Clinical Newswire, July 9, 2010 - Glucosamine was not more effective than placebo in relieving pain-related disability in patients with chronic low back pain (LBP) with degenerative lumbar osteoarthritis (OA), according to research published in the July 7, 2010 issue of JAMA.
Chronic LBP with degenerative OA is widespread in adults, yet it remains challenging to clinicians and most of the interventions used to treat it have limited effect. Similar to
peripheral joints, the spine can develop osteoarthritic (facet joint) and degenerative (disk area) changes, which often present independently of LBP. However, studies indicate that such changes may cause LBP.
Glucosamine, a precursor of proteoglycans that make up joint cartilage, is increasingly used orally by patients with chronic LBP. It is hypothesized that glucosamine restores cartilage and has anti-inflammatory properties and could therefore provide benefit when taken in high doses, as degenerative lumbar OA is associated with cartilage destruction and inflammation. More than one-quarter of patients with chronic LBP have taken glucosamine supplements in order to relieve their back pain, however there is little evidence about the effect of glucosamine on LBP, with most trials conducted previously having various limitations.
The current study by Wilkens et al was a double-blind, randomized, placebo-controlled trial that was conducted at Oslo University Hospital Outpatient Clinic, Oslo, Norway. Two-hundred and fifty patients older than 25 years with chronic LBP for at least 6 months and degenerative lumbar OA were recruited between December 2006 and July 2008. Patients were randomized to receive a daily dose of 1500 mg of glucosamine sulfate (n=125) or placebo (n=125) for 6 months, and effects of the treatment were evaluated at the end of the 6-month intervention period and at 1 year. Pain-related disability, the primary outcome measure, was measured with the Roland Morris Disability Questionnaire (RMDQ). Secondary outcomes were patient-rated pain at rest and during activity, and quality of life (QOL).
Study results show that at 6 months, the mean RMDQ score was the same for the glucosamine and placebo group (5.0, 95% CI 4.2-5.8) and at 1 year there was no statistically significant difference between groups (glucosamine: 4.8, 95% CI 3.9-5.6, placebo: 5.5, 95% CI 4.7-6.4, p=0.72). There was also no statistically significant difference between groups after the 6 month intervention period and at 1 year for LBP at rest or during activity, and QOL. There were no serious adverse events in either of the groups.
“Based on our results, it seems unwise to recommend glucosamine to all patients with chronic LBP and degenerative lumbar OA”, the authors conclude. Further research is needed to clarify if glucosamine is useful in other LBP populations.
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