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zoom RSS 慢性腰痛に対してグルコサミンは効果なし

<<   作成日時 : 2010/07/14 20:24   >>

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 新たな研究結果により、骨関節炎による慢性腰痛に対して有名なグルコサミン・サプリはほとんどまたは全く効果がないという。しかし、5-10年といったより長期の効果についての研究が必要である。
 骨関節炎は2000万人を超える米国人が罹患し、今後増大すると見られている。グルコサミンは骨関節炎の治療薬として市販されている。
 慢性背部痛と変形性腰椎骨関節炎を持つ250人の患者を毎日1,500mgのグルコサミンかまたはプラセーボ服用に無作為に割り当てた。6週、3、6、12ヶ月で痛みを調査した。開始時の痛覚スケールで、グルコサミン服用者は9.2、対照者は9.7だった。6ヶ月後には両群とも 5.0、1年後にはそれぞれ 4.8, 5.5 だった。
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Glucosamine Ineffective for Lower Back Pain Linked to Arthritis
Study finds it's no better than placebo in relieving discomfort or boosting quality of life
By Steven ReinbergHealthDay Reporter
http://health.msn.com/health-topics/alternative-medicine/articlepage.aspx?cp-documentid=100260962

Study finds it's no better than placebo in relieving discomfort or boosting quality of life.

TUESDAY, July 6 (HealthDay News) -- The popular supplement glucosamine offers little or no relief for sufferers of chronic lower back pain caused by osteoarthritis, a new study finds.

The Norwegian trial seems to be another knock against glucosamine, with other recent studies showing similar results.

"The study answer the questions: 'I have suffered low back pain for a long time (more than 6 months), will a 6-month intake of glucosamine help me?'" said lead researcher Philip Wilkens, a research fellow in the orthopedic department at the University of Oslo. "And the answer according to this study is no."

On the up side, "glucosamine appears safe to use," he added. "And more research is needed to answer if glucosamine is beneficial to prevent chronic low back pain or have benefits in longer term, like 5 to 10 years."

Osteoarthritis affects more than 20 million Americans, and the number is expected to increase, the researchers note. Glucosamine is a common over-the-counter treatment for osteoarthritis, even though its use has been controversial.

For example, a University of Pittsburgh study presented at a rheumatologists' meeting in October found the supplement did not prevent loss of cartilage in osteoarthritic knees, while studies published in 2008 in Arthritis & Rheumatism and the Annals of Internal Medicine found glucosamine had little or no effect on arthritis of the knee and hips, respectively.

The new report is published in the July 7 issue of the Journal of the American Medical Association.

For the study, Wilkens's team randomly assigned 250 patients with chronic back pain and degenerative lumbar osteoarthritis to 1,500 milligrams daily of glucosamine or an inactive placebo.

The patients' pain was measured using the Roland Morris Disability Questionnaire at 6 weeks, then again at 3, 6 and 12 months. In addition, the researchers evaluated the patients' self-reported quality of life.

At the start of the 6-month trial, patients taking glucosamine scored 9.2 on the pain scale while the patients taking placebo scored 9.7, the researchers note. At the 6-month point, both groups scored 5.0, and after one year the glucosamine group scored 4.8 while the placebo group scored 5.5, Wilkens's group found.

However, the small differences in scores at six months or one year were not statistically significant, the researchers say. Nor were minor differences in quality of life between the two groups deemed significant.

The bottom line, according to Wilkens: "People with chronic low back pain and degenerative osteoarthritis will not benefit more from glucosamine than placebo for treating their back problem."

Dr. Andrew L. Avins, a scientist in the division of research at Kaiser Permanente Northern California and the author of an accompanying journal editorial, said that, "from a clinical standpoint, the study demonstrates that glucosamine does not appear to be better than placebo for patients with chronic low back pain and spinal arthritis."

However, the study found no ill effects from taking the supplement. So, patients who take glucosamine and feel that it is helping them should be reassured that it's at least not harmful, said Avins, who is also professor of medicine, epidemiology & biostatistics at the University of California, San Francisco.

"The larger implications [of this study] are that we still know very little about how to help most patients with chronic low back pain, and we need much more careful, directed research to help make progress in providing relief to patients with back pain," he added.

Even though back pain is an incredibly important public health and quality of life problem, it suffers from insufficient attention and research funding, Avins believes. "In the U.S., we spend far more on treatments of little or questionable value than we spend on research to find effective therapies; it's a poor use of scarce health-care resources," he said.

