CHICAGO—A new research publication from JAMA (2010;304(1):45-52) reported glucosamine supplementation failed to reduce pain related disability in osteoarthritis (OA) patients. The double-blind, randomized, placebo-controlled trial was conducted at Oslo University Hospital Outpatient Clinic, Norway, and featured 250 patients 25 years of age and up, who had degenerative lumbar OA and chronic lower back pain (LBP) for more than six months.
Subjects took either 1500 mg/d of oral glucosamine (n = 125) or placebo (n = 125) for six months, and researchers assessed the effects after this intervention period and at one year (six months post-intervention). They used the Roland Morris Disability Questionnaire (RMDQ) to assess pain-related disability, the primary outcome, while also investigating the secondary endpoints using pain-rating scales of patients at rest and during activity, and the quality-of-life EuroQol-5 Dimensions (EQ-5D) instrument. Pain results were the same for both intervention and placebo groups after six months, and although there was a difference between the two groups after one year, this was judged to be not statistically significant.
In their report, the authors state OA affects more than 20 million Americans, and LBP is the second-most common complaint from OA patients in primary care. The concern from health care provider, the researchers contended, is the cause of OA-related LBP is not clear and known intervention have had only a limited effect.” Glucosamine is widely used as a treatment for OA, despite its controversial and conflicting evidence for effect, and is also increasingly taken by LBP patients, even though the evidence of its effectiveness remains inconclusive,” they wrote. “Based on our results, it seems unwise to recommend glucosamine to all patients with chronic LBP and degenerative lumbar OA. Further research is needed to clarify whether glucosamine is advantageous in an alternative LBP population.”
In an accompanying editorial (“Glucosamine and the Ongoing Enigma of Chronic Low Back Pain.” JAMA. 2010;304(1):93-94), Andrew L. Avins, M.D., M.P.H., of Northern California Kaiser-Permanente, Oakland, advised the disappointing results in the Oslo-glucosamine study should not be discouraging. “Clearly, much more work remains before realizing the kinds of success in the treatment of chronic LBP that other conditions have experienced,” he wrote. “With an objective and determined focus, sufficient support, greater collaboration, and a working partnership with patients, there is every reason for optimism, however cautious. The real test will be whether the environment for this success can be created and sustained.”
