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Second Time Around: Glucosamine and Facet Joint Pain

If something is worth writing about, it’s worth writing about twice. This is the second time I have occasion to bring up glucosamine in connection with facet joint pain. The first time was an article called “Can Glucosamine Prevent Facet Joint Pain?” in which I indicated that evidence of cartilage benefit in the spine is inconclusive. Now, thanks to digging back further in time, I found a study nearly 10 years old that flatly states there is no benefit at all. Read on.

What is glucosamine?

Glucosamine occurs naturally in living things where it functions in bone and joint support. It is a type of molecule called an aminomonosaccaride (amino sugar) and is found in the fluid around the joints, in the shells of shellfish, in animal bones, bone marrow, and certain fungi. It plays a role in the formation and repair of cartilage, an amazingly versatile substance that lines the ends of bones where they meet to form a joint. Since cartilage is strong, slippery, and absorbs shock, it allows bones to slide over each other in joint movement, even under heavy loads. This also means it goes through wear and tear.

Glucosamine can be formulated as a dietary supplement. In fact, it’s the most common non-vitamin and non-mineral supplement on the market. Since it is plentiful in the shells of crabs, lobsters and shrimp, most commercially available glucosamine is derived from these. There are also preparations made from the fungus Aspergillus niger or fermented corn for vegetarians or those allergic to shellfish. Some glucosamine is sold as a blend with chondroitin, another substance found in connective tissue.

People take glucosamine to prevent osteoarthritis, the thinning and wearing away of joint cartilage. This can become a very painful condition. Without sufficient cartilage, bone begins rubbing on bone, forming painful bone spurs. As the space between bones closes up, pressure on nerves that pass in or near joints can become intense, leading to burning or shooting pain. Inflammation builds up in the soft tissues (tendons, ligaments, muscles), around joints, causing tenderness, soreness or aches during movement. Glucosamine is “…hypothesized to restore cartilage and have anti-inflammatory properties.”i

Norwegian study is bad news for glucosamine

As I mentioned earlier, research evidence for the ability of glucosamine to rescue people from arthritis is mixed. This is not good news for glucosamine as a supplement, but many people—especially with knee arthritis—swear by it. Knees are not the only victims of arthritis pain. The spine has small, cartilage lined joints between each backbone (vertebra). They are called facet joints, and they too can lose cartilage. Often, the first warning is lower back pain—though other conditions can also cause lower back pain. However, if facet joint arthritis is the culprit, it would be great if a simple over-the-counter supplement could alleviate or even prevent the problem.

That could be wishful thinking. Some randomized glucosamine studies of low back pain and osteoarthritis of the spine have shown that glucosamine performs no better than a placebo (an identical mimic of glucosamine so participants don’t know if they’re getting the experimental substance).

This was the case with the study I mentioned at the beginning. A Norwegian research team conducted a randomized, controlled clinical trial with 250 participants. All participants were adults with chronic low back pain and osteoarthritis of the lumbar (lower) spine. They were randomly assigned to two groups, each with 125 members: for six months, one group received oral glucosamine (1500 mg), the other received an identical placebo (1500 mg). They were then assessed for disability and pain at the six-month point (when they stopped taking the substances) and again at one year.

Here’s the result: “Among patients with chronic LBP and degenerative lumbar OA [osteoarthritis], 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.”ii

The bottom line

While this is just one study, it is a persuasive one because of the number of participants and the randomized/controlled design. But, if you are inclined to take glucosamine, it is unlikely to do harm—unless you are allergic to shellfish in which case take a different formulation. Always discuss with your doctor before starting any new supplement.
For low back pain due to facet joint deterioration, there are many interventions that can be done at home to bring temporary pain relief. However, if pain becomes frequent, intense, and eventually chronic, consider being evaluated for a one-time noninvasive outpatient procedure to deaden the nerves causing pain. It is called MRI-guided Focused Ultrasound, and the Sperling Medical Group is proud to offer it.

For more information, or to schedule a consultation, visit our website.

iWilkens P, Scheel IB, Grundnes O, Hellum C, Storheim K. Effect of glucosamine on pain-related disability in patients with chronic low back pain and degenerative lumbar osteoarthritis: a randomized controlled trial. JAMA. 2010 Jul 7;304(1):45-52.

Facet Pain