Dr. Andrew Sherman, an associate professor and vice-chair of the department of rehabilitation medicine at the University of Miami Leonard M. Miller School of Medicine, agreed that the findings should dissuade doctors from recommending glucosamine to patients with back pain.

However, "this [study] is not going to stop people from trying it," he added, and the finding does not mean that glucosamine won't work for other forms of arthritis.

More information

For more information on arthritis, visit the U.S. National Library of Medicine.
SOURCES: Philip Wilkens, M.Chiro., research fellow, orthopedic department, University of Oslo, Norway; Andrew L. Avins, M.D., M.P.H., research scientist, Division of Research, Kaiser Permanente Northern California, professor, of medicine, epidemiology & biostatistics, University of California, San Francisco; Andrew Sherman, M.D., associate professor and vice-chair, department of rehabilitation medicine, University of Miami Leonard M. Miller School of Medicine, July 7, 2010, Journal of the American Medical Association

Copyright @2010 HealthDay. All Rights Reserved.

----------------------------------------------------
Glucosamine No Remedy for Lower Back Pain, Says Study
New Research Suggests Popular Supplement Does Little to Ease Aching Backs
http://abcnews.go.com/Health/PainManagement/glucosamine-cure-chronic-lower-back-pain-study/story?id=11098747
By JANE E. ALLEN
ABC News Medical Unit
July 6, 2010

画像Glucosamine has looked like salvation to many people with joint pain, but it proved no better than a sugar pill at reducing pain, disability or improving quality of life in a study of people plagued by chronic lower back pain and degenerative osteoarthritis.
Dr. Bauer and Dr. Hunsi offer their expertise.

But the findings, published in this week's issue of the Journal of the American Medical Association, are unlikely to be the last word on glucosamine, which remains a popular alternative to prescription drugs and other traditional therapies. Although some research studies have found it doesn't help osteoarthritis, others suggest it may provide some mild benefit to painful osteoarthritis of the knees and hips.

Statistics attest to the supplement's widespread appeal. A 2007 federal survey of Americans' use of complementary and alternative medicine found that more than 6 million adults in the United States had taken glucosamine in the previous month. A study from the U.S. Centers for Disease Control and Prevention, published in 2004, found that among women treated at New Mexico hospitals for joint and muscle pain, 25 percent of those with osteoarthritis used glucosamine.

Because a quarter of Americans with chronic low back pain turn at some point to glucosamine, researchers wanted to know more objectively if it could help. The latest findings came from Philip Wilkens at the Oslo University Hospital in Norway, a country where glucosamine is a prescription drug.

For six months, he and his colleagues gave 250 adults with chronic lower back pain and degenerative osteoarthritis either 2,500 mg daily of glucosamine sulfate or a placebo. At the six-month and one-year marks, there weren't any significant differences among patients in the two groups. Both groups did seem to be helped by the placebo effect, which is common in pain patients, in which people apparently feel better simply because they are receiving treatment.

Despite mixed reviews to date for glucosamine, the Oslo study had the rigorous elements of being randomized, double-blind and placebo-controlled. Previous studies using glucosamine for low back pain "have either been small in size, or had significant limitations in the design of the trial itself," said Timothy C. Birdsall, a naturopathic doctor and vice president of integrative medicine at Cancer Treatment Centers of America in Arizona.

Birdsall said that the study results would make him "much more likely to recommend they discontinue the glucosamine, and take other approaches to deal with the pain."

Other experts in integrative medicine, orthopedics, pain medicine and rehabilitation noted that the study didn't give patients glucosamine combined with chondroitin, which is how it's typically found at local pharmacies, health food stores or other retail sources.

But Wilkens defended the trial design, calling glucosamine "the main substance people use" and saying he was unaware of evidence "that the combination of glucosamine and chondroitin is better." But, he added, "We realize a similar study is needed to answer the question about glucosamine in combination with chondroitin."

Dr. Gregory Plotnikoff, senior consultant for integrative medicine at Abbott Northwestern Hospital in Minneapolis, said vitamin D deficiency could be skewing the results, given Norway's extreme northern latitude and lack of sunshine during winter months.

"We know vitamin D deficiency is a common cause of chronic, nonspecific musculoskeletal pain including chronic low back pain," Plotnikoff said.

