A couple of days after Thanksgiving, I described my adventure with a knee that was no longer cooperating with the rest of the body. That post drew over 20 comments, with many suggestions on what to do next.
I was not a good patient, and did not introduce the knee to the medical establishment. I did find a description of simple exercises designed to aid arthritic knees, a category which might plausibly include my own. Those exercises, designed to strengthen muscles around the knee, certainly helped.
I also began taking daily doses of glucosamine in one of those combos available at Costco.
Over the next few weeks, I jumped back into our early morning walks, slowly increasing the distance every day or two until I managed to make it through the whole walk of about 3 miles. It was slower going than usual, but I made it. And, gradually, the occasional sharp pains became less frequent, and the knee is almost back to normal. It still offers reminders that special care and attention is necessary, but it is no longer disrupting my typical day.
I was ready to declare victory for glucosamine. Then I looked again at the available scientific literature.
Consumer Reports refers to a “natural medicine” database and reports an optimistic finding that glucosamine is
likely effective for osteoarthritis.
Some research suggests that glucosamine reduces pain of osteoarthritis in the knee about as well as the over-the-counter pain reliever acetaminophen (Tylenol). It also seems to reduce pain about as much as the nonsteroidal anti-inflammatory drugs (NSAIDs) ibuprofen (Motrin, Advil) and piroxicam (Feldene). But there is a difference between glucosamine sulfate and these drugs in the time it takes to reduce pain. The NSAIDs, such as Motrin, Advil, and Feldene, relieve symptoms and reduce pain usually within about 2 weeks, but the glucosamine sulfate takes about 4-8 weeks.
But the “Science-Based Medicine” blog is highly critical of mildly optimistic research results.
Although no one study can be definitive, this one is pretty convincing when viewed in the context of all the other published data. The authors rightly conclude that glucosamine doesn’t work any better than placebo, but they go on to say some rather strange things. They say it should not be recommended for “all” patients with osteoarthritic low back pain, implying that it might still be recommended for “some” patients. But if so, which patients and according to what criteria? They seem strangely defensive. They stress that glucosamine caused no side effects and could be used safely. They suggest that glucosamine might work for a subset of patients or for joints other than the spine. For instance, the knee. But another new study has confirmed that it is ineffective for the knee.
I don’t understand this. If they had found that a new antibiotic worked no better than a placebo for pneumococcal pneumonia, would they say it should not be recommended for “all” patients with pneumococcal pneumonia or would they simply say it should not be used for pneumococcal pneumonia? Would they speculate that it might work for a small subset of pneumonia patients or for infections in other parts of the body? Probably not. They thought glucosamine worked; they tested it; it didn’t. Why not just say so? Are they letting a prior belief in glucosamine influence their thinking? Unbiased science-based researchers are not usually so hesitant to give up on a treatment that repeatedly fails to pass tests.
A follow-up reported on a more recent study.
A new study was published 19 February 2008 in the prestigious Annals of Internal Medicine. It is arguably the best study to date, and may shed some light on the controversy. Carried out in the Netherlands in a primary care setting, it studied 222 patients with hip osteoarthritis over a 2 year period. Half the patients took glucosamine sulfate 1500 mg a day; half took a placebo. They concluded that glucosamine sulfate was no better than placebo in reducing symptoms and progression of hip osteoarthritis.
The Arthritis Foundation has a statement on glucosamine based on a widely-cited 2006 study.
While the study overall concluded that glucosamine and chondroitin were not better than placebo in reducing knee pain in the majority of people with OA, it did find that the combination of the two supplements provided significant pain relief for people with moderate-to-severe knee OA. Based on the findings from this study, the Arthritis Foundation recommends that individuals with knee OA speak to their doctors about whether combined glucosamine-chondroitin therapy might be a beneficial addition to their overall treatment plans….The more severe the pain, the better the response. People with moderate-to-severe knee OA pain experienced 25 percent greater pain relief than those taking other treatments.
Meanwhile, Quackwatch says any medical benefit is “unlikely.”
Actually, it’s a bit more blunt.
Chondroitin appears to be useless. Whether glucosamine is useful is conflicting, but the best-designed studies are negative. This usually means that negative evidence will eventually prevail. Decisions to use glucosamine must be based on information that is less complete than is desirable. In addition, product quality control may be a significant problem.
Despite the evidence, I’ll likely keep taking this stuff as long as my knee keeps improrive and the bottle isn’t empty.
Just call me Mr. Placebo!
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As my arthritis doctor says: “Sure go ahead and take glucosamine if you like to take pills. It won’t help osteoarthritis, but it won’t hurt it either.”
