Glucosamine May Be Ineffective for Back Pain

Glucosamine sulfate may not help alleviate chronic lower back pain, a new study suggests.

Glucosamine is a natural compound that is part of healthy cartilage. Glucosamine sulfate is one of the most commonly used supplements, and it has shown consistent benefit in relieving pain associated with knee osteoarthritis. It has been proposed that glucosamine sulfate may improve other types of osteoarthritis and that it may have anti-inflammatory properties, which could be useful in treating patients with inflammatory bowel disease and rheumatoid arthritis.

Researchers at Oslo University Hospital in Norway recruited 250 adults who had chronic lower back pain and degenerative osteoarthritis of the lower back. Half of the patients were randomly assigned to take 1500 milligrams of glucosamine sulfate, while the other half took a placebo for six months.

After the six-month treatment and again at a one-year follow up, the participants filled out questionnaires about their pain, pain-related disabilities and quality of life. No statistically significant differences were found between the two groups.

Additional research is necessary to fully assess the effect of glucosamine in adults with chronic lower back pain before conclusions can be made.

Conventional treatment options for patients with lower back pain caused by osteoarthritis include physical therapy and exercise, surgery and medications. Commonly used medications include non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin®) and celecoxib (Celebrex®), narcotic or opiate pain relievers such as hydrocodone/acetaminophen (Lortab®) and oxycodone extended release (OxyContin®), corticosteroids (such as prednisone) and muscle relaxants.

Some other integrative therapy options with strong supportive evidence for treating osteoarthritis include acupuncture, chondroitin sulfate and willow bark. Therapies with good evidence for back pain include cayenne, chiropractic therapy, devil's claw, hydrotherapy, physical therapy and willow bark.

For more information about integrative therapies for joint pain, please visit Natural Standard's Comparative Effectiveness database.

Comments

[CAM]

Glucosamine is believed to work by the sulfate moiety providing clinical benefit in the synovial fluid by strengthening cartilage and aiding glycosaminoglycan synthesis. If this is a correct hypothesis, then this is conflicting evidence with the new study that was just published. The human vertebrae also has synovial fluid located between each vertebrae. Many times we do not stop and think of the human vertebrae as having synovial fluid because we most commonly associated this with common joints such as the knee or shoulder. Perhaps glucosamine does not work as much in the vertebrae as it does in the knee due to the lack of cartilage. The knee is full of cartilage, which the glucosamine could work on.

Another interesting angle is that there could be a placebo effect for the patients taking glucosamine for chronic knee pain. Very interesting study, and I look forward to hearing more results for the use of Glucosamine.

[Molly]

I was very disappointed to see the results of this trial, as so many suffer with back pain. The study was designed in such a way that the participants were allowed to continue to use other therapies to manage their pain. While ethical, this does not exclude the possibility that those treatments influenced the results (positively or negatively). I wonder if the participants’ outcomes would have been any different if supplementary treatments had been limited to those that did not alter the body composition?

[LC]

Since there has been such great success shown in other types of osteoarthritis with glucosamine supplementation (mainly, knee), I hope to see further studies continue in this area, even though this one failed to show any benefit. It is unfortunate to see people with osteoarthritis, or any type of lower back pain for that matter, rely on so many pain medications, especially for those who end up addicted. Further study in alternative therapies for chronic arthritis is must!

[Angie]

I have osteoarthritis in my hip, and I use glucosamine. It helps a great deal. I was skeptical at first, and it did take some time and consistency before I noticed that it was helping, but it really worked. It's too bad that it may not be effective for lower back pain. This seems to be such a difficult problem to address!

[husky86]

Since glucosamine usually has relatively mild side effects, I think that for most patients with joint pain, it is worth a try. In general, I have seen that some people claim that it works very well, while other say that it doesn’t help at all. I had an older dog with hip dysplasia, and when we started giving him glucosamine every day, he was noticeably more active, and it was easier for him to get up.

[sdfsdf]

It is disappointing to hear that glucosamine sulfate did not show significant benefit on back pain alleviation. I am wondering if there was any difference in their pain characteristics between two randomized groups before either glucosamine or placebo intervention. Was there any difference in the pain reduction between two groups?

[cups]

You can click on the link ‘new study’ of the blog story, and then you can see the abstract of the actual study. The pain disability scores were a little higher in the placebo group before the treatment, 9.7 vs 9.2. After treatment, it was 5.5 vs 4.8 in placebo and glucosamine groups, respectively. Even though it was not statistically significant, the glucosamine group had larger reduction. In addition, the one-year duration may not be long enough to see the full effect of glucosamine for back pain.

