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Millions of Americans who traditionally have reached for painkillers for relief of osteoarthritis pain can now choose between a host of alternative therapies, which though not entirely proven by science, are catching on in doctors offices.
Nutritional supplements, heat and cold treatments, injections made from rooster combs, and magnets all make the list of new osteoarthritis treatments. Experts say each has been tried with varying degrees of success. However, they caution that most of the evidence that these therapies work is anecdotal, rather than scientific.
W. Hayes Wilson, MD, chief of rheumatology at Piedmont Hospital in Atlanta and chairman of the Georgia chapter of the Arthritis Foundation, says he doesn. t discount the new therapies, yet he says patients should not rule out traditional painkillers as a way to relief.
“What works for the patient is what counts, Wilson says. “That is our final goal.
Nearly 29.7 million Americans suffer from osteoarthritis, a degenerative disease that causes the breakdown of cartilage in the joints and leads to stiffness or pain. Osteoarthritis, which typically comes with advancing age (over 45), often occurs in the knees and hips and can so debilitating that it affects a person’ s ability to walk.
A new wave of treatments
The newer alternative therapies are particularly welcomed by patients who dislike taking medication particularly for an extended time, as painkillers and anti-inflammatory drugs are often indicated since osteoarthritis is a chronic disease.
“I have patients who say, under no circumstance do I want to use medication, Wilson says. “I say, that’ s fine..
Two nutritional supplements, glucosamine and chondroitin sulfate, have become the biggest rage. Both are normal constituents of the cartilage in the joints. Many people take them believing that they either slow down the degeneration of cartilage or restore cartilage.
While that benefit has been documented in animal studies, so far it has not been confirmed in the short-term studies in humans. Still, from what Wilson says he has observed, glucosamine and chondroitin do have some anti-inflammatory effect and they may actually provide a “good environment for the body to heal. Another plus, the supplements really don’t have any side effects.
The downside, though, is that the Food and Drug Administration does not regulate them, so patients can’t be sure they are getting what they think they are getting, according to Wilson.
Omega 3 oils
There are a host of other nutritional supplements that are believed to have anti-inflammatory qualities, such as Omega 3 oils, particularly salmon, cod liver oil, oil of evening primrose, and flaxseed oil. “People have to be careful of cod liver oil, because it has vitamin A in it, Wilson says. Vitamin A is fat-soluble and stored in the body, so there is a danger of taking too much. (The daily adult requirement is 900 micrograms.)
Another option for treating osteoarthritis is a natural substance called hyaluronic acid, which is present in the connective tissue and joint fluid in humans and animals and gives elasticity to the joints. Preparations of hyaluronic acid for relief of osteoarthritis pain are extracted from roosters. combs. Hyaluronic acid is injected into the joint over a period of five weeks, once a week, and provides relief for up to six months afterward.
“When it works, it works great, Wilson says. “But it doesn’ t work for everyone. Hyaluronic acid is also expensive, though, and it is unclear whether it provides any real protection against joint deterioration.
Still, it is a natural substance and many people prefer it over traditional cortisone shots, which can also be used to provide pain relief for a severely inflamed joint. Frequent injections of corticosteroids, however, can lead to the destruction of cartilage and bone.
Some osteoarthritis patients are also turning to magnetic therapy for relief. Those who believe in magnets. healing qualities say that when a magnet is applied to the body, magnetic waves pass through the tissues, creating secondary currents. The theory is these currents clash with magnetic waves, producing impacting heat, which is very effective to reduce pains and swelling.
Wilson says the use of magnetic fields hasn’ t been studied all that well, but its not invasive and some patients like that. “If someone says should I or can I get magnetic insoles for my shoes, whether they should or not, I can. t tell, Wilson says.
Still other patients also swear by hot showers or cold packs for occasional osteoarthritis flare-ups. Applying a cold pack first to an inflamed area can help reduce the inflammation, and heat afterward can help relax the muscles, he says.
Bye bye painkillers?
These alternative therapies may be in the limelight, but experts say patients shouldn’ t shun painkillers, which have been the drugs of choice for treating osteoarthritis.
“The least expensive, effective therapy for osteoarthritis is still acetaminophen, says Eric G. Boyce, Pharm D, professor of clinical pharmacy at the University of the Sciences in Philadelphia. Boyce adds that acetaminophen . Tylenol. s active ingredient – is a safe drug providing people stay within the recommended doses and don. t abuse alcohol, which can lead to acetaminophen-induced liver damage.
Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen sodium, are the other option. NSAIDs relieve inflammation as well as pain. One disadvantage, though, is that they have been known to cause an assortment of side effects, including irritation and bleeding in the stomach, and decrease in kidney function. NSAIDs should also be used with caution by anyone who drinks alcohol.
A newer generation of NSAIDS, called Cox 2-inhibitors or “super aspirins. . (such as celecoxib and rofecoxib), are as effective as the older NSAIDS, but are safer and more expensive, Boyce notes. These compounds don. t cause the gastrointestinal irritation of the older anti-inflammatory drugs, he says.
Patients can take acetaminophen or anti-inflammatory drugs for decades, providing they tolerate them well. “Never take anything longer than needed, and never take more than you need,. . Wilson says, providing one yardstick for use of those drugs.
Wilson and Boyce say patients should not overlook the importance of weight control and exercise in managing osteoarthritis. Federal studies have shown that a moderate amount of weight loss can decrease the chance of osteoarthritis by 50 percent.
“One of the first things I recommend to a patient is get as close to your ideal body weight as possible, Wilson says. “If you lose 10 pounds it. s like taking 30 pounds off the knee.
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Age 45 years and older