Natural Remedies for Arthritis Pain Relief?

Osteoarthritis, the most common form of joint disease, affects roughly 20 million Americans.  Once thought to be a natural consequence of aging, it’s now understood to result from a number of different factors.

Formerly referred to as degenerative joint disease, osteoarthritis occurs when the (hyaline) cartilage in your (articular) joints breaks down.   However, our current understanding of osteoarthritis suggests that it’s not limited to just the cartilage in your joints.  In fact, it also affects the entire joint organ including the tissue lining the joint (synovium) as well as the subchrondral bone.

For those who suffer from osteoarthritis, the pain can be debilitating and ultimately result in the need for joint replacement (total arthroplasty).

Given that osteoarthritis is essentially a condition related to aging and elderly patients often have reasons to avoid using antiiflammatory drugs such as NSAIDs (concern over gastric bleeding or increased risk of heart attacks and stroke), many choose to look toward natural arthritis remedies such as glucosamine.  For those looking to natural remedies, one key question is whether or not they actually work?

About Natural Remedies for Arthritis Pain Relief

Let’s face it, there’s an overwhelming amount of information about arthritis available on the internet.  Sadly, much of this information is either outdated or just plain wrong.  In this article based on his prior Arthritis Secrets E-book, Jarret D. Morrow, MD,  presents an overview of known facts about arthritis and natural treatment options based on the latest available research.

This article starts by answering some basic questions that you may have about arthritis and ends with a summary of natural remedies including doses, evidence level, and cautions.

Natural Remedies for Osteoarthritis

Grade:  A (Strong Scientific Evidence)

Acupuncture

Despite the problem with the lack of any of the concepts of traditional Chinese medicine being validated themselves by scientific inquiry, acupuncture has been shown in clinical trials to be effective at reducing osteoarthritis pain and improving level of function.  Though these benefits may largely be related to placebo effects, patients who used acupuncture founding meaningful benefits ( Manheimer E et al 2010).

Exercise / Weight Loss

Exercise has been studied including both cardio and resistance training programs.  Typically, exercise is more effective for relieving pain and improving function in those with mild osteoarthritis rather than moderate or severe forms.

Glucosamine Sulfate

Glucosamine sulfate, a naturally occurring chemical (amino sugar), is found in the fluid surrounding joints.  Dietary supplements containing glucosamine can either be from shellfish sources or derived synthetically.

Despite recent controversy (Wandel et al, 2010), there’s reasonable scientific evidence to support the use of glucosamine sulfate.  Part of the reason for the mixed results in clinical trials is that the data mixes studies on glucosamine sulfate with other types of glucosamine such as glucosamine hydrochloride or n-acetyl glucosamine.

• Dose:  1500 mg/day total taken in three divided doses of 500 mg
• Cautions:  glucosamine can theoretically elevate blood sugar levels and depending on the manufacturer may contain allergens that affect those with shellfish allergies.  In theory, it may also increase your risk of bleeding particularly when taken with blood thinners.
• Important:  Only buy products containing glucosamine sulfate NOT glucosamine hydrochloride or n-acetyl glucosamine.

Grade:  B (Good Scientific Evidence)

Avocado and Soybean Usaponifiables – ASU

Avocado and soybean unsaponifiables are derived from certain oils found in avocados and soybeans.

A fairly recent meta-analysis concluded that a three-month trial of avocado and soybean usaponifiables is recommended for patients with osteoarthritis (Christensen R et al, 2007).

• Dose:  typical studies include 300-600 mg/d of ASU

Devil’s Claw Extract(harpagophytum procumbens)

Devil’s claw is a herb which is sold in dietary supplements in the form of devil’s claw extract.  The plant itself is native to Africa.  The extract has been studied primarily for decreasing osteoarthritis and lower back pain.

• Possibly safe rating for taken up to 1 year.  Most common side effect is diarrhea.
• Dose:  2600 mg/d total taken in 3 divided doses.  Total of 50-100mg of harpagoside (active ingredient) daily

Physical Therapy

Neither ultrasound therapy or TENS (transcutaneous electrical nerve stimulation) have been shown to offer much benefit.  However, physical therapy combined with exercise can improving flexibility and strengthening the muscles surrounding joints.

S-adenosyl Methionine or SAMe

SAMe is a natural chemical found throughout the human body.  It’s also made synthetically and sold as dietary supplements marketed towards those with depressive disorders and osteoarthritis.  It has a long history of use in Italy dating back to 1979.

• Cautions:  avoid use by those with diagnosed bipolar disorder as it can possibly convert depression to mania (in those with bipolar disorder).
• Dose:  200 mg taken three times daily for a total daily dose of 600 mg/d

Grade C (Unclear or Conflicting Scientific Evidence)

• Boron

• Boswellia serrata

• Bromelain

• Chondroitin sulfate

• Green-lipped muscle (Perna canaliculus)

• Hyaluronic acid (oral)

• Magnet therapy

• MSM (methylsulfonylmethane)

• Niacin (vitamin B3)

• Tumeric

• Willow bark

How many types of arthritis are there?

