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National Institutes of Health • National Center for Complementary and Alternative Medicine

NCCAM Clinical Digest

Chronic Pain and Complementary Health Practices—Arthritis :
What the Science Says

July 2012

Osteoarthritis

Glucosamine and Chondroitin Sulfate for Osteoarthritis

The dietary supplements glucosamine and chondroitin sulfate—taken separately or together—are marketed for supporting joint health and have also been widely used for treating osteoarthritis (OA). Both supplements are forms of chemicals found naturally within the body’s cartilage.

Scientific Evidence

  • NCCAM funded a study that examined the use of glucosamine and chondroitin sulfate for knee pain from OA. The Glucosamine/chondroitin Arthritis Intervention Trial (GAIT) enrolled close to 1,600 participants. Results indicated that overall, a 6-month treatment with the dietary supplements was no better than placebo. While there was some evidence suggesting that participants with moderate-to-severe pain had modest reductions in pain with the combined supplements, this has not been confirmed.
  • In a followup study of GAIT participants, researchers examined whether glucosamine and chondroitin could prevent the progression of OA—an evaluation based on measuring joint space width. Results showed no significant change in joint space width or improvement in pain and function.
  • A 2010 meta-analysis of the scientific literature that analyzed 10 glucosamine and chondroitin trials involving 3,803 patients with knee or hip OA published similar results. Compared with placebo, glucosamine, chondroitin, or a combination of both did not significantly reduce pain or change joint space.

Safety

  • Glucosamine and chondroitin appear to be relatively safe and well tolerated when used in suggested doses over a 2-year period. In a few specific situations, however, concerns about side effects or drug interactions merit special attention:
    • Glucosamine may interact with the anticoagulant (blood-thinning) drug warfarin.
    • There is conflicting evidence about whether glucosamine might have negative effects on glucose metabolism, especially in people with insulin resistance or impaired glucose tolerance; more research on this topic is needed.
    • It is possible that glucosamine might make asthma worse, although this has not been proven.
    • There have been concerns that glucosamine—which is often derived from the shells of shrimp, lobsters, or crabs—might trigger allergic reactions in people with allergies to these shellfish. However, no such allergic reactions have been reported.
    • Finally, although recent studies conducted by the U.S. Food and Drug Administration show that high doses of glucosamine hydrochloride taken by mouth in rats may promote cartilage regeneration and repair, this dose was also found to cause severe kidney problems in the rats—a serious side effect of the treatment.

Dimethyl Sulfoxide (DMSO) and Methylsulfonylmethane (MSM) for Osteoarthritis

DMSO and MSM are two chemically related dietary supplements that have been used for arthritic conditions.

Scientific Evidence

  • A 2009 meta-analysis of a small number of studies looked at topical (applied to skin) DMSO and oral (taken by mouth) MSM as potential therapies for OA of the knee. There was no evidence of significant reductions in pain compared to placebo.

Safety

  • Although there is limited safety data available, some side effects from topical DMSO have been reported, including upset stomach, skin irritation, and garlic taste, breath, and body odor.
  • Only minor side effects are associated with MSM in humans including allergy, upset stomach, and skin rashes.

S-Adenosyl-L-methionine (SAMe) for Osteoarthritis

SAMe is a molecule that is naturally produced in the body and is also marketed as a dietary supplement.

Scientific Evidence

  • A 2009 Cochrane review concluded that there was not enough evidence to use SAMe for OA of the knee or hip. The reviewers did indicate that small improvements in pain and function were seen in some but not all studies.

Safety

  • SAMe is generally considered safe. Common side effects include gastrointestinal problems, dry mouth, headache, sweating, dizziness, and nervousness.

Acupuncture for Osteoarthritis

Acupuncture has been studied in clinical trials for pain in a number of conditions including OA. There is evidence that acupuncture may help to lessen pain and improve function in other joints such as the hip.

