Daily Archives: April 14, 2010

Walking Plus Glucosamine Sulfate May Improve Symptoms of Osteoarthritis

A 30-minute walk taken at least 3 days a week combined with glucosamine sulfate supplements may reduce symptoms of mild to moderate hip or knee osteoarthritis (OA), researchers report in a new study published online in the journal Arthritis Research & Therapy.

Here’s are some of the details based upon a MedScape report:

“Management of [OA] includes the use of non-pharmacologic and pharmacologic therapies,” wrote Norman T. M. Ng, MD, from the University of Queensland, Brisbane, Australia, and colleagues. “Although walking is commonly recommended for reducing pain and increasing physical function in people with OA, glucosamine sulphate has also been used to alleviate pain and slow the progression of OA.”

The main goal of this feasibility study was to evaluate the combined effects of a progressive walking program and glucosamine sulfate intake on OA symptoms and physical activity participation in people with mild to moderate OA.

In addition, the investigators compared the effectiveness of 2 frequencies of walking (3 vs 5 days per week) and 3 step levels (1500, 3000, and 6000 steps per day), combined with glucosamine sulfate supplements, and also examined compliance with supplement intake and the walking program.

The study included 28 patients aged 42 to 73 years. All patients were given 1500 mg of glucosamine sulfate per day for 6 weeks and then began a 12-week progressive walking program while continuing to take glucosamine.

Fifteen patients were randomly assigned to walk 5 days per week, and the remaining 13 were randomly assigned to walk 3 days per week. The participants received a pedometer to monitor their step counts. Step level of walking was gradually increased to 3000 steps per day during the first 6 weeks of walking and to 6000 steps per day for the next 6 weeks in both groups.

Patients were assessed at baseline and at 6-, 12-, 18-, and 24-week follow-ups.

Glucosamine Alone Was Helpful

The researchers found that during the first 6 weeks of the study, when patients were taking glucosamine supplements only, physical activity levels, physical function, and total Western Ontario and McMaster Universities scores improved (P < .05).

These outcomes continued to improve through to the final follow-up, although most improvements were seen between weeks 6 and 12, the authors report.

Compliance with the walking program was the same for both groups

Walking 5 days per week was not more effective than walking 3 days per week in reducing pain and stiffness, increasing physical function, or improving most other measures used in the study, the authors report.

Participants in the 3-day walking group walked 3 days per week, but participants in the 5-day walking group walked slightly less than 4 days per week, which suggests that it may be difficult to get people with hip or knee OA to walk more than 3 to 4 days a week, the authors write.

Increased Activity Further Improved Results

Increasing the number of steps from 1500 to 3000 steps per day, combined with glucosamine intake, resulted in a 125% increase in minutes of physical activity, a 17% reduction in pain scores, and improvements in physical function. Increasing the steps to 6000 steps per day resulted in a further 57% increase in physical activity participation and further improvements in physical function.

“Although the study included a small sample, the findings provide preliminary evidence that OA sufferers can obtain health-related benefits from the combination of glucosamine supplements and walking,” the authors conclude. “If the benefits of this program are confirmed, it could be promoted to increase physical activity among people with hip or knee OA.”

Chris Morris, MD, a practicing rheumatologist at Arthritis Associates in Kingsport, Tennessee, commented on this study for Medscape Rheumatology, saying that it supports what many rheumatologists believe — that low- to no-impact exercise can make a difference in OA of the knee.

Dr. Morris added that many patients have unrealistic expectations about the beneficial effects of exercise. “They expect immediacy in terms of results — they expect to be able to do everything they did 20 years (and often 50 pounds) earlier, and when their knees hurt, they just give up. Patients need to understand that they have to start out light and gradually work their way up — that any program takes time, and that they must commit to the activity long-term.”

The study by the Australian researchers “provides yet another study to help support the viewpoint that exercise can help arthritic symptoms and the patient’s well-being,” Dr. Morris said. “I encourage my patients to exercise and have recommended walking to those who do not have the resources or access to health clubs, wellness centers, water exercise programs. Most people live reasonably near an enclosed shopping mall, many of which are carpeted, and most of which open their doors early for walkers.”

Concerning glucosamine and/or chondroitin for osteoarthritis, here are the recommendations to physicians from the Doctors of Pharmacology at the Natural Medicine Comprehensive Database:

  • If recommending a product, suggest glucosamine SULFATE; Glucosamine Hydrochloride products might also help, but the best evidence is for glucosamine SULFATE, particularly a specific product called Dona (Rotta Pharmaceuticals, Italy).
  • Recommend a dose of 1500 mg once daily; however if this dose is not tolerated, suggest switching to 500 mg three times daily.
  • Chondroitin sulfate appears to be effective for osteoarthritis when combined with conventional treatments; however, there is more and better evidence for glucosamine SULFATE.
  • Combination products of glucosamine plus chondroitin are probably effective, but there is no reliable evidence that the combination is better than treatment with just glucosamine SULFATE.

Acupuncture may provide some relief from depression during pregnancy

The New York Times reported in “Vital Signs” that, according to a new study published in the journal Obstetrics & Gynecology, “acupuncture may provide some relief” from depression “during pregnancy.”

In an eight-week study of “150 depressed women who were 12 to 30 weeks pregnant,” 52 of whom were randomized “to receive acupuncture specifically designed for depressive symptoms, 49 to regular acupuncture, and 49 to Swedish massage,” Stanford researchers found that nearly “two-thirds of the women who had depression-specific acupuncture experienced a reduction in at least 50 percent of their symptoms, compared with just under half of the women treated with either massage or regular acupuncture.”

This might be an option many women would be interested as there are potential risks of using systemic medications (whether prescription, OTC, herbal, or supplements) during pregnancy.

TENS judged to be ineffective for low-back pain

Lots of us doctors, and many physical therapists, utilize TENS (transcutaneous electric nerve stimulation) for low back pain. Now a Los Angeles Times “Booster Shots” blog reports that, according to new guidelines published online in the journal Neurology, the “popular pain therapy using a portable device called TENS should not be used to treat chronic low-back pain.” Wow, this will be a change for many of us.

After reviewing studies and medical literature, researchers from the Kansas University Medical Center said that “the therapy is ineffective for low-back pain.”

HealthDay reported, “An exception was diabetic nerve pain, also known as diabetic neuropathy, which can cause symmetrical numbness, decreased sensation, and a feeling of burning, usually involving the legs, but sometimes affecting the hands.”

Study lead author Richard M. Dubinsky, MD, MPH, FAAN, “chair of practice improvement for the” American Academy of Neurology (AAN), said “there is good evidence that TENS is effective in this condition, which develops in about 60 percent of people with diabetes.”

WebMD explained that TENS, which “is a pocket-sized, battery-operated device that sends electric currents to the nerves via electrodes with the goal of treating pain,” has been “used for pain relief for four decades.”

But, after reviewing five “TENS studies involving patients with chronic low back pain lasting three months or longer,” AAN investigators found that while some “studies did show a benefit for TENS, the two most rigorously designed and executed trials reviewed by the researchers did not.”

Well, I guess TENS is now out of my tool bag for low-back pain.