More than 100 different types of arthritis have been identified by researchers.  However, the most common types include osteoarthritis, rheumatoid arthritis, and gout.

What is osteoarthritis?

The most common type of arthritis, osteoarthritis (OA) is generally associated with aging and joint wear and tear. It can also result from other disorders such as diabetes or congenital abnormalities.

Osteoarthritis can affect several joints, from the large, weight-bearing joints of the hips and knees to the smaller joints of the spine, hands, feet, and shoulders.  In contrast, OA rarely affects the elbows, ankles or wrists.

What is rheumatoid arthritis?

Rheumatoid arthritis (RA) is a long-lasting disease where the immune system—the body’s defense against disease—mistakenly attacks itself and causes the joint lining to swell. The inflammation then spreads to the surrounding tissues, where it can damage cartilage and bone. RA can affect joints in any part of the body, but the hands, wrists, and knees are the most common. In more severe cases, rheumatoid arthritis can affect the skin, eyes, nerves, and internal organs.

What is gout?

Historically, gout has been referred to as the ‘disease of kings’ due to its association with red meat, in particular, and red wine.  However, gout is essentially a metabolic condition which arises when your body can’t eliminate a substance called uric acid.  It’s an inflammatory type arthritis.  Severe pain results when the excess uric acid forms needle-like crystals in joints.  The joints most commonly affected by gout include the big toe, knee, and wrist joints.

How many people suffer from arthritis?

More than 46 million adults in America suffer from arthritis and chronic pain. Approximately one-half of these individuals suffer from osteoarthritis, and that number is growing rapidly as the population over age 50 increases. By 2030, the CDC’s National Center for Chronic Disease Prevention and Health Promotion estimates that 67 million Americans will have been diagnosed with an arthritic condition.

What is the societal impact of arthritis?

According to the Centers for Disease Control and Prevention (CDC), arthritic conditions are the main cause of disability in the USA. These conditions cost the U.S. economy more than $128 billion annually, and that figure will continue to increase as the population ages.

Arthritis Causes

What causes osteoarthritis?

In osteoarthritis, biochemical and metabolic changes in the body result in the breakdown of joint cartilage. Over time, the joint cartilage wears away and bony growths (osteophytes) may form at the edges of joints. The cartilage loses its ability to effectively cushion the area between the two bones, and osteophytes may press on surrounding tissue. This results in pain that may range from mild to disabling.  Though osteoarthritis results in the breakdown of articular cartilage it also affects subchondral bone and the synovium.

How do joint injuries result in osteoarthritis?

Cartilage is produced by cells called chondrocytes.  Normally, chondrocytes die off (apoptosis) at a rate of 2-3% compared to rates of 18-19% in OA chondrocytes.  Within 48 hours of trauma to a joint, the cell death rate shoots up dramatically—sometimes as high as 37 percent. The dying cells stimulate the release of enzymes that destroy cartilage, which in turn can lead to arthritis.

What is the association between allergies and osteoarthritis?

There is some evidence of a potential link between food sensitivities and joint inflammation in certain individuals. More research in this area is needed to determine the nature of this connection.

Arthritis Risk Factors

What are the risk factors for osteoarthritis?

1. Advancing age
2. Obesity
3. Insulin resistance or diabetes
4. Congenital abnormalities
5. Joint injuries
6. Lack of physical activity
7. Hereditary susceptibility or Genetics
8. Female gender
9. Muscle weakness

What is primary osteoarthritis?

Osteoarthritis is classified as primary (idiopathic) when the exact cause is unknown, and secondary if it is associated with a specific disease or condition such as diabetes. Most primary OA is related to aging. Approximately 80-90 percent of men and women have evidence of OA by the time they reach age 65.

In the vast majority of cases, OA develops silently before causing noticeable pain and stiffness. Affected individuals often do not have any symptoms until after age 50.

What factors increase the likelihood of developing type 2 diabetes, a major risk factor for osteoarthritis?

Your likelihood of developing type 2 diabetes increases with the number of risk factors. If any of the risk factors below apply to you, please talk to a health care professional about how to lower your risk and determine if testing is needed.

