Pain is something everyone experiences from time to time. Most aches and pains are a minor nuisance, rather than a serious problem, but six million people in Great Britain suffer from chronic and persistent pain on a daily basis.
Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are widely prescribed to treat acute and chronic pain. Although they are effective analgesics, they are associated with a number of adverse events, including kidney damage, exacerbation of asthma and gastric ulceration. Recently, the use of NSAIDs was found to increase the chance of developing heart failure in older people; one study showing that currently taking an NSAID increased the risk of a first hospital admission for heart failure by 30%. For those with previous heart failure, taking an NSAID increased the chance of admission to hospital almost nine-fold1. NSAIDs have also been associated with the appearance of psychiatric symptoms, including changes in mood, thought processes and exacerbation of pre-existing psychiatric problems2. A number of NSAIDs have also been withdrawn due to increased risk of heart attack and stroke. Overall, it is estimated that around 25 million NSAID prescriptions are issued in the UK each year, resulting in ‘2,000 admissions to hospital to treat serious side effects, and as many as 2,600 deaths3.
Many people therefore prefer to try a natural alternative especially for treating arthritis. Whereas NSAIDs can only damp down inflammation and pain, food supplements such as glucosamine plus chondroitin have the potential to halt the degenerative effects of osteoarthritis. The following supplements can help to reduce joint or back pain.
Glucosamine stimulates the formation of proteoglycans (protein molecules) important for strengthening cartilage so it can resist compressive forces; it is also thought to have an anti-inflammatory action. A pivotal trial published in the Lancet showed that taking glucosamine supplements (1,500mg once daily) produced significant improvements in pain and disability, with no significant loss of joint space seen over the three year trial period. In contrast, those taking placebo developed worsening symptoms with increased narrowing of the knee joint space4.
A systematic review of 20 randomised controlled trials found that, in people with osteoarthritis, glucosamine was more effective at relieving pain than placebo with a 28% improvement in pain and a 2’% improvement in joint function5. This review included four trials in which glucosamine was compared to an NSAID glucosamine was shown to be superior in two, and at least as effective in two, with a considerably lower risk of side effects (similar to that seen with inactive placebo).
Chondroitin also stimulates proteoglycan synthesis and promotes cartilage formation.
It is often combined with glucosamine for their naturally synergistic actions. A clinical trial in which people with osteoarthritis of the knee took chondroitin for 3 months, on two occasions throughout the year, showed that treatment significantly improved pain and joint function. In those taking placebo, joint space width decreased, while in those on chondroitin, there was no deterioration in joint space6. This suggests that, like glucosamine, chondroitin has a disease modifying action against osteoarthritis of the knee. In a recent trial, the effects of glucosamine and chondroitin were compared with that of the NSAID, celecoxib. The study showed that, for people with moderate to severe knee pain, the combination of 1,500mg glucosamine plus 1,200mg chondroitin per day was more effective at producing a 20% decrease in knee pain over the 24 week study than celecoxib7.
Other natural painkillers
MSM (methyl-sulphonyl-methane) has an anti-inflammatory action that reduces the formation of free radicals by white blood cells8. MSM can reduce joint pain in people with osteoarthritis by 80% within six weeks, compared with an average improvement of only 20% in those on placebo9. MSM is often taken together with glucosamine and, in one study, the combination of 500mg glucosamine plus 500mg MSM three times per day was found to significantly improve joint function and reduce pain and swelling more than either agent alone. The combination also produced a more rapid improvement in symptoms10.
Bromelain, a proteolytic enzyme derived from pineapple, has an anti-inflammatory action, reducing the migration of white blood cells into areas of inflammation, and damping down their release of inflammatory chemicals11. Bromelain has been shown to significantly reduce acute knee pain and stiffness, and to improve general well-being in a dose-dependent manner12. It helps to reduce pain and swelling associated with arthritis, sprains and soft tissue injury. Reduces knee pain and inflammation associated with rheumatoid arthritis. Improve mobility of osteoarthritis.
