Supplements for Pain: Some Patients Find Relief, But Don't Expect Miracles
Evidence for many pain supplements is preliminary or weak, according to some experts. But they’re generally safe—unless you’re taking blood thinners.
Interview with Philip Gregory, PharmD, MS, FACN and Marc I. Leavey, MD.
Many popular supplements used for pain relief may provide modest benefits for some patients, but are not a magic bullet, according to Philip Gregory, PharmD, MS, FACN, Director for the Center for Drug Information and Evidence-Based Practice at Creighton University in Omaha, Nebraska.
Studies looking at the effectiveness of such supplements as turmeric, cat’s claw, and devil’s claw have been small, and the evidence is generally weak, Dr. Gregory said. The evidence for glucosamine sulfate’s effect on osteoarthritis pain is somewhat stronger, but still not overwhelming, he added.
He noted that while these supplements generally are safe when taken in the recommended dose, anyone taking blood thinners such as warfarin should first check with their doctor before using one of these supplements because some have anti-blood-clotting properties.
Turmeric, a colorful spice used in curry, is also used in supplement form for chronic conditions such as arthritis. “There is some evidence turmeric has anti-inflammatory activity,” Dr. Gregory said. “Data from a few small human studies suggests it might help improve pain and joint mobility in people with osteoarthritis or rheumatoid arthritis, but the evidence is underwhelming,” he said. “But some people may find it helpful. The pain relief will be subtle—it’s not like taking 800 milligrams of ibuprofen.”
A relative of ginger, tumeric has another benefit that makes it unlike anti-inflammatory drugs such as ibuprofen—tumeric is not likely to cause stomach upset.
Cat’s Claw and Devil’s Claw
Both cat's claw and devil's claw are used for arthritis pain. As with turmeric, there is some preliminary data suggesting these supplements may be useful in reducing pain. “The evidence for devil’s claw is stronger than for cat’s claw or turmeric, but it’s still not strong,” Dr. Gregory said. According to the Arthritis Foundation some studies suggest stomach acid may counteract the benefits of harpagoside (the active ingredient in devil's claw). To avoid this problem, the foundation suggests taking the supplement between meals when less stomach acid is released.
Glucosamine is a popular supplement for treating arthritis. Dr. Gregory explained there is a lot of confusion about this supplement because a study called the Glucosamine/chondroitin Arthritis Intervention (or GAIT) Trial seemed to show no benefit. “The researchers used a form of glucosamine hydrochloride, which is not commercially available,” he said. “Studies that have used glucosamine sulfate have more consistently shown some benefit in osteoarthritis-related pain. There is some contradictory data, but most of it is on the positive side.”
He added that the benefits are modest at best. “Some people swear by glucosamine, while others say it helps a little bit, and others say it doesn’t help them at all.” Some people find adequate relief just using glucosamine, while others find they need to add ibuprofen or acetaminophen for acute flare-ups, Dr. Gregory said.
Glucosamine is often bundled with another supplement, chondroitin. “The evidence is strongest for glucosamine sulfate—there isn’t evidence that using glucosamine and chondroitin together is better,” he said. Both glucosamine and chondroitin have been linked with reports of bleeding in patients taking anti-clotting drugs such as warfarin. So be sure to check with your doctor before taking these supplements.
Some people take fish oil supplements for pain after exercise because fish oil has anti-inflammatory effects. “Data shows it reduces inflammation, but there is not really good data that shows it reduces pain specifically,” Dr. Gregory noted.
SAMe is an acronym for S-Adensyl-L-methionine (also called S-adenosylmethionine) and commonly used for osteoarthritis. “There’s some pretty good data that suggests it can modestly reduce pain related to osteoarthritis,” he said. A drawback to SAMe is that it is quite expensive, Dr. Gregory noted. It is also used to treat depression, because it seems to affect the brain chemical serotonin. For this reason, patients taking anti-depressant drugs should not also take SAMe, he advised.
Some supplements sold as “joint formulas” contain many ingredients, such as glucosamine, turmeric and vitamins. “Oftentimes there is not enough of any one ingredient to be effective,” Dr. Gregory said. “There may be ingredients that could be problematic for people taking other prescription products,” he added. Any supplement with many ingredients increases the risk of interactions. "If you have a side effect or allergic reaction, you won’t know which ingredient caused it," he said. "The ingredients in the capsule may interact with each other, or with other medicines."
Always Tell Your Doctor Before Taking Any Supplements
If you take any supplements for pain or other conditions, it’s very important to tell your physician so he can help you avoid potentially dangerous interactions with other medications. Marc I. Leavey, MD, a primary care specialist at Lutherville Personal Physicians, part of Mercy Medical Center in Baltimore, Maryland said some of his patients who take supplements assume they are natural and therefore harmless.
“That’s a bad assumption,” Dr. Leavey said. “I tell my patients, ‘Tobacco is natural, too, and it’s not harmless.’ If your doctor doesn’t know what supplements you are taking, he or she may add a medication to it that can cause interactions or side effects.”
Dr. Leavey explained that many supplements, when used with the knowledge of a physician, are generally safe if not taken in large doses. While there is a lack of strong scientific evidence for the efficacy of most supplements, he said, there is some anecdotal evidence that some products may be helpful. “If a supplement seems to be working for patients, I have no problem with a patient taking it,” he said. “If they are getting pain relief, that’s great—more power to them.” He has found if he discourages patients from taking supplements, they won’t tell him about other supplements they take in the future so he's always careful when discussing the topic.
His patients have tried a variety of supplements for pain relief, including glucosamine/chondroitin for arthritis, as well as green tea, boswellia and grapeskin extract.
When a patient tells him they are taking a supplement, he often looks it up on Epocrates, a physician online resource that lists side effects and drug interactions. “People may hear about a supplement from a friend, neighbor, online, or a TV doctor promoting their latest and greatest product,” Dr. Leavey said. “They tell me the product is totally safe, but I explain the product probably causes some type of reaction, otherwise why are they taking it? I make them understand that even if they are natural, these supplements are pharmaceuticals.”
If you'd like more information about supplements, here are two good online sources of information:
National Institutes of Health, Dietary Supplements Fact Sheets https://ods.od.nih.gov/factsheets/list-all/
University of Maryland Medical Center, Complementary and Alternative Medicine Guide http://umm.edu/health/medical/altmed