Glucosamine and Chondroitin for Aromatase Inhibitor-Induced Joint Pain

glucosamine chondroitin osteoarthritis back pain spinal stenosis shark cartilageA new study presented at a conference last month revealed data supporting the use of glucosamine and chondroitin for joint pain and stiffness connected to osteoarthritis and aromatase inhibitors. Osteoarthritis in the neck can lead to pinched nerves, subluxation, and even spinal cord compression, causing neck pain and stiffness, as well as headaches, and even paraesthesia, numbness, and weakness in the limbs. Aromatase inhibitors may contribute to neck pain via this mechanism, but the drugs are increasingly used to improve survival times in breast cancer patients. Discussing their findings at the 8th International Conference of the Society for Integrative Oncology, researchers from Columbia University talked about the adverse effects on joint health in breast cancer patients taking aromatase inhibitors to manage their cancer. Joint pain and stiffness experienced by these women appeared to be relieved by the concomitant use of glucosamine and chondroitin, although the symptoms remained largely unresponsive to conventional pain medication.


Joint Pain from Aromatase Inhibitors

The incidence of joint problems and musculoskeletal issues in those women prescribed aromatase inhibitors is often blamed for the low adherence to such therapy. Findings ways to minimise joint pain in those taking aromatase inhibitors could help more women attain the survival benefits conferred by the drugs. Unfortunately, other studies have not found the supplements effect in the general population for treating osteoarthritis symptoms, with a 2006 meta-analysis looking at the use of glucosamine and chondroitin over a six-month period. A previous meta-analysis, in 2002, suggested that the supplements might effectively relieve disability and pain in osteoarthritis. The benefits are usually described in the knee joints, ankles, and wrists, rather than in the spine however, and there are those who consider it unlikely that neck pain or back pain could be relieved by using glucosamine and chondroitin simply because the low levels of blood circulating to the spine would preclude significant movement of the substances to the region.

Glucosamine and Chondroitin Study Details

The researchers presenting their data at this conference were almost stopped in their tracks by the negative results of the 2006 meta-analysis. Looking at a subgroup suffering from moderate to severe pain at the start of the studies revealed that there were some patients who did appear to benefit from the supplement regime however, and so Dr Greenlee and colleagues persisted with their own research, sponsored by AstraZeneca. Their study is a Phase II single-group trial of postmenopausal women with breast cancer stage I to III. All the patients had been taking aromatase inhibitors for three months or more prior to the study’s commencement and all reported joint pain higher than 4 on a 10 point visual analog scale. Those with pre-existing osteoarthritis were included if their pain had worsened after initiating treatment with aromatase inhibitors.

Problems with the Study


This study only looked at a small number of patients, with just 37 completing the trial over twelve weeks. However, the study group was quite diverse, with 40% of patients white, and 40% Hispanic, and with a median age of 61, possibly making the results more likely to be applicable to a larger number of women. Most of the women were overweight however, which is a known factor for joint pain as excess stress is put on the musculoskeletal system to support the extra weight.

How Much Glucosamine to Take for Joint Pain

The doses used in this study were 1500mg/day of glucosamine and 1200mg/day of chondroitin, and the researchers evaluated the patients every six weeks in the clinic. The main assessment method used was the Outcome Measure in Rheumatology Clinical Trials and Osteoarthritis Research Society International (OMERACT-OARS) criteria, although the researchers themselves have questioned the appropriateness of such a measurement following the trial’s conclusion. Other evaluations were completed, including the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index, Modified Score for the Assessment and Quantification of Chronic Rheumatoid Affections of the Hands (M-SACRAH), and Brief Pain/Stiffness Inventory-Short Form (BPI-SF). The primary end-point assessment method was chosen so as to allow the researchers to compare their results with the 2006 meta-analysis using the same experimental assessment.

Functional Improvements with Glucosamine and Chondroitin

glucosamine chondroitin shellfish back pain spinal stenosisAlthough the patients reported reductions in pain and stiffness in the hips and knees at 12 and 24 weeks, along with improved function, other joints were also positively affected during the study, including the wrists and hands. Grip strength improved during the trial, and between 35% and 50% of the patients reported pain and stiffness reduction overall. Commonly reported adverse effects included headache, dyspepsia, and nausea, although no severe adverse effects of taking glucosamine and chondroitin were noted. The researchers thus concluded that the regime was safe for women with breast cancer, and may be beneficial in those experiencing aromatase-inhibitor-induced joint pain. The low negative effect of the supplement regime makes the drugs appear more favorable when accounting for their lower effect compared to other interventions that have higher risks of adverse reactions. In cases where aromatase inhibitors are thought to be causing or exacerbating osteoarthritis and neck pain, glucosamine and chondroitin could offer relief it seems.


References


8th International Conference of the Society for Integrative Oncology: Abstract 4. Presented November 10, 2011.

Stuber K, Sajko S, Kristmanson K., (2011), Efficacy of glucosamine, chondroitin, and methylsulfonylmethane for spinal degenerative joint disease and degenerative disc disease: a systematic review. J Can Chiropr Assoc. 2011 Mar;55(1):47-55.

Ruane, R., Griffiths, P., (2002), Glucosamine therapy compared to ibuprofen for joint pain, British Journal of Community Nursing, Vol.7, no.3, pp.148-52. PMID 11904551

Walsh, J.A.L., O’Neill, C.W., Lotz, J.C., (2007), Glucosamine HCl alters production of inflammatory mediators by rat intervertebral disc cells in vitro, The Spine Journal, Vol.7, no.5, pp.601-608.

Phillipi, A.F., Leffler, C.T., Leffler, S.G., Mosure, J.D.C., Kim, P.D., (1999), Glucosamine, chondroitin and manganese for degenerative joint disease of the knee or low back: a randomized, double-blind, placebo-controlled pilot study, Military Medicine, Vol.64, no.2, pp.85–91.

Deal, C.L., (1999), Neutraceuticals as Therapeutic Agents in Osteoarthritis, Rheumatic Disease Clinics of North America, pp.379-395.

Forsyth, R., Brigden, C., Northrop, A., (2006), Double blind investigation of the effects of oral supplementation of combined glucosamine hydrochloride (GHCL) and chondroitin sulphate (CS) on stride characteristics of veteran horses, Equine Veterinary Journal, Vol.36S, pp.622-5. PMID 17402494

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