Devils Claw is a natural herbal painkiller for low back pain and inflamed joints. Two clinical trials examining the effects of Devil’s Claw found strong evidence that it was better than placebo for improving back pain, while another study found it was at least as effective as the NSAID rofecoxib (which has now been withdrawn)13.
Green lipped mussel extracts contain omega 3 fatty acids that have an anti-inflammatory action. A recent trial showed these extracts significantly improved the signs and symptoms of osteoarthritis by 53% within one month, and 80% within two months14.
Turmeric contains curcumin, a powerful anti-inflammatory agent’15 which helps to ease stiff joints. Unlike NSAIDS, turmeric protects the stomach from peptic ulceration and it is traditionally used as a treatment for gastritis16.
Ginger also has a significant analgesic effect against joint pain and has been shown to suppress inflammation by blocking the release of inflammatory chemicals within synovial, cartilage and white blood cells17.
So if you have joint or back pain and are wary about taking a non-steroidal anti-inflammatory drugs, a number of food supplements have anti-inflammatory, pain-killing actions. As well as being as effective as some prescribe analgesics, these food supplements are less likely to cause serious adverse side effects.
1 Huerta c et al. 2006. nonsteroidal anti-inflammatory drugs and risk of first hospital admission for heart failure in the general population. heart may 22 (epub)
2 onder g et al. 2004. nsaid-related psychiatric adverse events: who is at risk? drugs. 64(23):2619-27.
3http://www.jr2.ox.ac.uk/bandolier/booth/painpag/nsae/nsae.html
4 Reginster jy et al. 2001. long-term effects of glucosamine sulphate on osteoarthritis progression: a randomised, placebo-controlled clinical trial. lancet 357(9252):251-6
5 Towheed te et al. 2005 glucosamine therapy for treating osteoarthritis. cochrane database syst rev. (2):cd002946.
6 Uebelhart d et al. 2004. intermittent treatment of knee osteoarthritis with oral chondroitin sulfate: a one-year, randomized, double-blind, multicenter study versus placebo. osteoarthritis cartilage. 12(4):269-76.
7 Clegg do et al. 2006 glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis. n engl j med 23;354(8):795-808
8 Beilke ma et al. 1987. effects of dimethyl sulfoxide on the oxidative function of human neutrophils. j lab clin med 110:91-96.
9 Jacob sw, appleton j. msm: the definitive guide. a comprehensive review of the science and therapeutics of methylsulfonylmethane. topanga, ca: freedom press; 2003:107-121.
10 Usha pr, naidu mur. 2004. randomised, double-blind, parallel, placebo-controlled study of oral glucosamine, methylsulfonylmethane and their combination in osteoarthritis. clinical drug investigation.24:353-363
11 Hale lp et al. 2002. bromelain treatment alters leukocyte expression of cell surface molecules involved in cellular adhesion and activation. clin immunol. 104(2):183-90
12 Walker af et al. 2002. bromelain reduces mild acute knee pain and improves well=being in a dose-dependent fashion in an open study of otherwise healthy adults. phytomedicine 9(8):68106
13 Gagnier jj et al. 2006 herbal medicine for low back pain. cochrane database syst rev (2):ch004504
14 Cho sh et al. 2003. clinical efficacy and safety of lyprinol, a patented extract from new zealand green-lipped mussel (perna canaliculus) in patients with osteoarthritis of the hip and knee: a multicenter 2-month clinical trial. allerg immunol (paris) 35(6):212-6
15 Lantz rc et al. 2005. the effect of turmeric extracts on inflammatory mediator production. phytomedicine. 12(6-7):445-52.
16 Prucksunand c 2001. phase ii clinical trial on effect of the long turmeric (curcuma longa linn) on healing of peptic ulcer. southeast asian j trop med public health. 32(1):208-15.
17 Phan pv et al. 2005. ginger extract components suppress induction of chemokine expression in human synoviocytes. j altern complement med 11(1):149-54
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