You can just scroll down to start reading or use these links to jump to a particular section:
Part One – Intro to joint pain, what it is, the most basic technique for treatment
Part Two – The role of trigger points (are you sure it’s a joint problem?), hydration, weight, fish oil, MSM, glucosamine
Part Three – Acupuncture, food sensitivities
Part Four – Niacinamide, Boron, SAMe
Part Five – Vitamin D
Part Six – Heat
Part Seven – Devil’s claw, bromelain, green tea, turmeric
Part Eight – Willow bark, other salicylates, steroids
Part Nine – CMO & ASU
Part Ten – Boswellia, ginger, collagen II
Part Eleven – Nettle, pantothenic acid, rose hips, Imbue
Part Twelve – The Great Recap – a brief review of all 30 interventions
First, some basics. “Arthritis,” which means “joint inflammation,” (arthr=joint, itis=inflammation) is a descriptive term, and not the most meaningful diagnosis, since there are more than 100 forms of the condition. Actually, most of the time people use the word arthritis, they mean arthralgia (arthr=joint, algia=pain), since there may or may not be inflammation involved.
When a doctor makes a diagnosis of arthritis, he or she usually means “osteoarthritis,” (osteo=bone) which technically means, “bone joint inflammation.” Good thing they clarified that by adding the osteo part, eh? Osteoarthritis is often referred to as the “wear and tear” type of arthritis. It’s very common, and it occurs through years of damage to a joint, mostly just by decades of everyday use, but perhaps accelerated by sports, injuries, occupation, genetics, overweight, infection, and other factors. At the ends of bones where they come together in a joint, they are covered with cartilage, which is smooth and resilient, like plastic. In osteoarthritis, the cartilage has partially or completely worn away, leaving bare bone. In comparison to cartilage, bone is hard and unforgiving. It often hurts to use a joint without cartilage.
The loss of cartilage often goes along with instability of the joint. The body may respond to the instability, the increased exposed bone, and the chronic mechanical irritation by growing little protrusions, like teeth, called osteophytes. Sometimes we call these “bone spurs.” In osteoarthritis of the hands, osteophytes give a telltale knobby appearance to the finger joints (these are called Heberden’s nodes and Bouchard’s nodes). Osteophytes frequently reduce a joint’s range of motion and cause pain.
The term osteoarthritis is primarily used in contradistinction to rheumatoid arthritis. Rheumatoid arthritis is a more severe and much less common condition. Its key characteristic is that the damage to joints (and sometimes other tissues) comes from one’s own immune system. There are many hypotheses as to why this occurs, but ultimately the body’s immune cells become confused and fail to recognize one’s own body as self, which it then wages war on. Unlike osteoarthritis, which occurs primarily in our later years, rheumatoid arthritis can start early in life. Osteoarthritis is something most people just live with, without getting any significant medical treatment for it. But, if you have rheumatoid arthritis, unless it’s in remission, you likely need to be working closely with a healthcare practitioner. There are lots of natural interventions worth utilizing for rheumatoid arthritis, and I’ll mention a few of them in the upcoming sections. However, the bulk of this series pertains mainly to osteoarthritis.
There are lots of things that can help joint pain. There’s no single approach that completely manages the pain for everyone, so you need to do some investigation and some trial and error. It is often worthwhile to consult with a healthcare practitioner who is knowledgeable in this area, though in many cases you’ll be going through the same trial and error with them (hopefully informed, however, by their clinical experience), so it does hurt to try some of these approaches on your own.
One of the most basic approaches massage therapists and many of my patients employ is to simply rub the joint itself, at the most tender area, deeply and thoroughly. I know it sounds absurdly simple, but when I ask a patient if they or anyone else has ever massaged their painful joints directly, they usually say no. But it frequently provides quite a lot of relief. In a few cases, after a really deep local massage, a patient has told me the pain was completely gone. I don’t tell anyone to expect this kind of miraculous response, however. Most of the time, people do report feeling notable relief. Massage improves local circulation and can help reduce inflammation. I often tell my patients to do this on themselves, starting with just a minute or two per day and gradually increasing it to several minutes per day. I always tell them to stop if there is ever very sharp pain, swelling, or worsening (if any of these happen, I have them apply ice several times over the following 24 hours).
