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17/Dec/2020

…when it comes to complementary, alternative and ‘natural’ treatments

Many Australians use complementary or alternative treatments to manage their health condition (e.g. arthritis, anxiety) or to improve their overall health and wellbeing. But what are these treatments and what do you need to consider before trying them?

Complementary and alternative treatments include a wide range of therapies, medicines, products or practices that aren’t currently considered to be a conventional or mainstream medical treatment. They include acupuncture, meditation, massage, herbal treatments, yoga, aromatherapy and naturopathy.

The word complementary usually refers to treatments that are used alongside conventional medicine, whereas alternative usually means the treatment is used instead of conventional medicine.

To make things easier (and less wordy), we’ll use the term complementary treatment when referring to all types of complementary or alternative treatments in this article.

Why do we use complementary treatments?

People are attracted to these treatments because they often have a more holistic approach and treat the entire person, rather than just their condition or symptoms. They also appear to be more natural and safer than conventional medicine.

But it’s important to understand that as with any treatment, complementary treatments may cause harm and make you unwell if they’re not taken correctly, if they interact with one of your other medications, or if the practitioner you see isn’t properly trained or qualified. That’s why you should discuss your use, or intended use, or any complementary treatments with your doctor.

Do they work for musculoskeletal conditions?

While many people feel that using complementary treatments has been beneficial for their health and wellbeing, there isn’t as much evidence to support its use for musculoskeletal conditions as there is for conventional medicines.

For many complementary treatments there just aren’t enough well-designed randomised controlled trials to show whether or not these therapies are effective. And if they are effective, for which conditions or symptoms.

However some types of complementary treatments show promise and may be helpful for managing your condition. More and more research is now focusing on these treatments. But at the moment the evidence is still lacking so it’s best to take your time, do your research and make sure the treatment is right for you.

Tips for starting a new complementary treatment

Let your doctor know what you’re doing. Keep them informed about any things you’re taking or considering taking (e.g. supplements, homeopathic treatments, herbal medicines) as well as any other therapies you’re trying or considering trying (e.g. acupuncture, yoga).

Continue taking your medications as prescribed. Don’t stop taking any medications without first discussing it with your doctor. Some medications need to be gradually reduced, rather than simply stopped, to avoid side effects.

Think about what you want to get out of the treatment. Are you hoping to control symptoms like pain or fatigue? Sleep better? Reduce or stop taking certain medications? Manage your anxiety? When you have a clear goal from the beginning of your treatment, you can monitor your progress and see if there are any improvements. After starting a new treatment, write down any changes you notice for a month – remember to include any medication changes, changes in your exercise program, the amount of sleep you’re getting and anything else that could affect your symptoms. At the end of the month, you’ll have a clearer picture of whether or not the treatment is working. If it’s not, it may be time to look for an alternative.

Do your research and ask lots of questions. Some treatments may help you manage your condition or symptoms, while others will have no effect. Visit websites such as MedlinePlus and The Cochrane Library to learn more about the treatment. And talk with your doctor and the therapist. Find out if:

  • there’s any current evidence that the treatment is effective and safe for people with your condition?
  • the treatment’s been shown to be effective in repeated scientific studies with large numbers of people?
  • the research used a control group? A control group is a group of people who don’t have a particular treatment compared with a group of similar people who do. This helps to show that any results are due to the treatment and not some other factor.
  • potential risks, side effects and interactions with other treatments are clearly identified?
  • you can continue to use your current effective treatments, as well as the complementary treatment?
  • the treatment’s something you can afford and can access easily?

If you answered no to any of these questions, you should be wary of the treatment. Discuss it with your doctor or specialist before you go any further.

Check the qualifications of the person providing the treatment.

  • Do they receive regular training and updates?
  • Have they treated other people with your condition or health issues?
  • Are they a member of their peak body?
  • Are they accredited?

Buy Australian. Australian complementary medicines are subject to strict safety and quality regulations. This may not be the case in other countries. In Australia the Therapeutic Goods Administration (TGA) ensures the safety of medicines and other therapeutic treatments.

Call Medicines Line on 1300 MEDICINE (1300 633 424). As well as information on your prescription and over-the-counter medicines, they can also help you find out more about herbal medicine, vitamins and minerals.

After doing your research, if you have any doubts about the treatment, don’t use it.

Talk with your doctor or contact our MSK Help Line weekdays on 1800 263 265 helpline@msk.org.au for information about other treatment options.

Call our Help Line

If you have questions about things like managing your pain, your musculoskeletal condition, treatment options, COVID-19, telehealth, or accessing services be sure to call our nurses. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

More to explore


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12/Feb/2020

The jury is no longer out – the evidence is in

For many years, glucosamine has been one of the most commonly used supplements for osteoarthritis (OA). And even though the jury has been out on how well it works, it has been considered safe to use.

When it comes to glucosamine, there’s been a lot of conflicting research with some studies showing positive results and some showing no effect. To add to the confusion, studies have used different preparations of glucosamine – for example glucosamine sulfate, glucosamine hydrochloride, glucosamine sulfate with chondroitin etcetera – and different dosages. Which makes it difficult to determine how effective glucosamine really is for treating the symptoms of OA.

Until recently, despite the evidence indicating that glucosamine has little, if any benefit for people with OA, it’s been seen to be relatively safe for most people.

Now, a recent study has raised some serious concerns about the side effects of glucosamine for people with shellfish allergy.