[Julia]

Back pain can be so debilitating. My grandmother actually suffers from it, and I know how much stress it causes her. It's too bad that this study found no effect from glucosamine, which has been found to be efficacious for a few other indications. More research must be done on back pain in general, and maybe that will lead us to CAM therapies that are effective and won't have negative effects like traditional therapies often do.

[T.R.]

I agree with LC. So many patients rely on narcotic painkillers to alleviate their back pain, and unfortunately, some become addicted. Exploring an alternative to narcotics for back pain such as glucosamine is a must. I wonder if glucosamine is effective if it is used for back pain before it becomes a chronic problem? Further research could be helpful in that area. Then we would know if taking glucosamine on a preventative basis would help prevent some patients from developing chronic back pain……..

[sun444]

I'm so glad the topic of addiction to pain medications was brought up by other bloggers. It is a very big problem, regardless of social status, race and economic status. Lower back pain is also a huge problem, and many patients feel as though they don't have many options. In addition to more studies on glucosamine and other supplements, I hope more research is done on patients using chiropractic care. Personally, I experience amazing relief after visiting a chiropractor I trust very much. I hope others can also benefit.

[KIT]

It is disappointing to see that a study shows there's no statistically significant benefit of glucosamine use for lower back pain; however, my grandma started taking this a few months ago, and she thinks it's miraculous! A few years ago, she was told to start using a cane to help her walk. She has major pain throughout her body. Her bones are very fragile, and she has trouble walking and standing, but she loves to be up and about. Walking around with a cane embarrasses her. A few days ago, she said that the glucosamine lets her walk around the block without her cane. Needless to say, she's ecstatic! Maybe it's all in her head, but then again maybe future studies will support its use.

[summersun]

It is important to remember that glucosamine and glucosamine/chondroitin supplements are expensive. In today's economy, most people are not willing to pay a lot for treatments, especially if its effectiveness is not proven. Hopefully, there will be stronger evidence for glucosamine in the future that may encourage people to pay more for a non-addictive treatment.

[BL]

I agree that the use of chronic pain management medications is not ideal for patients with chronic lower back pain, but we must make sure to use proper terms when discussing patients using chronic opiates for therapeutic reasons as being physically dependent, not addicted.

Secondly, consider the pathophysiology of osteoarthritis (OA) compared to that of chronic lower back pain. We know that OA results from loss of cartilage in joints and result in bone on bone rubbing, but chronic lower back pain results from multiple etiologies. When considering how alternative therapies such as glucosamine and chondroitin work, enhancing the natural cartilage repair process and inhibiting enzymes that degrade cartilage accordingly, it makes sense these therapies probably would not work on a large number of etiologies causing lower back pain.

[SK]

This is definitely interesting to evaluate in patients with lower back pain, but I would like to know what different etiologies of lower back pain the patients included had. Also, I would like to see further studies comparing the efficacy of the many combination products out there containing glucosamine, chondroitin and MSM. Will the combined ingredients have additive effects on lower back pain? What about the cost-effectiveness of these therapy choices?

Currently, even some of the store brands of these products are quite expensive, considering one can often get a three-month supply of a non-steroidal anti-inflammatory medication for merely ten dollars. I think cost-effectiveness and long-term safety must be compared in the future.

[MJ]

Currently, the use of non-steroidal anti-inflammatory medications (NSAIDs) is a powerful and relatively safe way to manage lower back pain, but as with treating every disease state, a medical professional must weight the risks (e.g., gastrointestinal bleeds) versus the benefits (e.g., improved quality of life). In today's society with the medications available, there is no reason anyone should have to live their life in pain, so although the use of narcotics like oxycodone for chronic pain is not ideal, it is better than decreasing a patient's quality of life simply in fear of them becoming physically dependent. Physical dependence on narcotics used therapeutically is an uncontrollable adverse effect, but this doesn't lead to addiction when used appropriately under the care of a physician.

[BP]

Since glucosamine works differently from narcotics and pain medications, it's nice to see studies showing some effectiveness. Glucosamine is actually a natural compound found in cartilage and is thought to strengthen the cartilage if supplemented. So, it almost feels like instead of taking a pain-reliever to mask the symptoms, you're actually affecting the condition itself by using glucosamine. It may make some people feel more comfortable to seek treatment, and, if it can reduce the need for high doses of pain medications, it could (like TR and LC have mentioned) hopefully prevent users from becoming dependent on them, or even from experiencing adverse events from them. Hopefully, we'll see more positive evidence on its use!

[GC]

I've always wondered about the combined effects of chondroitin and glucosamine for back pain. Chondroitin is also a natural product derived from natural sources like shark or beef cartilage. Can glucosamine and chondroitin exert the same effects individually, or is there an added benefit if taken together? I've seen some sources say that we aren't exactly sure if either one is more effective than the other or the combination. I wonder what type of evidence there is regarding this.