When I prescribe self-massage (or have a patient instruct a family member to do it to them), I have them carefully press all over every millimeter of the joint, really getting into all the little corners and grooves in the bones, to find the places where the joint is the most tender, and then focusing their efforts on these spots. A nice side benefit of this process is that patients often come back knowing quite clearly the exact spot the pain is coming from. Sometimes they come back telling me that the joint itself doesn’t really hurt to the touch; it’s more of a vague or deeper pain. We’ll talk more about why this could be the case later. (Please bear in mind I am not giving medical advice or addressing anyone’s particular health situation in this blog. Consult with your healthcare practitioner.)
First, be sure it’s actually coming from your joint. You may not be able to figure this out for sure on your own, but you can be fairly certain that if you discover tender spots in the muscles near the affected joint(s) which, when massaged or treated with other methods (e.g., acupuncture, our pain patch), cause the joint pain to go away mostly or completely, you’re onto something. Check out my online course, Live Pain Free, which includes many, many, many strategies for managing and eliminating your pain. It also features a tool called the “Pain Expert” which helps you identify if the pain is likely to originate in a particular form of muscular strain (and the physiological changes that follow) known as a myofascial trigger point, which can cause pain that seems to be coming from somewhere else. Shoulder pain, for instance, is not usually due to something wrong with the shoulder joint itself. Often, it’s due to myofascial trigger points in nearby muscles. This is good news. It’s almost always much easier to treat irritated muscles than damaged or deteriorating joints.
Drink more water. If you’re not already drinking about half the number of pounds you weigh as ounces of water each day, start doing it, and pay attention to how your joints feel. A dehydrated body has less pliable tissue, less flexible muscles, less fluid joints. Water is such a basic intervention for pain, we often don’t take it seriously enough. I wrote an article on the many benefits of water that you can read HERE.
Lose weight. Most joints can be burdened by having to move more weight around. This is especially the case for joints lower in the body, like the lower spine, hips, knees, and ankles. When climbing stairs, the knee takes a burden of 3 to 5 times one’s body weight, which translates into a significantly greater strain on this joint. If you’re obese, you already know there are all sorts of other benefits to your losing weight, not the least of which is that you’ll feel better about yourself.
Consider MSM (methyl sulfonyl methane). MSM is an organic form of sulfur. It’s found in many of the foods we eat. In our bodies it plays a role in the formation of healthy hair, skin, nails and connective tissue. (It does a lot of other useful things, too.) If you’re going to try supplements for your joint pain, MSM is a good place to start because it’s very, very safe. The worst thing I’ve heard from patients is that it gives some of them smelly gas. It’s a good idea to start with a fairly low dose, like 500mg or so each day, and gradually increase the dose to about 1000mg (1g) for every 50 pounds of your body weight, twice a day. So, if you weigh 150 pounds, you’d take 3g twice a day. Since this is kind of a lot, it’s a good idea to get the stuff as a tub of powder, which makes it more economical. You can just mix it with water; it doesn’t taste bad. If you notice good results at a lower dose, you don’t need to take this much. It tends to take a couple weeks (up to a couple months even) to notice the full benefit of MSM. If you don’t feel like it’s helping after a couple months, there’s no reason to keep taking it.
