The effect of glucosamine on pain-related non-specific low back pain

Background. Low back pain that has lasted more than six months and has no specific cause, such as a tumor, infection, fracture or herniated disc and which is found in imaging arthritis of the spine, is common and difficult to treat. Glucosamine has been registered for the, still proved insufficient
indication pain relief in osteoarthritis of the hip and knee ( EB 2005; 39: 61-66 and EB 2006; 40: 107-108 ). This dietary supplement is becoming more like self-medication by patients with low back pain, although nothing is known about its efficacy. This has led us to carry out an intervention study in Norway. 1

Method. The researchers randomly assigned 250 patients with chronic low back pain, and with well-defined criteria for MRI degeneration of intervertebral discs or the movable joints of the spine (facet joints), to a treatment for six months with 1,500 mg of glucosamine sulfate or placebo. All other treatments were allowed to continue. It was a double-blind study. The back pain-related physical discomfort were measured with a score on the Roland Morris Disability Questionnaire (RMDQ), a widely used and validated questionnaire. A positive response was an improvement after six months, or 12 of at least three points on this 24 point scale.

Result. The groups were comparable at baseline good and there was good adherence and little downtime. In the placebo group decreased the average RMDQ-score after six and 12 months from 9.7 to 5.0 and 5.5, and in the glucosamine group from 9.2 to 5.0 and 4.8, all the differences were not significant. Also on some secondary endpoints, such as pain, quality of life, and adverse events, there were no significant differences between the groups.

Conclusion researchers. In patients with chronic low back pain and osteoarthritis of the lumbar spine gives treat six months with glucosamine no reduction of pain associated with physical limitations as compared with placebo. Neither was the case with control half a year later.

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Given the high quality of design and execution, according to the author of an accompanying editorial, the only possible conclusion from this study that six months administration of glucosamine probably no more than a placebo effect on low back pain in osteoarthritis. 2 However, this statement is not complete. Other possible explanations include the natural history and regression to the mean ( EB 1997; 31: 1-6 ).

In chronic diseases shows the severity of the symptoms often strong fluctuations. If a patient consults a physician at the time that it has the most complaints, is it likely that this, again following a decrease in the symptoms in the course of time. This phenomenon, which is that serious complaints or symptoms go back to the more usual level of a patient is called regression to the mean.

It is also called "the friend of the doctor," because no matter what a doctor, the symptoms will have decreased on average over time. It is not possible to quantify the three factors on the results of the study the individual contribution separately.

The negative results of good research are very valuable to useless treatments such as prolonged bed rest and glucosamine, do not advise more low back pain which may emerge other treatments.