Most people over the age of 35 start to show signs of wear and tear – either in deteriorating physical condition, stiffness and soreness of joints or muscles, or with actual medically diagnosed conditions such as osteoarthritis, rheumatoid arthritis, fibromyalgia or other pain syndromes. This can be due to accumulation of microtrauma over years – tendon microtears, cartilage fissures, stress fractures; or can be from ongoing effects of incompletely healed traumatic injury like fracture, inter-vertebral disc prolapse, or scar tissue from large muscle tears. It can also be from auto-immune malfunction – the body’s immune system going haywire and mistaking joint cartilage or muscle for foreign tissue, and so attacking and destroying healthy normal tissue.
Almost everyone who has ongoing pain (in the Western medical setting, in which we live) has taken the option of taking a medication or a supplement to try to ease this pain and restore normal, pain free function. These can range from simple Panadol or Nurofen to Endone and Oxycontin, and a raft of non-prescription nutrients or herbal supplements such as Glucosamine, Fish or Krill Oil, Turmeric, Arnica, Comfrey, White Willow bark and the list goes on. This article is about the non-pharmaceutical options – nutritional and herbal supplements.
Unfortunately, companies that manufacture these products have no responsibility to ensure that they are in fact effective, just that they don’t cause harm. Other than that, the Therapeutic Goods Administration has to continually monitor importation and manufacture to test the claims made by all products sold in Australia, and ensure that these beneficial claims are supported by good scientific data. If not for them, we’d all be taking powdered Rhino horns for impotence, or similar fanciful products.
Thankfully, some really good scientific research is being done all over the world to try to work out exactly which of these supplements actually do make some difference (I’m not going to bog down this article with proper scientific referencing, if anyone wants links to articles please contact me). Some of the studies that report the greatest benefits turn out to be funded by the companies that make the products, rendering their results questionable, but peer-reviewed scholarly articles and literature reviews (where researchers examine all available studies, test their methodology for rigorous scientific method, and examine their power of comparison, or ability to be generalised to a larger population) are generally non-biased, and can give us some real information about the effectiveness of a supplement on a test population. If the study is well done, then we can generalise this result with some confidence.
Glucosamine: This one seems to divide the medical community, with many of my patients being advised by their doctors, and even Rheumatologists that it is useless, and not to bother taking it, and yet almost all well designed studies show some positive effect on both pain and reduction of joint space narrowing over time (from arthritic degeneration) in osteoarthritis. The strength of the effect varies from mild to strong depending on the study, and the studies showing the strongest effects do show some bias with funding received from companies manufacturing the products. The problem with this supplement is that the community seems to be poorly educated as to which conditions it gives some benefit; for osteoarthritis there is good evidence to support its use, but in Rheumatoid arthritis or Fibromyalgia (and other chronic pain syndromes) there is little to none. This is because it is a nutrient that the body uses to make new cartilage, and so if the pain is not coming from physical destruction of the cartilage then it wont help.
Fish Oil: (or Krill oil, same active ingredient) This product seems to be relatively well accepted by almost the whole medical community as being significantly beneficial to cardiac health, but there is also plenty of support for its use as an anti-inflammatory in conditions that cause inflammation (both auto-immune and physical). Because of this, there is good evidence to support its use in Rheumatoid arthritis and osteoarthritis. It is important to note that like most anti-inflammatory medications, fish oil prolongs blood clotting time (anti-coagulant) and so care must be taken when using this in combination with other anti-coagulants like aspirin, warfarin, heparin etc.
Turmeric/Curcumin: No news to the equestrian community who have been using turmeric paste for years to treat inflammation in horses, recent studies have tested the use of turmeric as an anti-inflammatory medication against other common Non-Steroidal Anti-Inflammmatories Drugs(NSAIDs). Interestingly, it has been shown to be more effective than Ibuprofen (or at least as effective in other studies) but without the other common side-effects that make NSAIDs undesirable for many in the community, namely gastric irritation due to promoting stomach acid secretion, and cardiovascular effects such as increased blood pressure, and stroke. Due to this turmeric is an effective and safe alternative to NSAIDS like Ibuprofen in treatment of all arthritic conditions and inflammatory conditions. It may not be strong enough to have much effect in conditions such as Rheumatoid arthritis or Lupus, but is a great baseline treatment with little to no ill-health effects.
In the author’s opinion, these are the three supplements that have the best scientific evidence to support their use in managing pain. It is important to remember the goal of using any such supplement, and that it is the sustained and long term use that gives best benefit. Simply taking Glucosamine when you’re sore will have no effect, as is takes 4-5 weeks to positively effect the Chondroblast (cartilage building cells) activity to the point where it is therapeutic. Fish oil and turmeric can be used a little more episodically, but for people with chronically inflammatory conditions it is best to take them daily, as part of your normal nutritional routine.