What is glucosamine?

At the ends of most of our bones we have a slippery cushion called cartilage. It absorbs shocks and helps our joints move smoothly. Glucosamine is a naturally occurring substance found in our cartilage.

For people who have osteoarthritis, this cushiony cartilage becomes brittle and breaks down. Some pieces of cartilage may even break away and float around inside the joint causing inflammation and pain. The cartilage no longer has a smooth, even surface, so the joint becomes stiff and painful to move.

Treating osteoarthritis

Until recently, treatments for OA have focused on managing the symptoms – controlling pain and reducing inflammation. Medications included analgesics – e.g. paracetamol – and anti-inflammatories – e.g. ibuprofen (*see note). Along with exercise and weight management, these were the mainstays of osteoarthritis treatment. There has been no silver bullet or treatment that worked quickly and effectively.

So when glucosamine first came on the market, with positive reviews, many people were excited at the prospect of this new, ‘natural’ treatment and began taking glucosamine regularly. Glucosamine seemed to provide pain relief for many people with osteoarthritis and improve their joint function.

However over the years as more research has taken place, the evidence for the use of glucosamine has come under more and more scrutiny. Earlier, positive research was mostly funded by pharmaceutical industry, and later research, that showed glucosamine provided limited improvements, was publicly funded. This called into question the potential for bias in the earlier reporting of the benefits of glucosamine.

The peak bodies respond

Based on recent independent evidence, the American College of Rheumatology (ACR) and the Australian Rheumatology Association (ARA) have both responded publicly.

In their latest guidelines for treating OA, the ACR “strongly recommend against” using glucosamine for osteoarthritis. And the ARA has stated that this new information highlights growing evidence that glucosamine doesn’t help people with OA and it‘s a reminder that people with a shellfish allergy shouldn’t take glucosamine.

Safety concerns

It’s been known for some time that glucosamine can interact with blood thinners such as warfarin, and that it may raise blood sugar levels in people with diabetes. Glucosamine may also have a negative effect on cholesterol and chemotherapy drugs and has been linked to worsening asthma

However it’s not been widely known to the general public that many glucosamine supplements are made from shellfish and can cause serious allergic reactions.

Recent research from the University of Adelaide investigated “spontaneous adverse drug reactions [or side effects]…to glucosamine and chondroitin in the Australian population between 2000 and 2011, with a primary focus on hypersensitivity reactions.”

They found that during that period, the Therapeutic Goods Administration (TGA) was notified of 366 recorded adverse reactions. This is more than the combined adverse reactions of other supplements such as echinacea, valerian, black cohosh, ginkgo and St John’s wort. However, hundreds of thousands of people also took glucosamine during that time with no ill effects, highlighting that the risk of a severe reaction was still very low.

A major issue raised is the labelling of glucosamine. Labelling must report that it contains seafood, but not specifically shellfish. And this information is often in small writing. So people who are aware that they have a shellfish allergy may not realise that they’re taking something that’s harmful to them.

In 2016, the TGA changed the rules for this, and required manufacturers to be clear if products contain shellfish. And this information must be easy for consumers to find. However they also gave manufactures until August 2020 to do this. So many products publicly available may still not may it clear to consumers if the product contains shellfish.

So what should you do if you currently take glucosamine?

  • If you have a shellfish allergy stop taking glucosamine immediately and discuss with your doctor.
  • If you have taken glucosamine for some time and haven’t had any negative side effects, and want to continue taking it, then you can do so under the advice of your doctor.
  • Talk to your pharmacist about any potential interactions with other medicines you may be taking.
  • Talk with your doctor about other treatment options – including exercise, weight management, pain management techniques.
  • Call our MSK Help Line weekdays on 1800 263 265 or email helpline@msk.org.au and talk with our nurses about OA and ways you can manage it without glucosamine.
  • Stay up-to-date. As well as being painful, living with a chronic musculoskeletal condition can be confusing and frustrating, especially with so much conflicting information circulating through the news, social media, and our network of family, friends and acquaintances. Follow us on Facebook and sign up for our eNewsletter to stay informed about the latest information, research, events and much more.

* Note

We now know that these medications provide very little benefit for managing the ongoing symptoms of OA. Currently the best evidence is for weight management (maintaining a healthy weight or losing weight if you’re overweight) and exercise. Treatments such as massage, heat and the short term use of anti-inflammatories may provide temporary relief, but the evidence is not as strong.

References


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27/May/2018

A book by people like you

Chronic pain is a common and complex problem that affects 1 in 5 Australians.

It’s exhausting, a bit tricky and hard to know where to start.

Fortunately, with our book Managing your pain: An A-Z guide you can start anywhere!

Medications, sleep, laughter, fatigue, breathing. Think of it as a ‘choose your own adventure’ to getting on top of your pain.

The book emphasises practical strategies tried and tested by people like you – consumers living with musculoskeletal conditions. There are also a bunch of quotes and useful insights to keep it real.

You might also like…

We also have a helpful kids pain book called The worst pain in the world. It’s beautifully illustrated and loaded with practical advice for children living with pain (not just those with arthritis). It also gives kids who don’t live with pain an understanding of what their friends or family are going through.




Musculoskeletal Australia (or MSK) is the consumer organisation working with, and advocating on behalf of, people with arthritis, osteoporosis, back pain, gout and over 150 other musculoskeletal conditions.

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