Consider Glucosamine Sulfate. So, it’s only the most popular dietary supplement for joint pain. There must be a reason people use it, right? Well, about half my patients who have tried it reported a distinct improvement in their pain while on it. Theoretically, glucosamine contributes to the production of new cartilage in joints where it has worn away. Another theory is that it works by stimulating production of a substance called hyaluronic acid in the joints, which supports their lubrication and shock absorption, and also has anti-inflammatory properties. In any case, in order to get any benefit from it, one usually needs to take enough of it – at least 1500mg a day (usually this is 750mg twice a day or 500mg three times) – and stick with it for months. Since the studies on glucosamine have been primarily on the sulfate form, this is widely considered to be more effective than the cheaper hydrochloride form. If you stop taking it, expect your results to disappear eventually.
Consider Fish Oil. Another popular supplement, fish oil has gotten so much press for good reason. It supplies essential fats we get through very few dietary sources. These fats are deeply lubricating and anti-inflammatory. They help some cases of joint pain, and have numerous other benefits to the body. When patients tell me they take fish oil, but aren’t sure if it’s helping, I ask them how much they’re using, and invariably, it’s a very small amount. As a starting dose, I usually prescribe a teaspoon of liquid fish oil morning and night with some food in the stomach. This is equivalent to about 10 large softgels. If a patient doesn’t notice any benefit at this dose, I have them go up to as much as a tablespoon twice a day, which is equivalent to roughly 30 large softgels per day. Frequently, my patients tell me they’re taking one or two softgels a day. Liquid makes a lot more sense, both because it’s much more economical, and because it’s easier to take one quick swallow of oil than to try to down 5 to 15 pills at once.
Before you start with any new dietary supplement, talk to your doctor.
These were some of the more basic interventions for joint pain. Next time we’ll continue to look at the long list of therapies that can help painful joints. Meanwhile, use the comments section to let me know what you’ve tried and what your results have been, or to ask about any other joint therapies you may be interested in.
In parts one and two of my series on joint pain, I discussed the technical stuff on arthritis and introduced some of the most basic things you can do to manage your pain. Not everything works for everyone, so I have more options for you. Part of the reason for people’s variable responses to these supplements is that there are many possible causes of joint pain. Different supplements address different facets of the mechanisms involved in joint pain. As I said last time, even the bestseller glucosamine sulfate only makes a big difference for about half the people who try it. So, let’s check out some other interventions.
Acupuncture. Full disclosure – I stick needles in people, so you might take my frequent endorsements of acupuncture with a grain of salt. However, I am a total skeptic. I take very little on faith alone. I want RESULTS. If acupuncture didn’t get me and my patients the results we want, I’d find other ways to treat them. But, I consistently utilize acupuncture because it has demonstrated big positive results over and over. Joint pain is usually very responsive to treatment with acupuncture. When muscle tension is present (including trigger points in muscles, which are often the true cause of joint pain), the response is typically excellent. When there is significant joint damage or degeneration, results may be slower and/or less dramatic, but it’s still worth trying a series of treatments.
If you don’t notice any change after 3 to 5 treatments, consider trying someone else. There are lots of conditions that take 10 or more acupuncture treatments to improve, but pain is not usually one of them. I don’t mean to imply that any case of pain should be cured within 3 to 5 treatments, but you should be noticing at least temporary improvement at this stage, which generally becomes increasingly significant and permanent with subsequent treatments. As with all fields of medicine, there is spectrum of skill level among acupuncturists.
Figure Out if There’s a Connection to Your Diet, and Stop Eating Offending Foods. There are lots of ways to diagnose food sensitivities – too much to write about here – but a good starting point is to consider cutting out the most likely culprits. In my experience, the five most common foods people have issues with are: wheat products (including bread, muffins, bagels, cereal, pasta, etc.), corn products (including corn, corn syrup, corn starch, corn meal, often maltodextrin, etc.), soy products (soybean oil, textured vegetable protein, tofu, soy sauce, etc.), eggs, and milk products (cheese, casein, milk, cream, whey, ice cream, yogurt, etc.).
