Alternative Ways to Easing Arthritis Pain

Experts look at the pros and cons of alternative arthritis therapies.

From the WebMD Archives

Alternative therapies for arthritis range from A (acupuncture) to Z (zinc sulfate), with much in between -- from copper bracelets to magnets to glucosamine to yoga, to name just a few. But do alternative therapies really provide arthritis pain relief?

Many arthritis sufferers are looking into alternative therapies in an effort to find relief from the pain, stiffness, stress, anxiety, and depression that accompany the disease. Indeed, the Arthritis Foundation reports that two-thirds of those suffering from the disease have tried alternative therapies.

Some Work, Many Don't

A survey conducted for Arthritis Today by Leigh Callahan, PhD, reported that the favorite alternative therapies of the 790 arthritis sufferers who responded to the survey included everything from prayer and meditation to glucosamine and magnets. Callahn is associate director of the Thurston Arthritis Research Center at the University of North Carolina, Chapel Hill.

Of the 2,146 physicians who responded to the survey, the alternative therapies most recommended were capsaicin, relaxation, biofeedback, meditation, journal writing, yoga, spirituality, tai chi, acupuncture, and glucosamine.

And some of these alternative treatments really work, say leading arthritis specialists, and even have scientific evidence behind them (although most doctors admit that more research is needed). On the other hand, many more of the alternative treatments don't work or need more studies to support anecdotal claims.

Battling Arthritis With Movement

Deborah Litman, MD, a clinical assistant professor in the division of rheumatology at the Georgetown University School of Medicine, is a strong proponent of exercise (though it's not listed as an alternative treatment per se) in the treatment of arthritis.

Biking, for example, she explains, strengthens the quadriceps muscle above the knee; the stronger the muscle, the more likely you are to see an improvement in your symptoms.

"Impact-loading" activity, on the other hand, such as jogging or high-impact aerobics, is not recommended, but more gentle exercise, such as swimming or water aerobics, is.

The mind-body practice of yoga may also help arthritis sufferers.

Though there are few studies that look at the effects of yoga on arthritis per se, a 1994 study published in the British Journal of Rheumatology did find that people with rheumatoid arthritis who participated in a yoga program over a three-month period had greater handgrip strength compared with those who did not practice yoga.

The same year, another study published in the Journal of Rheumatology reported that arthritis sufferers who practiced yoga showed a significant improvement in pain, tenderness, and finger range of motion for osteoarthritis of the hands.

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Sticking It to Arthritis Pain

Acupuncture is another possibility; it is a therapy that has been studied extensively. As far as we know, says Litman, it doesn't change the course of the illness. But it can be helpful in managing pain and reducing stress associated with living with the chronic condition.

The University of Maryland School of Medicine completed a four-year NIH-funded study, the largest ever undertaken, to determine how well acupuncture works. The results, published in December 2004 in the Annals of Internal Medicine, found that traditional Chinese acupuncture significantly reduces pain and improves function for patients with knee osteoarthritis who have moderate or more severe pain despite taking pain medication.

However, a more recent study published in the same journal in July 2006 found no significant difference in reported pain or function between patients with osteoarthritis of the knee who received acupuncture or a sham procedure.

Larry Altshuler, MD, is a board-certified internist in Oklahoma City who practices both conventional and alternative medicine. He uses acupuncture on his arthritis patients and says he was "pleasantly surprised" when his patients reported they were getting relief from their pain. "Most of my patients have had beneficial results from acupuncture," says Altshuler.

Helpful, Healthy Supplements?

Glucosamine and chondroitin are nutritional supplements that are being studied for their effectiveness in treating arthritis. While significant evidence in the past has shown the supplements work, a newer study has stirred debate in the medical community.

Could these supplements offer nothing more than a placebo for people with mild arthritis? Are they best for those with moderate to severe pain, as the new research suggests?

Jason Theodosakis, MD, says that "first-line therapies" for the treatment of arthritis should always be improving biomechanics, injury prevention, weight control, and low-impact exercise. Theodosakis is an assistant clinical professor at the University of Arizona College of Medicine; he serves on the oversight committee for a $16 million NIH trial on glucosamine and chondroitin.

"But there is also enough scientific evidence -- 42 human clinical trials to date -- to recommend the use of glucosamine and chondroitin," says Theodosakis, also the author of The Arthritis Cure.

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In 2003, an analysis of 15 studies of glucosamine and chondroitin was published in Archives of Internal Medicine. The studies involved a total of 1,775 patients - 1,020 taking glucosamine and 755 taking chondroitin.

Researchers found "significant changes" in the symptoms of patients taking them - pain, stiffness, physical functioning, and joint mobility; no placebo group showed that kind of improvement. Glucosamine significantly improved joint space narrowing; it also helped slow the progression of osteoarthritis, researchers found.

Taking at least 1,500 milligrams of oral glucosamine sulfate for at least three years was the most effective in slowing the degenerative process, they reported. While there were similar findings on chondroitin, those findings were not as clear-cut. Overall safety of both glucosamine and chondroitin can be considered "excellent," according to researchers.

