Osteoarthritis of the knee: Choosing the right pain medicine
Natural Remedies for Osteoarthritis Knee Pain
Natural remedies straddle the border between nutrition and medicine. What should you consider before taking herbals or supplements for osteoarthritis knee pain?
By Jeff Muise
Medically Reviewed by Pat F. Bass III, MD, MPH
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Beyond meeting nutritional needs, the foods we eat contain ingredients that may play a role in preventing or alleviating disease, such as knee pain for those with osteoarthritis.
This is the concept behind "natural remedies," including ancient herbal remedies, so-called functional foods (foods or drinks with beneficial health effects), and the new category of nutraceuticals (supplements made from extracted food ingredients delivered in a powder, pill, or other form).
Osteoarthritis Knee Pain Relief
There is a long list of non-prescription natural osteoarthritis remedies used for knee pain relief, each with its own proponents and devotees. Among the natural remedies that are more generally accepted are:
- Chondroitin sulfate.A substance found in cartilage and bone, it is reputed to reduce inflammation and pain, slow disease progression, and improve joint function. It is produced from bovine trachea or pork by-products.
- Glucosamine.Reportedly slows cartilage deterioration, relieves pain, and improves joint function. It is made from the shells of crabs, lobsters, and shrimp.
- Avocado soybean unsaponifiables.A supplement to slow disease progression, it is extracted from avocado and soybean oils.
What to Expect From Natural Osteoarthritis Remedies
With the plethora of different natural remedies, selecting the right one for your osteoarthritis knee pain is a daunting challenge. Roberta Lee, MD, vice chair of the department of integrative medicine at Beth Israel Medical Center in New York City, has guided many patients through the confusing world of natural remedies. She offers the following advice for anyone considering a natural remedy:
- Be patient.Unlike prescription medications, natural remedies work slowly and the benefits are cumulative. Dr. Lee says it can take two weeks to a month for the effects of a supplement to become noticeable.
- Think palliative care.Natural remedies may help slow disease progression, but they are basically palliative, meaning they ease symptoms, not restorative.
- Consider combined therapies.Natural remedies often are combined with other natural therapies and lifestyle modifications in a "multilayered" approach. These can include acupuncture, stress reduction techniques, and general health practices like getting sufficient sleep and eating a healthy diet.
- Watch out for interactions.Natural remedies can be used with prescription medication, but be careful of interactions. Talk to your doctor before starting a natural remedy, as there are numerous interactions that can occur. As Lee says, "Everything interacts with everything."
- Go the supplement route.Enriching your diet with a food or herb may not be enough. Take natural remedies in supplement form, through capsules, gel tabs, or powders.
- Stick with it.Sticking with your natural remedy regimen is critical. "Compliance is terrible if someone is expecting the supplement to act like a medication and then it doesn't," Lee says. "I can't emphasize enough how important it is to manage lifestyle in addition to using the supplements."
Natural Remedies for Osteoarthritis Knee Pain Relief: The Studies
Many small clinical studies have claimed effectiveness for one remedy or another, but many of the studies lacked scientific rigor. Generally accepted evidence for the effectiveness of natural osteoarthritis remedies remains surprisingly scant.
The GAIT Study.In 2006, the National Institutes of Health published mixed results from the Glucosamine/Chondroitin Arthritis Intervention Trail (GAIT). The researchers found that the combination supplement did not provide significant relief for osteoarthritis knee pain in most subjects compared to placebo. However, a subgroup of subjects with moderate to severe pain did gain significant relief. In 2008, in an ancillary GAIT study, the supplements were found to be no better than placebo in slowing loss of cartilage in osteoarthritis of the knee.
A Swiss Review of Natural Remedy Studies.In a recent study, Swiss researchers screened 2,026 clinical trials of natural osteoarthritis remedies and fully analyzed 53 trials of 18 supplements that met their inclusion criteria (the analysis excluded studies on glucosamine/chondroitin, which had been extensively reviewed elsewhere). The researchers identified four clinical trials that produced good evidence for the efficacy of avocado soybean unsaponifiables for improved functioning and symptom relief after several months of use — but no evidence for long-term relief or structural improvement of joints.
Lee says scientific trials of natural osteoarthritis remedies may just not be long enough to show results, and that subtle effects don't emerge from large-scale data. "Those kinds of subtle influences need time to be demonstrated, and the longer a study goes on, the harder it is to get funding for it," she says.
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