Knee muscle exercise is good. But if it’s pressure exercise it will just increase the arthritic damage. A recumbent bike is ok. Swimming is ok. Running is not ok.
OK, you’re Mr. Placebo.
I looked at the fine print of one of the acid reducers that became available non-prescription. It was effective, it said, for 50% of those who took it. A placebo, on the other hand, was effective for 37% of those who took it.
So there is only a 13% difference, the real pill over a placebo.
The placebo is significantly cheaper than the high-priced remedy. Perhaps doctors should discuss with their patients a trial with the placebo to see if that works.
Only half joking.
–Larry
I have been taking the generic form of Voltaren (diclofenac) for about a year. I have hardly any cartilage left in my knees following years of distance running. It really helps- I can tell the difference if I skip a day. It has contraindications, but weighed against daily pain, I can function better with it.
I don’t have osteoarthritis but I do have degenerative disc disease leaving me with no discs in my last two inter-vertebral spaces in my back resulting in chronic severe pain. Though this is just anecdotal, for the past 15 years I’ve taken glucosomine and condroiten and whenever I’ve stopped for any period of time- even a missed day or two- the pain is markedly increased until I start again. Take it for what you will. Apparently it isn’t a “placebo effect” because usually the “missed doses” are because I fill a strip with seven daily container- for a week’s worth of various vitamins and meds at a time- and what happens is usually that a few days into the week I’m feeling a lot more pain than usual and, invariably, when I check I forgot to put the glucosomine in with my other meds.
What ever the reason, I’m very glad to hear that your knee is steadily getting better.
Ian,
I ran across the other day. Some of the language is NSFW but I found it very enjoyable.
It also contains my new favorite line, “Do you know what they call alternative medicine that works?.. Medicine.”
http://www.youtube.com/watch?v=HhGuXCuDb1U
Nuthin’ wrong with a good dose of placebo if it works.
Sometime ago, I began taking saw palmetto for this prostate thing I have. I was convinced that it helped. Then I read reports about a new study testing the effectiveness of SP for the prostate thing. Many subjects in that study who were given SP reported improvement, but a slightly larger percentage of the subjects given the faux SP (i.e. a placebo) reported improvement, and the improvement the latter reported was slightly greater. I have continued to take the SP, but sometimes I wonder…
In solidarity.
Here’s an interesting question to which I do not know the answer. If a patient knows a pill is (merely) a placebo, does the patient nevertheless get some or all of the beneficial effects a placebo would produce if the patient did not know it’s a placebo?
Here’s a similar question where I recall that some research has been done but I do not recall what was discovered. Does praying for someone else’s health to improve actually produce improvement? And if so, does the existence or amount of the improvement depend on whether the person knows someone is praying for him? (If God does not exist then, of course, all prayer is merely a placebo)
God and prayer can be unrelated. Depends on how you are wording yer prayer.
I’ve been sleeping in a cave. One night weeks ago the hard rock surface I’d been sleeping on kind of dislocated my right shoulder, so that every so often a new movement would require a little crack.
Then yesterday morning I woke up at 3 o’clock really dehydrated because of exercise, 4 big pizza slices without water, and some Australian 13 % red wine. So I walked some to find water, and I remember at that point my entire upper chest had siezed up, it felt like the dislocated shoulder, as if something almost had to be cracked to be put right, some kind of thoractic back spasm or something. I slept till dawn but throughout yesterday morning I couldn’t decide what I was ailing from. I could hardly breathe, could hardly plan on seeing 2012, seriously, like the Robert DeNiro character in a New York hospital in the new film “New Years Eve” with Halle Berry watching him die.
So I wound up in a life or death search yesterday morning in a discount pharmacy which has remedies for nearly everything and finally, being very cost conscious, bought a $5.39 plastic bottle of mosquito repellant. That’s because the nearest I could come to a spot diagnosis was dengue fever, or possibly West Nile virus. It seemed like a good idea at the time because by 5:30 each morning the mosquitos are an on-going terror, even though medically I hadn’t a clue; and mosquito repellant is non-invasive isn’t it, compared to emergency surgery.
Today I’m at 100 %. I’m writing about this because I thought I was dead, but today time has told, the lungs are breathing at 100 %, the heart is beating at 100 %, even better than before, everything is cooperating. Even the dislocation in the shoulder is virtually gone. My ailment has now vanished (except on the internet). I may not be as well researched as you, but I spent significantly less money.
Im a 40 year old HNL on again off again runner w/knee issues. The glucosamine works for me. A new addition, suggested by a friend and the guy at GNC, is fish oil. Fish oil seemed to work within days. It has some gross side effects (gas, bad breath) that you have to monitor, but it really worked for me, just as advertised. Available at Costco too.