Non-drug approaches to osteoarthritis pain

Now that the most common osteoarthritis medicines have either been removed from the market or are under a cloud of suspicion, it's worth taking a look at some non-drug approaches to pain. Since there is no cure for arthritis, alleviating pain and improving mobility are the goals of all the treatment options. A survey published last June showed that many older people with knee osteoarthritis were willing to forgo effectiveness for a lower risk of adverse drug reactions. What's more, the same survey showed that when people are responsible for the full cost of their medication, over 40% said they prefer capsaicin, the over-the-counter topical cream.

Acupuncture

Last month, two acupuncture studies were published in the same issue of Annals of Internal Medicine. Acupuncture alleviated pain for people with knee osteoarthritis, but failed to help people with chronic neck pain. The cost of this traditional Chinese treatment, which involves the painless insertion of needles in various areas of the body, is covered by only some insurance companies.

In the successful study, 570 older people with knee osteoarthritis, were randomly assigned to receive 23 acupuncture treatments or a fake acupuncture (e.g., needles placed at incorrect body sites). At eight weeks, the people who were in the group that received the real acupuncture reported greater improvement in knee function but not pain. After 23 weeks, the people who had received real acupuncture had greater improvements in both pain and function. No adverse effects were reported.

This study, led by Brian M. Berman, MD, of the University of Maryland School of Medicine, was funded by the National Center for Complementary and Alternative Medicine, a division of the U. S National Institutes of Health. Dr. Berman and colleagues described it this way, "the largest randomized, placebo-controlled acupuncture trial to date and that it involved a more intensive acupuncture regimen (23 sessions) for a longer period (26 weeks) than any other trial." The length of the treatment schedule was defended: "While the duration of our acupuncture treatment may seem long, we used only eight weeks of focused treatment, followed by a tapered schedule for maintenance purposes. This is not an un common practice in China."

The reviewers offered no explanation for the rather high dropout rate--25% of the people in both groups dropped out before the end of the study. They did, however, note that the acupuncture took eight weeks to start showing an effect. Perhaps some people do not want to wait it out.

Glucosamine and Chondroitin

Another option that takes time to start showing a benefit is the over-the-counter supplement glucosamine, an amino acid that is often called the building block of the cartilage that cushions the joints. It is sold either alone or in combination with chondroitin, a carbohydrate that is a component of that cartilage. Both substances are produced by the body. Unlike the standard painkillers recommended for osteoarthritis, glucosamine and chondroitin seem to slow the progression of osteoarthritis and actually build up the cartilage.

An analysis of 15 clinical trials in which people with knee pain had been randomly assigned to take a placebo or a supplement showed moderate to large benefits to taking glucosamine and/or chondroitin (JAMA, 3/15/00). These supplements take more than a month to start taking effect.

Magnetic Bracelets

Bracelets with static magnets have been around for as long time as a popular means of alleviating arthritis pain. Though they have been subjected to studies over the years, results have been contradictory. Last month, the British medical journal BMJ published a study that showed wearing bracelets with static magnets decreased arthritis pain.

The study involved 194 men and women with osteoarthritis of the hip or knee. They had been randomly assigned to wear what the researchers described as "a standard strength static bipolar magnetic bracelet" or a non-magnetic (dummy) bracelet for 12 weeks.MMMM

The criticisms of this study that appeared on the BMJ Web site (www.bmj.com) largely centered on the design of the trial (not enough participants) and the fact that so many of the participants wearing the real magnetic bracelets were aware of the magnetic pull that the placebo effect could not be completely ruled out. A response to these criticisms came from a man who wrote that he markets "magnotherapy products." The placebo effect, he said, is always the knee-jerk response to studies like these. Yet "animals respond the same way as humans, their pain appears to reduce or disappear altogether after a few days of wearing the product (based on their ease of movement) and will return if the product is removed."

Obviously, this study is not the last word on whether magnetic bracelets are an effective means of alleviating osteoarthritis pain

To see the type of magnetic bracelet used in this study, go to the Web site of the British company that makes these products (www.ecoflow.plc.uk). The bracelets are sold only through independent distributors (but not in the U.S.). They are in the $58 to $96 range, which the researchers said was comparable to the cost of taking over-the-counter painkillers for a year.

COPYRIGHT 2005 Center for Medical Consumers, Inc.
COPYRIGHT 2005 Gale Group