A Complementary Approach to Pain Management

Meenakshi Khatta, MS, CRNP

Disclosures

Topics in Advanced Practice Nursing eJournal. 2007;7(1) 

In This Article

Nutritional Supplements

Avocado-soybean unsaponifiables (ASU) were compared with placebo in a 6-month RCT in patients with osteoarthritis of the hip and knee. The ASU preparation was superior in both pain control and functional measures.[55] A systematic review of all RCTs of ASU included 4 studies and suggested that ASU may be an effective treatment of osteoarthritis.[56]

Two randomized, placebo-controlled trials showed that 3 years of treatment with glucosamine sulfate slowed radiologic progression of osteoarthritis.[57,58] An NIH-sponsored multicenter, randomized, placebo- and celecoxib-controlled Glucosamine/chondroitin Arthritis Intervention Trial (GAIT) revealed that glucosamine (1500 mg/day) or chondroitin (1200 mg/day) alone or in combination did not reduce pain in the overall group of patients with osteoarthritis of the knee. However, there was some benefit noted in patients with moderate to severe pain when glucosamine and chondroitin were used in combination.

Fish oil is rich in EPA and docosahexaenoic acid, both of which have anti-inflammatory activity through their effects on prostaglandin metabolism. Several RCTs have shown clinical benefit of fish oil supplementation in RA.[59] Of note, alpha-linolenic acid (from, for example, flaxseed oil), a precursor of these omega-3 polyunsaturated fatty acids, does not seem to have the same clinical effects for RA.[60]

A small RCT using 800 mg of SAMe for those with fibromyalgia was found to be superior to placebo in improving[61]:

  • Disease activity;

  • Pain;

  • Fatigue;

  • Morning stiffness; and

  • Mood.

The proposed effect is due to anti-inflammatory and analgesic properties.

In an open pilot study, 20 RA patients received 20 or 1000 mcg selenium orally for 4 weeks.[62] At the end of the trial, there were positive results in both immunologic and clinical outcomes.

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