The second tier would include tomatoes, beans, peanuts, lentils, citrus fruits, chocolate, and potatoes. Any of these (or any other food, for that matter) could cause or worsen joint pain in an individual who’s sensitive to them. The nightshade vegetables are of particular interest, since joint pain seems to improve in a good percentage of people who cut them out. These include tomatoes, potatoes, eggplant, and peppers (including hot peppers, cayenne, paprika, etc.).
If you’re an enthusiastic, all-or-nothing type, try an elimination diet (talk to your naturally-oriented healthcare practitioner for the details) whereby you’ll eat just a few foods that are highly unlikely to cause any reactions for about two weeks in order to eliminate almost any food that could be antagonizing your joints. (Usually this limits you to salmon, lamb, and rice, with perhaps squash, sweet potato and certain other fruits and vegetables if you absolutely need more variety.) If your joints feel better, you can assume something you were eating before the elimination diet wasn’t getting along with your body. Then you can reintroduce suspected foods one at a time. With your new clean system, if you have a problem with a certain food, you’ll typically get an obvious negative response. It’s best not to reintroduce foods too close together, since the reaction may take up to three days to hit you, and it will be difficult to tell which food was responsible.
If the elimination diet sounds like absolute torture to you, you can try just eliminating all the common offenders I listed above. Or you could just eliminate the nightshade family vegetables. Or you could just eliminate the big five I mentioned first (wheat, eggs, milk, soy, corn). One big caveat: if you choose to eliminate just a few of these usual suspects and you don’t feel better, it doesn’t mean these foods are in the clear. It’s possible that you eliminated something you are sensitive to, but didn’t eliminate something else you’re sensitive to, and that kept your joints from improving.
Another option is lab testing for food sensitivities, which should get you in the ballpark, though isn’t without its errors. You might also consider a simple home method developed by a medical doctor named Arthur Coca in the 1950s. He was ahead of his time by identifying food sensitivities at a time when they were nearly unheard of. You can get his book (which is now in the public domain) for free HERE.
Consider Trying Niacinamide. Niacinamide is a form of the vitamin B3. It’s not quite the same as niacin, so please don’t use niacin in the doses I’m about to recommend (you would feel absolutely awful, especially if you’re a peri-menopausal woman). Several studies have confirmed niacinamide’s benefit for joint pain. A typical dose would be 1000 milligrams, three times a day. You need to give it a month before assessing its effectiveness. Most people reach a plateau of improvement at 12 weeks, at which time the dose can usually be lowered (though not discontinued altogether). Luckily, it’s cheap.
Consider Trying Boron. Boron is an element we need only in very small amounts, so you’ll never see a cereal box touting “Supplies 100% of the Recommended Daily Allowance of Boron!” However, in the past decade, there has been a growing recognition of the value of boron in bone and joint health. Supplemental boron may help improve bone density for osteoporosis, and it may also benefit joint pain. Studies have shown an improvement in both osteoarthritis and rheumatoid arthritis. A typical supplemental dose is just 3 milligrams, twice a day.
If You Have Money to Spend – and Especially if You Are Also Depressed – Consider Trying SAMe. SAMe (pronounced “Sammy”), a relative of the amino acid methionine, is not cheap, but it can be helpful for joint pain. Many people also find SAMe to lift their mood if they’re depressed (regardless of whether or not they have joint pain). One double-blind clinical trial showed SAMe to be superior to ibuprofen (Advil) in the treatment of osteoarthritis. A typical dose is 400 mg once or twice a day.
Optimize Your Vitamin D Levels.
For decades, vitamin D has been thought of as something of a hormone, with many authorities cautioning against getting too much. As you probably know, all that has changed in recent years, with current estimates putting 60 to 75 percent of Americans in the deficient category. We don’t get outside in the sun much, we wear sunscreen when we do, and it’s hard to get very much of it from food. Also, those who live in the northern latitudes (north of 37 degrees north latitude – or, for that matter, south of 37 degrees south latitude) rarely get exposed to sun that is direct enough to stimulate vitamin D synthesis in the skin. Except during a few months of summer, sun rays that hit the northern states come in at an angle (rather than being perpendicular to the earth) and they have to pass through a lot of atmosphere, which is full of dust that filters the intensity of the light, making it too weak for us to turn it into vitamin D.