• Obesity. Excessive body weight increases diabetes risk.
• Apple-shaped figure. Individuals whose bodies store fat in the abdominal area have a higher risk of diabetes than those who store excess weight in the hips and thighs.
• Age. Age increases the risk of type 2 diabetes.
• Sedentary lifestyle. Regular physical activity can prevent excess weight, which is a significant risk factor for type 2 diabetes. A second benefit of regular physical activity is improved blood sugar control in people who already have type 2 diabetes.
• Family history. The genetic link for type 2 diabetes is stronger than the genetic link for type 1. Having a blood relative with type 2 diabetes increases the risk. If that person is a first-degree relative, such as a parent, sibling or child, the risk is even higher.
• History of diabetes in pregnancy. If you had diabetes during pregnancy (gestational diabetes), you have an increased risk of developing type 2 diabetes.
• Impaired glucose tolerance (IGT). Also known as pre-diabetes, IGT means that the individual’s blood sugar level is elevated, but still below the level that qualifies as diabetes.
• Ethnic ancestry. Being of Aboriginal, African, Latin, or Asian descent increases the risk of developing type 2 diabetes. Risk levels for these groups are two to six times higher than for Americans of Caucasian origin.
• High blood pressure. People with high blood pressure are more likely to have or develop diabetes.
• High cholesterol or other fats in the blood. People with diabetic conditions often have high levels of harmful LDL cholesterol and triglycerides, and low levels of “good” HDL cholesterol.

Symptoms and Diagnosis of Arthritis

What are the symptoms of osteoarthritis?

Pain is the most frequent symptom of osteoarthritis. Other common symptoms are morning stiffness in the joint, limited range of movement, and crepitus (a crackling sound or feeling) when the joint is moved.

The pain of osteoarthritis is described as a sharp ache or burning sensation that worsens with use. Pain increases as cartilage erodes and bone surfaces lose their protection. The chronic pain and stiffness leads to decreased movement, which in turn allows the muscles to atrophy and ligaments to become lax.

What joints are affected by osteoarthritis?

Osteoarthritis can affect any joint in the body. The most common are the large weight-bearing joints such as the knees or hips, but osteoarthritis can also develop in the fingers, hands, feet, shoulders, lower lumbar vertebrae, and the cervical spine.

Could my back or neck problem be related to osteoarthritis?

Yes, it could. Vertebrae are bones, and areas between them are joints protected by cartilage disks. In addition to the problems resulting from disk erosion, osteophytes can also grow around the vertebrae in the neck or back. These can put pressure on the nerve root or other surrounding tissues (impingement on the spinal foramina), creating symptoms such as

• pain that radiates down the leg or arms (radicular pain)
• muscle spasms
• muscle atrophy
• neurological deficits

How is osteoarthritis diagnosed?

If you suspect osteoarthritis, your doctor will make a diagnosis based on your medical history, a physical exam, and X-rays of the affected joints. Your physician may also order an MRI (magnetic resonance imaging), an arthroscopy (examining the joint through a small incision), or arthrocentesis (drawing fluid from a swollen joint)

Researchers are currently attempting to identify markers in the blood that are associated with the severity of osteoarthritis in each patient. A recent study found that patients with especially high levels of TNF alpha (a protein that is part of the immune system) generally had lower physical function, more osteoarthritis symptoms, and worse knee radiographic scores. (Pennix et al, 2004)

What does the doctor see on an X-ray to diagnose osteoarthritis?

In a joint affected by osteoarthritis, the space where the two bones meet is abnormally narrow. This condition, known as joint space narrowing, results from the cartilage breakdown that occurs with osteoarthritis. The radiologist will also look for bony outgrowths at the edges of joints (osteophytes), another characteristic of osteoarthritis.

What is the association between depressed mood and the chronic pain of osteoarthritis?

Arthritis and depression are common and important health problems, and older adults are more likely to suffer from both. Patients with both conditions generally experience more pain and functional impairment than individuals dealing with pain alone (Bair et al, 2004). Systematic depression management has been demonstrated to be effective in decreasing pain severity among arthritis patients (Lin et al, 2006).

Treatment Options for Arthritis

What are some of the treatment options for osteoarthritis?

A multifaceted approach is best for maximum control over osteoarthritis. Every patient is unique and should—in conjunction with a physician—use whatever combination of treatments works best:

• patient education about osteoarthritis
• exercise
• weight control
• physiotherapy
• anti-inflammatory drugs (oral or topical NSAIDS)
• non-narcotic analgesics such as acetaminophen
• alternative medicines and natural remedies
• acupuncture
• local injections of glucorticoids
• local injections of hyaluronic acid
• surgery to relieve chronic pain in damaged joints (total arthroplasty)

What is the connection between food and osteoarthritis?

Although the current consensus within the medical community is that is diet and arthritis are not connected, there is some evidence that certain types of diets, with specific amounts of calories, protein, and fatty acids, may affect the inflammation that occurs with arthritis. An increasing number of physicians recognize the need to re-evaluate this position in light of new knowledge about food and its potential role in treating or preventing chronic conditions such as arthritis.

How does weight loss affect arthritis?

