doses, sometimes much higher — in the range of 40 g or 60 g under our personal supervision — to experience relief," adds Jacob.
One of MSM’s greatest proponents is actor James Coburn, who was diagnosed with crippling rheumatoid arthritis and began taking 1.5 g of crystal MSM in 1998. After six months, the 70-year-old actor said he had "virtually no pain at all" and he is working with a personal trainer in hopes of returning to playing tennis — something he has not been able to do for 20 years.
Reference
1. Jacob S, Lawrence RM, Zucker M. The Miracle of MSM. Berkeley, CA: Berkeley Books; 1999.
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