Along with a growing recognition of our low levels of this vitamin has come a ton of research showing how critical vitamin D is to our health. Vitamin D deficiency has been linked with low and/or wonky immune function, cardiovascular disease, osteoporosis, depression, gum disease, skin diseases, asthma, diabetes, and, the subject of this article – arthritis.
Low blood levels of vitamin D are associated with an increased risk of both rheumatoid arthritis and osteoarthritis. Studies have suggested a higher incidence of arthritis (particularly rheumatoid) in those living in the north. With rheumatoid arthritis – an auto-immune condition (confusion of the immune system, whereby it attacks the body itself) – this may arise because vitamin D is integral to healthy immune function. (This may also explain why vitamin D deficiency is prevalent in certain other auto-immune disorders, such as multiple sclerosis and psoriasis.) However, an especially interesting revelation of vitamin D research is that receptors for this nutrient appear all over the body – including in the joints. Vitamin D receptors like to be occupied with vitamin D – good things happen when there is sufficient vitamin D to fill them. In the case of our joints, vitamin D appears to be integral to the maintenance of our cartilage. One study on knee arthritis showed that participants with sufficient vitamin D had significantly less cartilage loss than those who were deficient in D. Cartilage loss is central to the development of osteoarthritis, so vitamin D should be a part of the nutritional regimen of anyone with arthritis.
In addition, when it comes to bone health, vitamin D is instrumental in the absorption of calcium from our intestines. When there is not enough vitamin D, even if we’re eating plenty of calcium, we won’t absorb it. This would lead to low levels of calcium in the blood, but because circulating calcium is vital for cardiovascular and neuromuscular health (including the beating of the heart), the body doesn’t let this happen. Instead, it stimulates glands called the parathyroids to secrete a hormone that causes dumping of calcium from bones into the blood stream. While this is good for the heart, it’s not good for the bones. Most studies show a connection between low vitamin D and osteoporosis. But low doses – like the “recommended daily allowance” (RDA) of 400 international units – don’t seem to help reduce the incidence of fractures. Only big doses, at least twice the RDA, appear to be beneficial in this regard.
As for supplementation, as I mentioned previously, there aren’t many rich food sources of vitamin D. The two primary ones are oily fish and egg yolks. Eating oily fish is generally a good idea, though some of these fish – tuna, in particular – also tend to be rich in mercury, not a mineral we need more of. Egg yolks are good for you, in moderation, though I recommend only eating eggs from free range chickens. Caged chickens have poor nutrition, and, unsurprisingly, produce eggs that are significantly less nutritious than those from chickens who roam freely and eat grass and bugs. The thing is, even these “vitamin D rich” foods supply only a bit of the stuff. Harvard Men’s Health Watch reported: “You’ll have to eat about 5 ounces of salmon, 7 ounces of halibut, 30 ounces of cod, or nearly two 8-ounce cans of tuna to get just 400 IU. An egg yolk will provide about 20 IU, but since it also contains nearly a day’s quota of cholesterol, you can’t very well use eggs to fill your tank with D.”
Therefore, most people will choose to take a vitamin D supplement. It’s important to choose vitamin D3 (cholecalciferol) – the form we naturally produce from sunlight, rather than D2 (ergocalciferol), a synthetic form which is less useable by the body. Unfortunately, most fortified foods contain D2. Dose recommendations vary wildly nowadays. Your best bet is to get your blood tested (get the 25(OH)D test). You should not be below 32 (ng/mL); optimal is 50-70. Doctors will often prescribe 10,000 to 100,000 units of vitamin D once a week to correct a verified deficiency. (Since vitamin D is fat soluble, your body can store it and utilize it as needed.) A more common daily recommendation, for both kids and adults, is 35 units of vitamin D per pound of your body weight, up to 5000 units. Please ask your healthcare practitioner what is the best amount for you.
