Alternative treatments joint pain



by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit




Arthritis is a common problem.

And because it is so common and because there are so many “pet remedies” that surround it, the allure of alternative therapies is particularly strong.


Guidance from the National Institutes of Health...

People with the most common form of arthritis, osteoarthritis, frequently turn to complementary or alternative therapies. In 1997, a national survey reported that 26 percent of people with self-reported arthritis had used a complementary or alternative therapy within the previous 12 months. The same year, another survey reported that nearly two-thirds of rheumatology patients used complementary or alternative therapies, with osteoarthritis patients constituting the most frequent users. The most common complementary and alternative remedies are discussed below.



Glucosamine

Used for many years in Germany and other parts of Europe, glucosamine has rapidly gained popularity in the United States. While some research supports its effectiveness, other research does not.

A study of more than 200 patients with osteoarthritis published in the British journal Lancet in January 2001 reported that people treated with glucosamine had fewer symptoms and exhibited less progressive damage on X-rays than did people treated with placebo. An NIH study is currently underway to determine how effective this supplement truly is.

The GAIT trial done by the National Institutes of Health was considered a negative study. However, there was a signal indicating that it might be effective in patients with moderately severe osteoarthritis.

Although glucosamine's effect on joint damage is still debated, many medical experts believe this supplement reduces pain and is safe. The usual dose is 500 milligrams three times a day. Twice this amount may be recommended for the first few weeks. It may take four to eight weeks to get significant benefit, and like most remedies, glucosamine does not work for everyone. Consider stopping it after twelve weeks if you do not experience any improvement.

Chondroitin And Sam-e

Two other supplements on the market, chondroitin and S-adenosylmethionine (SAM-e), are not as well studied or accepted in the United States as glucosamine. Most studies of these agents are of insufficient quality to draw firm conclusions. One study of SAM-e found the agent to have similar benefits as naproxen (Naprosyn, Aleve), used to relieve pain and inflammation.



Herbal Remedies

Some herbs, including evening primrose, ginger, stinging nettle and curcumin, are sold as remedies for arthritis pain, but there is not enough evidence to support their use.

Always discuss the use of herbs or other supplements with your doctor to check for interactions and side effects.

Before seeking an herbal therapy practitioner, first consult with your doctor. Another source of information is the National Center for Complementary and Alternative Medicine. Search their Web site to find research centers at universities and medical schools throughout the United States that are conducting studies on complementary and alternative therapies. Try to find the name of a researcher near you who is conducting an herbal study; find out if that person provides guidance to patients as well.



Homeopathy

Homeopathy is based on the theory that administering tiny (often undetectable) amounts of a medication than in higher doses might be beneficial. Scientific evidence of benefit is lacking. A recent review in a British homeopathic journal identified only four methodologically sound studies and concluded that the available studies "do not allow a firm conclusion as to the effectiveness of homeopathic remedies in the treatment of patients with osteoarthritis."



Vitamins And Fish Oil

Evidence that antioxidant vitamins can prevent arthritis is lacking. Fish oil capsules (containing omega-3 fatty acids) may decrease pain and swelling in some people with rheumatoid arthritis. Fish oil for osteoarthritis cannot be recommended. Omega-3 fatty acids have other health benefits, most notably related to heart disease. Fish that are especially rich in omega-3 fatty acids include salmon, mackerel, herring and sardines. But there is no proof that eating more fish to treat rheumatoid arthritis makes any difference.



Acupuncture And Acupressure

Acupuncture is an ancient Chinese practice. By inserting hair-fine needles into the skin along defined tracts called meridians, practitioners believe they can stimulate the flow of "qi," or vital life energy.

Acupressure and shiatsu, a Japanese form of acupressure, use no needles. Instead intense local pressure is applied to certain points on the body.

Although medical experts do not understand how acupuncture and acupressure work, some people experience less joint pain with these techniques. A large National Institutes of Health-funded multisite clinical trial will evaluate the efficacy, safety and cost-effectiveness of acupuncture for osteoarthritis.



Magnet Therapy

Magnet therapy has gained popularity, but again the scientific evidence of its benefit is lacking. Magnets are sold in various strengths, but there is no proof that one strength is better than the next. Or if any strength magnet really helps. A word of caution, keep them away from your computer and cell phone.



Diet Therapy

Efforts to find food allergies that cause arthritis have not yielded definitive results. The most common approach is to eliminate vegetables from the nightshade family: white potatoes, tomatoes, peppers and eggplant. Tobacco also belongs to this family. (Of course, there are more compelling reasons to avoid tobacco than its effect on arthritis.) Some people with arthritis also feel that dairy products aggravate their symptoms.

If you suspect food allergies may be affecting your arthritis (for example, if your symptoms become worse after you eat certain foods), keep a record of what you eat for several weeks, along with notes about your arthritis symptoms. Eliminate from your diet foods that seem to cause trouble; after a period of time, gradually reintroduce these foods one at a time, noting any change in symptoms. Research-based evidence on the value of this approach is lacking, but diet therapy still may be worth a try.



