Glucosamine for Low Back Pain from Osteoarthritis?
Glucosamine for Low Back Pain from Osteoarthritis?
Abstract & Commentary
By Russell H. Greenfield, MD, Editor
Synopsis: A number of studies suggest that glucosamine sulfate may help relieve pain and possibly repair cartilage damage in large joints affected by osteoarthritis. By extension, many patients use glucosamine to treat their chronic nonspecific lower back pain. The results of this study, which includes long-term follow-up, suggest there is little if any therapeutic value of glucosamine for chronic low back pain.
Source: Wilkens P, et al. Effect of glucosamine on pain-related disability in patients with chronic low back pain and degenerative lumber osteoarthritis. JAMA 2010;304:45-52.
Results of research examining the use of glucosamine for the treatment of osteoarthritis of the hip and knee, although at times conflicting, offer promise for the relief of symptoms in some patients. It makes sense that many people would extrapolate that promise to the use of glucosamine for the treatment of lower back pain secondary to degenerative arthritis (osteoarthritis, or OA), the effectiveness of which the authors of this Norwegian double-blind, randomized, placebo-controlled trial set out to investigate.
People with chronic low back pain (LBP) were recruited via practitioner referrals and through a newspaper advertisement. Inclusion criteria included the patient's primary concern being nonspecific LBP for at least 6 months, age older than 25 years, and a summed score of at least 3/24 on the Roland Morris Disability Questionnaire (RMDQ). Patients with leg pain were included, provided the degree of LBP exceeded that of leg discomfort. Subjects also needed a recent (less than a year old) MRI scan showing degenerative disease in the lower spine. Patients with findings of disc herniation or spinal stenosis were excluded.
A total of 473 people were screened for participation with 250 ultimately being randomized to receive either 1,500 mg glucosamine sulfate daily or matched placebo for 6 months. The most common reason for being excluded from participation in the study was LBP not being the primary complaint, followed by a history of previous back surgery. Only 5 subjects refused randomization. Baseline data collection included psychological status and an assessment of fear avoidance behavior.
Follow-up visits took place at 6 weeks, 3 months, and 6 months; then 6 months following termination of the intervention, follow-up occurred using postal questionnaires (12-month follow-up). Subjects were permitted to use currently prescribed pain and rescue medication as needed and their usual LBP therapy, including manual therapies. Primary outcome of interest was the RMDQ result, where a higher number is associated with increased disability. The authors chose at least a 3-point decrease in total RMDQ as signifying response to treatment. Secondary outcomes of interest included the degree of low back and leg pain at rest (determined by an 11-point pain rating scale), measures of health-related quality of life (EQ-5D and EQ-VAS), and assessment of the global perceived effect of glucosamine via 7-point Likert scale. Compliance with study protocol was established via pill count.
After 6 months, a total of 17 subjects had dropped out (6.8%, 7 in the glucosamine group), while at the 1-year mark 29 failed to return their postal questionnaires (15 in glucosamine group). Compliance was deemed high (87%) at the 6-month follow-up and side effects were noted to be mostly mild and self-limited. Fasting blood glucose, blood pressure, and lipid levels did not change appreciably during the course of the trial.
Baseline RMDQ for the glucosamine group was 9.2 (95% confidence interval [CI], 8.4-10.0) and at 6 months was 5.0 (95% CI, 4.2-5.8). The numbers for the placebo group were 9.7 (95% CI, 8.9-10.5) and 5.0 (95% CI, also 4.2-5.8), respectively. At the end of 12 months, RMDQ results were 4.8 (95% CI, 3.9-5.6) for the glucosamine group and 5.5 (95% CI, 4.7-6.4) for subjects receiving placebo. No significant differences were identified between the two groups with respect to the main outcomes of interest. The authors concluded that their findings suggest no beneficial effect of glucosamine for people suffering chronic LBP due to OA.
Commentary
Lower back pain is one of the most common chief complaints of people presenting to their primary care providers and is often associated with degenerative disease on MRI of the spine when obtained. When advised of their circumstances many people with apparent OA-related LBP choose to explore the use of glucosamine due to awareness of perceived benefit in the treatment of peripheral joint OA, or perhaps their own prior experience with the agent. In theory, glucosamine acts to decrease joint inflammation and support cartilage health, if not actually restore small amounts of cartilage. Studies on the use of glucosamine abound, but conclusions regarding effectiveness vary, although the greater number support a potential role in the treatment of large joint OA.
Of course the spine contains joints, too, and it would be no great leap to consider glucosamine use for patients with nonspecific LBP. The authors of the current trial did a very nice job of exploring the issue, however, and concluded that glucosamine did not offer significant benefit in the setting of OA-associated chronic LBP. Methodological weakness such as using pill counts to determine compliance and permission to continue using adjunctive LBP care do not offset the study strengths of sample size, duration of follow-up, and the fact that in Norway glucosamine is considered a prescription drug. It appears, at least on the basis of this single study, that glucosamine is not a good therapeutic choice for people experiencing chronic LBP in association with spinal OA.
Another reason for taking note of this study published in one of our more respectable conventional medical journals is that the lead author is a chiropractor, his co-authors being an MD and three PhDs. Further evidence that good science knows no boundaries.
A number of studies suggest that glucosamine sulfate may help relieve pain and possibly repair cartilage damage in large joints affected by osteoarthritis. By extension, many patients use glucosamine to treat their chronic nonspecific lower back pain. The results of this study, which includes long-term follow-up, suggest there is little if any therapeutic value of glucosamine for chronic low back pain.Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.