Collagen: An implausible supplement for joint pain

I’m one of those odd people that enjoys distance running. I end up spending a lot of time in the company of other runners. And when we’re not running, we’re usually griping about our running injuries. As the cohort that I run with ages, the injuries are getting more prevalent. Besides the acute conditions, the chronic problems are starting to appear. Our osteoarthritis years are here.

As the available pharmacist, I get a lot of questions about joint pain. What’s reassuring, I tell them, is that they shouldn’t blame running. Osteoarthritis is common — the most frequent cause of joint pain. For some, it starts in our twenties, and by our seventies, osteoarthritis is virtually certain. Regardless of your level of exercise, the passage of time means the classic osteoarthritis symptoms — joint pain and morning stiffness, that worsens over time. Continue reading

Kicking Glucosamine to the Evidence Curb

Today’s post is from pharmacist and SBP contributor Avicenna. Here’s his bio and his prior posts.

As a community pharmacist, I’m frequently asked about over-the-counter (OTC) and natural health products (NHPs) for the treatment of different chronic conditions. This consultation can be complicated by a reluctance for consumers to seek a physician’s advice (and a diagnosis) before beginning therapy. As a partner in the health care system it’s important to give both credible, science-based advice, while ensuring a patient’s primary care physician is aware of the consultation and recommendations.

Arthritis pain is a common complaint, and I’m regularly asked about glucosamine, and sometimes chondroitin (which it is often co-packaged with). As is true for most natural products, glucosamine’s popularity is not related to persuasive clinical evidence. Rather it seems to be secondary to perceptions of efficacy, driven by personal experience, anecdotes and persuasive marketing.  However, unlike many other supplements, glucosamine has been extensively studied in clinical trials, and is at least plausible as a pain reliever for conditions affecting joint articulations, such as osteoarthritis (OA).  The evidence, unfortunately, is largely contradictory, and on balance, disappointing. Continue reading

Topical NSAIDs

I have a mental basket of drugs that I suspect may be placebos. In that basket were the topical versions of non-steroidal anti-inflammatory drugs (NSAIDs). When the first products were commercially marketed over a decade ago, I found the clinical evidence unconvincing, and I suspected that the modestly positive effects were probably due to simply rubbing the affected area, or possibly due to the effects of the cream or vehicle itself. Frankly, I didn’t think these products worked. So when I recently noticed a topical NSAID appear for sale as an over-the-counter treatment for muscle aches and pains (seemingly only in Canada, for now), I was confident it would make a good case study in bad science.

It’s not that I’m partial to the oral NSAIDs. Yes, they’re among the most versatile, and probably most well-loved drugs in our modern medicine cabinet. They offer good pain control, reduce inflammation and can eliminate fever. We start using it in our sick and feverish infants, through childhood and adulthood for the aches and pains of modern life, and into our later years for the treatment of degenerative disease like osteoarthritis, which affects pretty much everyone as we age. An astonishing 17 million Americans use NSAIDs on a daily basis, and this number is expected to grow as the population ages. In the running groups I frequent, ibuprofen has the affectionate nickname “Vitamin I”, where it’s perceived as an essential ingredient for dealing with the consequences of training.

But NSAIDs have a long list of side effects. Not only do they cause stomach ulcers and bleeding by damaging the gastrointestinal mucosa, there are heart risks, too. It was the arrival (and departure) of the drugs Bextra and Vioxx that led to documentation of the potential for cardiovascular toxicity. And now there’s data to suggest that these effects are not limited to the “COX-2″ drugs – almost all NSAIDs, including the old standbys we have used for years, seem capable of raising the risks of heart attacks and strokes.

So despite my initial skepticism, I took another look at the topical NSAIDs. The data were not what I expected. Continue reading