Six months of supplementation did not appear to benefit people suffering from chronic low back pain (LBP) and degenerative lumbar osteoarthritis (OA), compared with placebo, according to findings from researchers from Oslo University Hospital and University of Oslo.
“Based on our results, it seems unwise to recommend glucosamine to all patients with chronic LBP and degenerative lumbar OA,” wrote the Norwegian scientists in the Journal of the American Medical Association (JAMA).
“Further research is needed to clarify whether glucosamine is advantageous in an alternative LBP population,” they added.
According to background information presented in JAMA, OA affects over 20 million Americans, and pain in the lower back is the second most common concern for these individuals.
Not the be all and end all
The study was questioned by Dan Fabricant, PhD, VP of scientific and global government affairs at the Natural Products Association (NPA) who noted that no gold standard comparison was used by the researchers. “If you used the gold standard, you’d probably get a null response, too,” he said.
Dr Fabricant noted that studies with glucosamine, in combination with chondroitin sulfate, like the well-known GAIT study, have shown benefits in subgroups of osteoarthritis.
The link between osteoarthritis and lower back pain is also debatable, said Dr Fabricant. “That link is not the most solid,” he added.
Andrew Shao, PhD, senior VP, scientific & regulatory affairs for the Council for Responsible Nutrition (CRN) added that “it is premature to draw firm conclusions from the results of this single study because there has been very little research conducted on therapies for lower back pain overall, and even fewer studies conducted on the use of glucosamine for lower back pain.
“Further, there are many reasons why a person might experience lower back pain - it's a formidable challenge to attempt to affect a widespread, chronic issue such as lower back pain. While more research should be conducted, the results of this particular study should not detract from the vast body of evidence supporting glucosamine's role in joint health,” added Dr Shao.
The efficacy of glucosamine sulfate for reducing pain-related disability and sensations of pain was evaluated in 250 people with chronic LBP and degenerative lumbar OA. The participants were randomly assigned to receive either glucosamine sulfate (1,500 mg, Pharma Nord, Denmark) or placebo (cellulose) for six months.
At the end of the intervention, the researchers noted no statistically significant difference between the groups
“To our knowledge, this is the first large, long-term trial investigating the efficacy of glucosamine in patients with chronic LBP,” wrote the researchers. “Our findings suggest that glucosamine is not associated with a significant difference in pain-related disability, low back and leg pain, health related quality of life, global perceived effect of treatment, or use of concomitant medications or therapy.”
The researchers admit that the participants recruited may not have responded to glucosamine. They also note that, although records showed participants consumed about 80 percent of the capsules, “the dose-response for glucosamine might require higher adherence to demonstrate efficacy”.
“Glucosamine may be more effective in other body articulations than in the lumbar spine,” they added.
In an accompanying editorial, Andrew Avins, MD, from Northern California Kaiser-Permanente described the study as “high-quality”. The apparent null results “were disappointing but should not be discouraging”, he added.
“Clearly, much more work remains before realizing the kinds of success in the treatment of chronic LBP that other conditions have experienced. With an objective and determined focus, sufficient support, greater collaboration, and a working partnership with patients, there is every reason for optimism, however cautious,” added Avins.
Benefits for knees
The market is dominated by glucosamine and chondroitin sulphate. Amongst the most important studies supporting the apparent benefits of the ingredients was the $14 million Glucosamine/chondroitin Arthritis Intervention Trial (GAIT), sponsored by the National Institute of Health, which studied the effects of the supplements in 1583 people with osteoarthritis
The results, published in the prestigious New England Journal of Medicine (2006, Vol. 354, pp. 795-808), indicated that the combination of glucosamine and chondroitin sulfate “significantly decreased” knee pain for people suffering from moderate-to-severe osteoarthritis.
However, in the general study population, which also included people with relatively mild pain, did not show any significant benefits, compared with placebo.
2010, Volume 304, Issue 1, Pages 45-52
“Effect of Glucosamine on Pain-Related Disability in Patients With Chronic Low Back Pain and Degenerative Lumbar Osteoarthritis: A Randomized Controlled Trial”
Authors: P. Wilkens, I.B. Scheel, O. Grundnes, C. Hellum, K. Storheim
2010, Volume 304, Issue 1, Pages 93-94
“Glucosamine and the Ongoing Enigma of Chronic Low Back Pain”
Author: A.L. Avins