This lack of agreement among the scientific community has led to an increase in the popularity of alternative back pain relief remedies. One such treatment approach is in the use of dietary supplements that claim to enhance joint health. And, among the many available supplements making such claims, the use of chondroitin and glucosamine are at the top of the list.
But will chondroitin and glucosamine provide back pain relief? Presented here is an excellent article published in Science-Based Pharmacy that takes a detailed look at the scientific evidence on the effectiveness of these supplements in maintaining and enhancing joint health.
Chondroitin and Glucosamine For Back Pain Relief
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.
What are Glucosamine and Chondroitin?
Part of the glycoaminoglycans (GAGs) family of substances found in various connective tissues but concentrated in cartilages, glucosamine and chondroitin are oral or topical supplements available without a prescription (in most countries) and traditionally used for osteoarthritis, rheumatoid arthritis, temporomandibular joint arthritis, knee or back pain. While chondroitin is typically formulated as the sulfate form (CS), glucosamine is formulated either as the sulfate (GS) or hydrochloride form (GH). Glucosamine is a molecule of an amino sugar (amino-monosacharide), extracted from shrimp, lobster and crab shells, that the body uses to link another sugar (monosacharide or hexose) to form a unit of a long chain which are GAGs. Chondroitin is the name of a specific GAG, which does not contain a glucosamine as an amino sugar.
The purported (but not demonstrated) mechanism of action is as follows:
- keratan and hyaluronic acid in cartilage (which contain glucosamine) and synovial fluid are reduced in OA patients
- replacing these with glucosamine supplements might alter chondrocyte metabolism or otherwise have protective effects on cartilage tissue.
Potential mechanism of actions include direct stimulation of chondrocytes, incorporation of sulfur into cartilage, and protection against degradative processes within the body through altered gene expression. However, these are theoretical mechanisms, based on in vitro or animal studies. In humans, it not even known if supplementation has any effect on the joint concentrations of glucosamine or chondroitin.
We do know that oral forms of glucosamine is well absorbed into the system and chondroitin isn’t, but not much else is known about the pharmacology of these products. The bottom line is this: glucosamine is not an essential compound since our body produces nearly all of it; small additional amounts ingested are not expected to make much difference; it is not known if ingested glucosamine reaches the chondrocytes; we do not know the preferred route of administration (topical, oral or injection) or the optimal dose; and the exact mechanism of action is yet unknown. A lot of “ifs” for a product without clearly demonstrated efficacy.
Confusingly, some scientists believe that glucosamine is not the active part: the sulfate form the glucosamine sulfate (GS) oral product might be the key. This is quite possible, as was pointed out at Science-Based Medicine, the amount of glucosamine found in supplements represents about 0.001 to 0.0001% of the total amount naturally produced by the body. Supplements are truly just drops in the bucket.
Do you have additional questions about the treatment of back and neck pain or chondroitin and glucosamine for back pain relief? Post your question in the comments section below and we’ll answer your question promptly.
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