Scientific Evidence

  • A 2009 NCCAM-funded critical literature review examined acupuncture for chronic back pain, OA, and headache. The authors concluded that acupuncture has a favorable safety profile, and limited evidence suggests it is a cost-effective treatment but not the clear therapy of choice.
  • In a 2008 NCCAM-funded systematic review of randomized controlled trials of acupuncture for OA of the knee, researchers examined 10 trials involving 1,456 participants. The authors concluded that these studies provide evidence that acupuncture is an effective treatment for pain and improving mobility in people with OA.
  • Authors of a 2007 NCCAM-funded meta-analysis suggested that although some large, high-quality trials have shown that acupuncture may be effective for osteoarthritis of the knee, differences in the design, size, and protocol of the studies make it hard to draw any definite conclusions from the body of research. These authors concluded that it is too soon to recommend acupuncture as a routine part of care for patients with osteoarthritis.
  • Authors of a 2010 Cochrane review looked at the effects of acupuncture in people with OA in peripheral joints of the body—knee, hip, or hand. The reviewers examined 16 trials involving 3,498 people and found that although acupuncture, when compared to a sham treatment, showed statistically significant, short-term improvements in osteoarthritis pain, the benefits were small and were not found to be clinically relevant (useful in a clinical setting). In contrast, the reviewers also found that acupuncture, when compared to a waiting list control, showed statistically significant and clinically relevant benefits in people with peripheral joint osteoarthritis. The researchers suggest the beneficial effects in the latter studies were due in part to expectation or placebo effects.

Safety

  • There are few complications associated with acupuncture, but adverse effects such as minor bruising or bleeding can occur; infections can result from the use of nonsterile needles or poor technique from an inexperienced practitioner.

Massage for Osteoarthritis

Massage therapy has been studied for pain; however, there are very few studies that look at massage therapy and OA specifically.

Scientific Evidence

  • The results of one clinical trial, which did examine massage on adults with OA of the knee, indicated that massage may reduce pain and improve function.

Safety

  • Massage therapy appears to have few serious risks—if it is performed by a properly trained therapist and if appropriate cautions are followed. The number of serious injuries reported is very small. Side effects of massage therapy may include temporary pain or discomfort, bruising, swelling, and a sensitivity or allergy to massage oils.

Tai Chi for Osteoarthritis

Tai chi is an ancient meditative practice that originated in China as a martial art.

Scientific Evidence

  • In 2009, Arthritis and Rheumatism published a small NCCAM-funded randomized controlled trial on the effects of tai chi on knee OA. The results indicated that participants who practiced tai chi had improvement in pain and physical function as well as in depression and health-related quality of life when compared to participants enrolled in an education and stretching program. Although previous tai chi studies have shown an improvement in balance, this study did not find a statistically significant improvement in participants’ balance tests.
  • In 2012, the American College of Rheumatology issued recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. These guidelines conditionally recommend that patients with knee osteoarthritis should, among other activities, participate in tai chi programs.

Safety

  • Tai chi is considered to be a relatively safe practice.

Qi Gong for Osteoarthritis

Qi gong is a group of traditional Chinese exercises, breathing techniques, and meditation practices. There are studies on qi gong and pain, but there is very little research specifically on qi gong and OA.

Scientific Evidence

  • A randomized controlled trial funded by NCCAM studied the effects of practitioner-led qi gong on OA of the knee. The results from this study were inconclusive.

Safety

  • Qi gong is generally considered to be a safe practice.

Rheumatoid Arthritis

In general, there is not enough scientific evidence to prove that any complementary health practices are beneficial for rheumatoid arthritis (RA) symptoms, and there are safety concerns about some practices. Some mind and body practices and dietary supplements may be beneficial additions to conventional RA treatments, but there is not enough evidence to draw conclusions.

NCCAM Clinical Digest is a service of the National Center for Complementary and Alternative Medicine, NIH, DHHS. NCCAM Clinical Digest, a monthly e-newsletter, offers evidence-based information on CAM, including scientific literature searches, summaries of NCCAM-funded research, fact sheets for patients, and more.

The National Center for Complementary and Alternative Medicine is dedicated to exploring complementary and alternative healing practices in the context of rigorous science, training CAM researchers, and disseminating authoritative information to the public and professionals. For additional information, call NCCAM's Clearinghouse toll-free at 1-888-644-6226, or visit the NCCAM Web site at nccam.nih.gov. NCCAM is 1 of 27 institutes and centers at the National Institutes of Health, the Federal focal point for medical research in the United States.

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