Wilkens took issue with the assumption that Norwegians are lacking vitamin D, and said his team felt before carrying out the study that vitamin D levels "were not going to affect the results."

Taking the larger view of glucosamine, Dr. Charles Kim, a specialist in integrative medicine and acupuncture at New York University Medical Center, said "the jury is still out." He also said some types of lower back pain that involve loss of cartilage at the joints may be more likely to respond to glucosamine.

K. Simon Yeung, a pharmacist and manager of the About Herbs website for Memorial Sloan Kettering Cancer Center, called the study well-done, but said Wilkens and his co-authors were looking at the wrong target for glucosamine. He noted that the knees and hips -- joints for which glucosamine has been shown to have some effect -- have lots of movement. "The spinal column doesn't seem to have that motion," he said.

Although some of his patients have used glucosamine, Dr. Andrew J. Haig, director of the spine program at the University of Michigan, said he never thought it helped.

"The psychological damage done by a doctor flailing around, trying any of the hundreds of unproven treatments when patients often do well on their own, is not worth the possible benefits," Haig said. The new study demonstrates "that again, a lot of seemingly-reasonable treatments are not useful."

Dr. Brian Berman, director of the Center for Integrative Medicine at the University of Maryland School of Medicine, said he doesn't recommend glucosamine for lower back pain, partly because it doesn't respond to a single approach. "It's highly unlikely that there is a single magic bullet, including glucosamine, to treat this perplexing disorder."

The study reinforces the notion "that there is no 'magic pill' that can replace the common-sense treatments of exercise and weight control for relief of musculoskeletal pain," said Dr. Mark Brown, chairman of orthopedic surgery at the University of Miami.

----------------------------------------------------
Effect of Glucosamine on Pain-Related Disability in Patients With Chronic Low Back Pain and Degenerative Lumbar Osteoarthritis

A Randomized Controlled Trial

Philip Wilkens, MChiro; Inger B. Scheel, PhD; Oliver Grundnes, PhD; Christian Hellum, MD; Kjersti Storheim, PhD

JAMA. 2010;304(1):45-52.

ABSTRACT

Context Chronic low back pain (LBP) with degenerative lumbar osteoarthritis (OA) is widespread in the adult population. Although glucosamine is increasingly used by patients with chronic LBP, little is known about its effect in this setting.

Objective To investigate the effect of glucosamine in patients with chronic LBP and degenerative lumbar OA.

Design, Setting, and Participants A double-blind, randomized, placebo-controlled trial conducted at Oslo University Hospital Outpatient Clinic, Oslo, Norway, with 250 patients older than 25 years of age with chronic LBP (>6 months) and degenerative lumbar OA.

Interventions Daily intake of 1500 mg of oral glucosamine (n = 125) or placebo (n = 125) for 6 months, with assessment of effect after the 6-month intervention period and at 1 year (6 months postintervention).

Main Outcome Measures The primary outcome was pain-related disability measured with the Roland Morris Disability Questionnaire (RMDQ). Secondary outcomes were numerical scores from pain-rating scales of patients at rest and during activity, and the quality-of-life EuroQol-5 Dimensions (EQ-5D) instrument. Data collection occurred during the intervention period at baseline, 6 weeks, 3 and 6 months, and again 6 months following the intervention at 1 year. Group differences were analyzed using linear mixed models analysis.

Results At baseline, mean RMDQ scores were 9.2 (95% confidence interval [CI], 8.4-10.0) for glucosamine and 9.7 (95% CI, 8.9-10.5) for the placebo group (P = .37). At 6 months, the mean RMDQ score was the same for the glucosamine and placebo groups (5.0; 95% CI, 4.2-5.8). At 1 year, the mean RMDQ scores were 4.8 (95% CI, 3.9-5.6) for glucosamine and 5.5 (95% CI, 4.7-6.4) for the placebo group. No statistically significant difference in change between groups was found when assessed after the 6-month intervention period and at 1 year: RMDQ (P = .72), LBP at rest (P = .91), LBP during activity (P = .97), and quality-of-life EQ-5D (P = .20). Mild adverse events were reported in 40 patients in the glucosamine group and 46 in the placebo group (P = .48).

Conclusions Among patients with chronic LBP and degenerative lumbar OA, 6-month treatment with oral glucosamine compared with placebo did not result in reduced pain-related disability after the 6-month intervention and after 1-year follow-up.

Trial Registration clinicaltrials.gov Identifier: NCT00404079

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