Recent studies indicate that weight loss through diet and exercise improves physical function in older obese adults with knee osteoarthritis, and that those with the most weight loss show the greatest improvement (Miller et al, 2006). One clinical study showed that a weight loss of just 10 percent resulted in a functional improvement of 28 percent (Christensen et al, 2005).

A recent meta-analysis demonstrated that patient education and exercise regimens each had a modest, yet clinically important, influence on well-being for osteoarthritis patients. (Devos-Comby L et al, 2006).

What is evidence based medicine (EBM)?

Evidence based medicine (EBM) is a new paradigm for making decisions about a patient’s health. Rather than relying exclusively on their own professional expertise, physicians using EBM also evaluate current clinical research to help make decisions about medical treatments and patient care. The evidence used may include randomized controlled trials, systematic reviews of series of trials, meta-analyses, and other information collection and research activities.

Recent Arthritis Studies:

How effective are NSAIDs at treating the pain associated with osteoarthritis?

A recent meta-analysis published in the European Journal of Pain concluded that the clinical effects of oral NSAID therapy in patients with moderate to severe arthritis are small and limited to the first three weeks after the start of treatment (Bjordal et al, 2007).

What impact does weight reduction have on osteoarthritis?

A recent randomized trial concluded that an intensive weight loss intervention program of diet and exercise improved physical function in older obese adults with knee osteoarthritis (Miller et al, 2006).

How effective is chondroitin sulfate for treating osteoarthritis?

A very recent meta-analysis published in the Annals of Internal Medicine concluded that the “symptomatic benefit of chondroitin is minimal or nonexistent. Use of chondroitin in routine clinical practice should therefore be discouraged” (Reichenbach et al, 2007).

How effective is acupuncture for treating osteoarthritis?

A recent meta-analysis on acupuncture for peripheral joint arthritis concluded that although further studies are needed to adequately evaluate its effectiveness for osteoarthritis, acupuncture’s favorable safety profile makes it an option worth considering (Kwon et al, 2006).

Which drug is more effective for treating osteoarthritis: acetaminophen or NSAIDS?

A recent review from the Cochrane Collaboration database concluded that NSAIDS appear to be more effective than acetaminophen for the treatment of arthritis (Towheed et al, 2006).  Though acetaminophen has been shown to be more effective than placebo at relieving arthritis pain, typical doses used in these studies were roughly 3g/day.  Liver toxicity can occur when taking acetaminophen particularly in those who consume a moderate amount of alcohol.

How effective are physical interventions in the treatment of knee osteoarthritic pain?

The knee joint is the joint most commonly affected by osteoarthritis.   A recent meta-analysis published in BMC Musculoskeltal Disorders (Bjordal JM, et), concluded that:

“TENS, EA and LLLT administered with optimal doses in an intensive 2-4 week treatment regimen, seem to offer clinically relevant short-term pain relief for OAK.”

[Transcutaneous electrical nerve stimulation (TENS, including interferential currents), electro-acupuncture (EA) and low-level laser therapy (LLLT)].

How effective are hyaluronic acid injections in relieving knee pain?

“Intra-articular viscosupplementation was moderately effective in relieving knee pain in patients with osteoarthritis at 5 to 7 and 8 to 10 weeks after the last injection but not at 15 to 22 weeks (Modawal et al, 2005).”

This study additionally included these practice recommendations:

1. Consider injections of hyaluronic acid injections only after conservative therapy has been tried for at least three months or the patient is unable to tolerate NSAIDS.
2.  Stress to patients that pain relief may not be fully experienced until 5-7 weeks following the last injection.

Hyaluronic acid injections vs. coticosteroids?

A meta-analysis recently published in the medical journal, Arthritis and Rheumatism (Bannuru RR et al, 2009) compared the effectiveness of corticosteroid vs. hyaluronic acid injections.

What the reviewers found is that corticosteroid injections provided greater pain relief in the first 4 weeks.  However by the 4th week, both treatments were similarly effective.  Beyond week 8, hyaluronic acid injections were superior to corticosteroids.

What does this mean?

Consider hyaluronic acid injections after other treatment options have been explored. In addition, hyaluronic acid injections may offer moderate pain relief, but the pain relief can take up to a month to reach the maximum effect.

How much do Hyaluronic acid injections cost?

Each hyaluronic acid injection costs approximately $230!  Current recommendations include patients receiving one injection per week for a total of five weeks which amounts to about $1150.

Related posts:

1. Do NSAIDS Provide Long-Term Pain Relief for Arthritis?
2. Does Purple Passion Fruit Peel Extract Ease Arthritis Pain?
3. Natural Treatment Options for Rheumatoid Arthritis
4. Omega-3 Fatty Acids for Rheumatoid Arthritis Pain?
5. Bromelain for Knee Arthritis?

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