More recently, a study funded by the National Institutes of Health looked only at pain reduction from glucosamine-chondroitin supplements. The study was conducted at 16 sites across the country -- and was the most rigorous examination of the widely used supplements ever done, according to researchers, whose study appeared in the New England Journal of Medicine.

Called the Glucosamine/Chondroitin Arthritis Intervention (GAIT) trial, it involved 1,583 people with osteoarthritis of the knee. They were randomly placed into five different groups -- each group taking either glucosamine, chondroitin sulfate, both the supplements, the Cox-2 anti-inflammatory pain reliever Celebrex, or a placebo.

Overall, researchers found no significant pain reduction in the patients taking either supplement alone or combined, or in those patients taking a placebo. The patients with mild pain got no greater pain relief -- whether they took the combination of supplements, just one supplement, or Celebrex -- compared with those taking a placebo.

However, those with moderate to severe knee pain -- who took a combination of the two supplements -- reported significantly greater pain relief, compared with patients taking either Celebrex or a placebo. This group of 354 patients was too small to prove the findings, researchers said.

What should you do? WebMD asked an arthritis expert. "It seems that researchers are having a difficult time confirming the beneficial effects of [glucosamine and chondroitin]," says Robert Hoffman, DO, chief of rheumatology at the University of Miami Miller School of Medicine.

"The good news is the supplements seem to be safe [at the standard dosage], but it's not clear that they're beneficial. I don't feel compelled to highly recommend them. But if patients don't mind taking another pill -- and paying for a pill that may or may not help them -- it seems quite reasonable. And really, there isn't anything else that helps slow the progression of osteoarthritis."

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Choose Wisely

Because the quality of herbs and supplements can vary, even some of these treatments might not work, cautions Tod Cooperman, MD, president of ConsumerLab.com.

ConsumerLab.com reviewed supplement products touted for their pain-relieving benefits. It found that one product, claiming to contain 500 milligrams per serving of "chondroitin sulfate complex" actually contained less than 90 milligrams of chondroitin sulfate -- only 18% of the 500 milligrams.

"Fortunately, most products contain what they claim," says Cooperman. "But consumers should choose their supplements wisely. If a product is not working, it may be the product itself that is flawed, and not the approach."

Useless, Dangerous Remedies?

There are a number of other alternative remedies that arthritis sufferers try.

Many of those -- such as copper bracelets or magnets -- may not have much, if any, scientific evidence to back them up or disprove them. Indeed, Kerry Ludlam, a spokeswoman for the Arthritis Foundation, reports that there is a lack of research both for and against the usefulness of alternative therapies.

"There's a void of information," she says. Since many of the alternative therapies cited for the relief of arthritis are considered harmless (other than perhaps to your pocketbook), many doctors say that if you want to try them, go ahead.

Other therapies, however, can be dangerous.

Bee venom could cause a potentially fatal reaction in those allergic to stinging insects. And even glucosamine, generally safe for most people, could be dangerous for people allergic to shellfish. (Shellfish-free glucosamine is now available.) For these reasons, it's important to check with your doctor first before trying any alternative treatment.

It's also important to note that herbs and supplements may have unknown and potentially dangerous interactions with medication. If you're taking medication, it's best to check with your doctor before trying any supplements.

Getting Started

Though more and more doctors are themselves investigating the benefits of alternative therapies and have no objections if their patients try some, most of them still suggest first following the medical guidelines for the treatment of osteoarthritis released by the American College of Rheumatology and the American Pain Society.

Begin with treatments such as exercise and weight loss, the guidelines advise, in combination with over-the-counter acetaminophen (Tylenol) as directed by your personal physician.

"Try the simplest and cheapest regimen first," says Litman. "That should be your first line of defense."

WebMD Feature Reviewed by Louise Chang, MD on September 21, 2006

Sources

SOURCES: Deborah Litman, MD, clinical assistant professor, Georgetown University. Larry Altshuler, MD, board-certified internist. Jason Theodosakis, MD, assistant clinical professor, University of Arizona College of Medicine. Erin Arnold, MD, Illinois Bone and Joint Institute. University of Maryland Medical Center web site: "Osteoarthritis Sufferers Seek Complementary Care." Arthritis Foundation: "Guide to Alternative Therapies." Vignon, E. Arthritis & Rheumatism, September 2003; vol 48: p S77. Reginster, J. Lancet, January 2001; vol 357: pp 251-256. WebMD Medical News: "Modest Arthritis Benefit Seen from MSM." Pavelka, J. Osteoarthritis and Cartilage, October 2004; vol 12: p S74. Tod Cooperman, MD, president Consumerlab.com. Kerry Ludlam, spokeswoman, Arthritis Foundation National Office. Robert Hoffman, DO, chief of rheumatology, University of Miami Miller School of Medicine. WebMD Medical News: "Glucosamine, Chondroitin Seem to Work." WebMD Medical News: Arthritis Supplements in Question." Clegg, D. New England Journal of Medicine, Feb. 23, 2006; vol 354: pp 795-808. Scharf, HP. Annals of Internal Medicine, July 4, 2006; vol 145: pp12-20.

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