Exercise And Weight Control

Exercise and weight control are among the most effective self-help measures for alleviating the symptoms of osteoarthritis (and perhaps other types of arthritis). The objective is to improve or maintain cardiovascular fitness, range of motion and muscle tone while avoiding excessive stress or injury to joints. Walking, biking, cross-country skiing and swimming are the best choices. Water offers support and gentle resistance; if possible, water temperature should be 83 to 88 F or warmer.

In one study, 33 adults with arthritis reported being better able to manage their disease symptoms and enjoyed better health after a three-month tai chi program; another study found improved balance and abdominal muscle strength. Other studies of moderate, low-impact exercise have suggested a benefit in arthritis symptoms. If you have arthritis, consider setting up an exercise program with the advice of a physician or physical therapist. He or she can also suggest effective weight control measures if needed.



Self-Help Measures

Many arthritis sufferers find that warm showers and baths -- particularly whirlpool baths -- are often helpful in reducing pain and stiffness, especially first thing in the morning. For arthritis in the hands, the simple act of squeezing a sponge in a basin or sink full of warm water provides gentle exercise and relief of stiffness. Warm, wet compresses, especially castor oil compresses (available where specialty health products are sold), may provide comfort for sore joints.

Helpful suggestions abound in books and magazines and on the Internet about joint-sparing techniques for ordinary activities. For example:

• Pick up a coffee cup with both hands instead of thumb and finger.
• Open doors with the side of your arm and body.
• Open a car door with both hands.
Occupational therapists are trained professionals who can teach these and many more helpful techniques.



Massage

Massage by an expert in therapeutic massage can contribute to an overall feeling of relaxation and well-being. There are many types of massage, including Western, Swedish, deep-tissue and neuromuscular. A massage therapist can teach you some do-it-yourself techniques.

Massage therapists are required to be licensed in at least 28 states and the District of Columbia. You can find a qualified practitioner by asking your physician or by contacting a professional massage therapy association.

A Positive Outlook

Like any person with a chronic disease, a person with osteoarthritis may be more prone to depression. You may worry about becoming increasingly unable to perform activities of daily living or doing things you enjoy. The capacity to adapt, cope and continue full function varies greatly among patients. Some patients feel disabled by their symptoms, but only a very small percentage will ever become severely disabled. A positive outlook, focusing on what you are able to do rather than what you are unable to do, can be immensely helpful. Some people find that meditation and other stress-reduction techniques help them to relax and better adjust the pace of their lives to the limitations imposed by their arthritis.



The Bottom Line

Recognize that for many unproven approaches, uncertainty about benefit and risk must be accepted before pursuing treatment. For example, small studies may find benefit for a particular approach, but if the patients in the study were highly selected (for example, taking no other medications and having no other major health problems besides their arthritis), that same approach may not work for others. A particular source of concern is that the treatment may interact with another medication, something the small studies cannot predict. Finally, keep in mind that herbs and supplements such as glucosamine are not regulated by the Food and Drug Administration; active ingredients, purity and quality may vary greatly.



Studies now underway should shed light on which treatments are helpful and which are a waste of time, money and faith. In addition, the reasons a treatment may work -- including the possibility of a placebo effect -- may also be sorted out in the next few years when the results of carefully performed studies are published. Even if it turns out that patients are better because of a placebo effect (in which the expectation of benefit from an inactive treatment somehow induces improvement), learning how to harness that effect may prove highly useful and safe.

-Discuss alternative treatments with your doctor. Some alternative treatments will not hurt you, may even benefit you, but there is potential for harm. There can be negative interactions between herbal or nutritional supplements and your current medications. Never stop a current medication in favor of an alternative treatment. Abrupt stopping of some medications can have consequences. When alternatives are considered, it should be "in addition to" rather than "instead of" current medical treatment. When alternative treatments are used "in addition to" they are categorized as "complementary medicine".

--Often remedies attract people by proclaiming they are "natural" substances. People regard natural substances as synonymous with purity, however these substances can contain potentially toxic chemicals. Do not be swayed by the word "natural".

--Herbal supplements are not subjected to approval from any regulatory board. Manufacturers are not required to disclose a full list of ingredients with these products. Many of the supplements contain a mix of herbs and drugs, and it is unclear exactly what you are getting. In some cases, herbal products have been found to contain steroids, Valium, and aspirin-based preparations as additives.

--Some alternative practitioners are licensed while others are not. Practitioners of biofeedback, chiropractic, acupuncture, massage therapy, and naturopathy typically have their own state and national boards and associations which offer licenses after a certain level of training. These practitioners are not governed by the same regulations as physicians.

--The placebo effect can fool people into believing a treatment has true value. It has been proven that when people believe strongly in a treatment their endorphins and natural pain mediators are enhanced. Also, arthritis characteristically has periods of flares and remissions. People may attribute feeling better one of the alternative treatments when it is truly due to a remission.

Physicians are much more open-minded and receptive to alternative approaches than in the past. They are beginning to see value in complementary medicine, realizing the high interest level of their patients in alternative treatments. Physicians continue to declare the importance of subjecting alternative treatments to scientific evaluation though. Until alternative medicine is subjected to scientific evaluation and regulation, skeptics will abound.



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Click here Second Opinion Arthritis Treatment Kit










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