According to Dr. James Dowd of the Arthritis Institute of Michigan, and author of The Vitamin D Cure, vitamin D works best when we have adequate amounts of potassium, magnesium, and calcium in our diet. So, eat plenty of vegetables while you’re at it.
Use Heat: Things contract when they get cold (like our skin, which turns into goosebumps) and they expand when they get warm. Contraction/cold makes most cases of chronic joint pain worse. People with chronic joint pain can often predict when the weather is about to take a turn for the colder (and damper), and they almost always feel better with warmth.
There is one time that cold seems to be useful, and that is briefly after some kind of trauma. Immediately after a minor strain (either a pulled muscle or a period of intense physical work, like giving someone a massage), about one minute of cold application can help. Right after a severe trauma, like a sprain, longer cold application – but no more than 24 hours – may be beneficial. However, many doctors and trainers now believe that cold application, unlike the other three standards for physical trauma – rest, compression, and elevation – may actually slow the healing process. Sure, it may numb the nerves to such a degree that you can’t feel the pain for a while, but when the area warms up again, the pain comes back.
In Chinese Medicine, the basic mechanism behind all pain is stagnation, and because cold inhibits fluid movement, it tends to promote (rather than alleviate) stagnation, so this notion of cold slowing the healing process makes perfect sense. This is precisely why joints hurt and get stiff in cold weather. Chinese Medicine has a special way to administer heat, called moxibustion.
Moxibustion, a contraction of the words “moxa” and “combustion” is the burning of an herb called moxa (also known by the common name mugwort – Artemisia vulgaris) over the skin to warm it up. For joint pain, most often we use a “moxa stick” or “moxa pole,” which is something like a cigar, a really thick incense stick, or a rod of charcoal. You light the end of it so that it’s hot and glowing at the tip. Then this glowing tip is held about an inch over the joint and slowly moved around in order to warm the whole area up. Moxibustion imparts a deep, lasting warmth to the area that can be very helpful for pain.
If you know an acupuncturist or have access to a Chinese herb store or grocery, you can probably find moxa sticks there. Be careful not to let the burning tip break off and fall on you – or your expensive carpet. It’s useful to have an ash tray handy, and to gently scrape the ash off the end about once a minute, gradually shaping it to a point, like the tip of a pencil. As the glowing area thus grows, it’s best to hold the stick sideways over the skin, to get more of the hot area over you. Don’t burn yourself. If you’re uncertain of how to do this, ask someone for help or look for a video online.
Another great means of instilling warmth in the joints is with hot paraffin. Paraffin machines – basically a crockpot that you fill with pellets of paraffin wax – are increasingly affordable and easy to come by. They start at around $30. You melt the wax and then dip the affected body part in – usually this is your hand or foot. Dip the part, let it cool for just a couple seconds, then dip it again, let it cool a couple seconds, and then dip it again. After the third dip, you should have a nice “sock” or “glove” of wax on, which should immediately be slipped into a plastic bag, tying the bag around the wrist or ankle to keep it closed. This helps hold the warmth in. Next, wrap the bag-enclosed hand or foot in an old towel. If you wish, you can even lay a heat pack or hot water bottle over or under the towel. Often, you can get the heat to last for a good fifteen or twenty minutes, and it really penetrates deeply.
It’s possible to use paraffin on other limbs, but you’ll need some help and creativity. One way is to buy a broad roll of plastic wrap, place a large piece under the affected limb, pour or spread the wax carefully but quickly over the limb, then immediately wrap the plastic around it, wrap it again with an old towel, and then optionally add a heat source.
Consider Devil’s Claw. This South African herb has a long history of use in treating digestive problems and pain. It is hugely popular in Europe, especially Germany, where it is use predominantly for joint pain. Studies on this herb have shown inconsistent benefits, so it may not be the supplement to spend all your money on. However, it seems worth trying, especially in combination with other herbs. Studies used 600 to 1200 milligrams of extracts of the herb for pain. Some sources report that extracts that are standardized to contain 50 to 100 milligrams of harpagoside are strongest.
