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.

Neuragen for Nerve Pain

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

An estimated 2 to 3% of the developed world  –  roughly 1 million Canadians and 10 million Americans  –  suffer from a debilitating form of chronic pain, called neuropathic pain (NP) or neuralgia.(1,2) What’s worse is that these numbers are expected to rise because of an aging population and the subsequent increase in diabetes and shingles, two common diseases associated with NP.(3,4) More simply called nerve pain, NP is quite a challenging medical condition to treat since current treatment options provide only modest relief, and usually with problematic side effects.

I’ve recently had a few patients asking me about a new over-the-counter treatment for NP. The product is called Neuragen which is a homeopathic mixture in a solution of five essential oil extracts.(5,6) Neuragen comes in either a “concentrated” dropper-bottle (5 mL or 15 mL ) or an 8 gram gel jar.  Canada-based Origin Biomed, Neuragen’s manufacturer, boasts of impressive pain relief with Neuragen, including “Effective for up to 8 Hours”, “Effective for more than 80% of sufferers”, and “Highly effective for 63% of sufferers”.  Before looking at the evidence for Neuragen, let’s look at what we’re trying to treat: a condition called neuropathic pain.

Pushing Pharmacy Towards Evidence-Based Practice

Today’s post is from a pharmacist who blogs under the pseudonym Avicenna, who looks at how to bring evidence to bear on decision-making. With this post Avicenna officially joins SBP as a contributor. Go check out his bio and his prior posts.

I am a community pharmacist who spends little time practicing evidence-based pharmacy. Most of my workday is devoted to medication distribution instead of medication management, patient care and education. Although I must say, I love being a community pharmacist with a passion and I’m glad that I chose this career. It’s incredibly fulfilling to realize that you’ve made a difference in a patient’s health, and being thanked for just doing your job.

When a someone asks me why they need a second medication to decrease their blood pressure, I must be ready to form a good answer. Part of what constitutes a good answer is if it is supported by evidence, while the rest is the result of counseling and communication skills. I need to emphasize the benefits and specify any harm of such therapy in a understandable way that relates to my patient. If I am limited in time but need to update my knowledge, I can offer my patient a callback when I’ll have done a bit of research. However, in order to increase my ability to find and use new evidence for my answer, I need to have a process to help me quickly locate and apply the latest studies. Evidence based practice is a process that deals with this important issue.

Does Coenzyme Q10 Relieve Statin-Induced Muscle Pain?

Editor’s Note:

Today’s guest post is from a pharmacist who blogs under the pseudonym Avicenna, who looks at the evidence supporting the use of Coenzyme Q10 to treat statin-related muscle pain.

My pharmacy stocks plenty of natural health products (NHPs) and ensuring they can be used safely is challenging, given the limited information available on safety, quality, purity, and efficacy. Answering patient questions is always interesting and often very challenging, as they can often be non-specific. A typical question like “Is product ‘X’ good for treating condition ‘Y’?” can be difficult to answer without gathering some further information.  My usual response is, “Let’s talk about this. I want to make sure I give you an answer that is right for you, given your medical conditions.”

I recently spoke with a patient taking atorvastatin (Lipitor), a cholesterol-lowering medication from the “statin” family, who was complaining about muscle pain, and asking about Coenzyme Q10 (CoQ10) for treating that pain. Treating or preventing statin-related muscle pain is a common question, given the popularity of statins and the frequency of the complaint: About 1 in 15 develop this symptom. Before diving into the efficacy of CoQ10, let’s review statins.

Statin Benefits

If you have high blood pressure, are overweight, diabetic, or sedentary, you should know your cholesterol levels: Keeping them in the normal range will lower your death risk in the short and long term.[1] If you need drug therapy to reduce your cholesterol levels, you’re probably on a statin. Statins are a class of highly effective cholesterol-lowering drugs that work to inhibit HMG-CoA [3-hydroxy-3-methyl-glutaryl-CoA] reductase. Statins work by lowering cholesterol points (e.g., low-density lipoprotein (LDL), triglycerides) and/or moderately increasing good cholesterol (i.e., high density lipoprotein (HDL)). High levels of “bad” cholesterol is a contributor to heart disease and other negative cardivascular outcomes. It clogs the arteries that feed oxygen to the heart, and is involved in the process of blood clot formation.

Cranberry for the Treatment and Prevention of Urinary Tract Infections

Editor’s Note:

Urinary tract infections (UTIs) are among the most common infections in women: one in three will have an infection in their lifetime. Many seek medical advice. And recurrent UTIs, while rarely serious, can be troublesome. Their ubiquity costs the health care system millions of dollars per year. Cranberries and cranberry juice have been touted as a preventative and treatment option of UTIs for decades. Today’s guest post is from a pharmacist who blogs under the pseudonym Avicenna, who looks at the evidence supporting the use of cranberries for urinary tract infections (UTIs).

In my short career in pharmacy, I’ve been approached many times by patients about the merits of cranberry supplements. Adolescent, adult and elderly women who have a soft spot for alternative therapies are generally curious about cranberry. Since their sources are usually anecdotal, like friends, family, and alternative health magazines, I’m happy to summarize the evidence for them.