Alternative Therapies for Osteoarthritis

There are many products around offering relief of pain for sufferers of arthritis. I constantly get asked my opinion on this or that product, so I have decided to summarise the main choices. I have also looked at the current research and where possible review the data.

Magnets

Magnetic therapy has been used since ancient times to treat various conditions. The thought is that the iron in the blood creates an electromagnetic field when the magnet comes into contact with it. This results in an increase in blood flow to the area. Cochrane review for static magnets showed no significant difference in pain reduction between magnet therapy and placebo.

Copper

Copper helps in keeping the blood vessels, nerves, immune system and bones healthy. Through wearing a copper bracelet, it is thought copper trace elements enter the body and increase blood cell formation and therefore healing. There is no randomized controlled evidence to support this.

Acupuncture

Acupuncture, thought to have originated in China in 1000BC and now practiced and taught around the world, works on the theory that there are points situated on meridians that vital energy called qi flows. Through inserting and manipulating fine needles into these points, pain and therapeutic relief occurs. It is thought that acupuncture tonifies where there is deficiency, drains where there is excess and promotes free flow where there is stagnation.

Most modern acupuncturists use steralised disposable stainless steel needles of fine diameter. The size and type of needle will depend on the style being practiced. It is thought that acupuncture works through the release of natural endorphins in the brain. There is also suggestion that it increases local blood flow and has effect on local inflammation and ischaemia.

Generally, research has shown there is little difference between acupuncture and sham acupuncture (where needles are inserted off the meridian). Where acupuncture was shown to be beneficial, it was felt that study design could have been improved and that further research would be beneficial. This led to the US Department of Health to issue the following statement.

“There have been many studies of its potential usefulness. However, many of these studies provide equivocal results because of design, sample size and other factors. The issue is further complicated by inherent difficulties in the use of appropriate controls, such as placebo and sham acupuncture groups...”

Injuries are rare amongst patients treated by trained practitioners. In most countries, needles are required by law to be sterile, disposable and used only once. Minor bleeding after the removal of needles is seen in about 3% of patients, haematoma (bruising) is seen in about 2% of patients and dizziness in about 1% of patients. Other risks specific to the areas needled are nerve injury, pneumothorax, kidney damage and transmission of infections diseases when needles have not been steralised. These risks are small and are further reduced with the use of properly trained therapists. Having said this, the risk for acupuncture is generally lower than that of many other accepted medical procedures.

TENS

Transcutaneous Electrical Nerve Stimulation is where small electrical impulses are delivered to the body via electrodes. These impulses block or confuse pain stimuli resulting in lower or fewer messages reaching the brain. They are generally used to treat problems in muscles, joints and nerves, and have virtually no side effects. It is not recommended for pregnant patients, or those with pacemakers, epilepsy or certain types of heart disease without medical supervision. Cochrane reviews of TENS show that it is significantly better at treating osteoarthritis than placebo. It is felt that TENS used in conjunction with other pain relieving techniques offer the best approach.

Synvisc

Synvisc is an elastic and viscous fluid made from hyaluron that is found in normal joint fluid. It acts as a shock absorber and lubricant within the knee joint. Very few side effects have been shown and research suggests it is effective in reducing pain and increasing function in an OA knee especially at the 5-13 week period post injection. There is however little evidence to suggest that these benefits are maintained in the long term.

Glucosamine

Glucosamine is found naturally in the body and helps to build cartilage. Supplementary glucosamine sulphate is commonly made from crab, lobster and shrimp shells. There is also product made from vegetarian sources. The possible effect of glucosamine is to provide an anti-inflammatory effect and decrease the effect of enzymes that contribute to the damage and death of articular cartilage.

There are conflicting reports on the effect of glucosamine. It is felt there may be benefit in patients with moderate to severe osteoarthritis in comparison with placebo.

Chondroitin

Commonly used in conjunction with glucosamine, chontroitin is a key structural component in cartilage. Supplements manufactured from shark cartilage are thought to assist cartilage to be resilient to compression. Studies show that glucosamine combined with chondroitin may be more beneficial than glucosamine alone.

Conclusion

Most of these products mentioned show little or no effect over placebo under randomized controlled trials. Of all the products, Synvisc has the best evidence of benefit, however it is also the most expensive and offers only short-term relief. In my experience, there is a lot of anecdotal evidence from patients who have found relief from one of these products, whether it is just from placebo effect or not. The bottom line is that there is minimal reported risk associated with any of these therapies, so if it is not doing you any harm and you think it will help then there is no reason not to try. If you can afford it, what’s to lose?