Consider Green Tea. Green tea, for all the press it gets, is not likely to yield dramatic results for any health condition – at least not in the short term. It’s an herb that is best taken day in and day out – drunk as a pleasant beverage, of course, so it doesn’t feel like one more supplement. You can learn to love it. In exchange for adopting it as your daily drink, it will confer upon you numerous anti-oxidant and anti-inflammatory benefits. In particular, a constituent called EGCG has shown promise as a treatment for rheumatoid arthritis. Mice given green tea instead of water had a lower risk of developing arthritis. University of Michigan researcher Salah-uddin Ahmed recommends drinking three or four eight-ounce cups of it throughout the day to reap its joint benefits. If you are sensitive to caffeine, luckily levels of EGCG are unaffected by decaffination. If you dislike the taste or can’t get around to drinking several cups of it a day, many encapsulated forms are available that can deliver doses of EGCG equivalent to multiple cups of tea. However, instant green tea and bottled green tea seem to lack the potency of the real thing or the capsules. As a supplement, green tea seems most valuable at preventing health problems, rather than as a medicine, so you might as well trade in your coffee for some green tea today.
Consider Bromelain. Bromelain is an enzyme from pineapple that has numerous health benefits, particularly in the area of pain relief. It reduces inflammation and alleviates pain. A German double-blind study compared it to the drug diclofenac (Voltaren) for patients with painful arthritis of the hip, and found that bromelain was as effective as the drug, but was better tolerated. Another study compared bromelain to dicofenac for osteoarthritis of the knee and also reported the bromelain to perform as well as the drug. A third study on acute knee pain showed improvements in pain, stiffness, and physical function following supplementation with bromelain. This study also showed that higher doses of bromelain (400 milligrams a day – ideally divided into two 200 milligram doses, taken on an empty stomach) yielded better results than smaller doses (200 milligrams a day). Other studies have recommended doses of up to 2,000 milligrams a day. Optimal results seem to come from a total dose of around 1,000 milligrams per day. Initial research indicates bromelain may also be useful for speeding healing after surgeries and traumas, treating cancer, clearing sinus infections, benefiting atherosclerosis and phlebitis, and alleviating inflammatory bowel disease.
Consider Turmeric. Turmeric is a yellowish-orange rhizome (underground stem) used to flavor and give a yellow color to curries, mustard, and other foods. Turmeric has well documented anti-inflammatory activity. You can consume it regularly if you have pain, though you’re likely to get more benefit by taking an extract of its most active constituent, curcumin. In Ayurvedic medicine, the ancient medical system of India, where turmeric hails from, turmeric is regularly combined with another herb called pippali or “long pepper” – a relative of black pepper – which is thought to enhance its absorption and effectiveness. Actually, modern research has shown that pepper contains a substance known as piperine that does indeed enhance the absorption of many substances through the digestive tract, so there are certain preparations of curcumin which are combined with pippali or piperine to make them stronger.
The most convincing research on the use of turmeric for joint pain is an Italian study where researchers gave 50 participants with osteoarthritis of the knee a turmeric preparation for 90 days. The results were quite impressive. At the end, participants had a 58 percent decrease in overall reported pain and stiffness. They had a three-fold improvement in emotional well-being. And a blood test called the C-reactive protein test, which is a general measure of inflammation, showed a 16-fold decline in this marker. The participants receiving turmeric were able to cut down on their pain drugs by 63 percent. Turmeric also appears to have some benefit in the treatment of cancer and Alzheimer’s disease.
Willow Bark Extract and Other Salicylate Sources
Willow’s botanical name is Salix, and Salix is the root of the word salicylic acid, a naturally occurring pain killer found in this tree’s bark. This pain killer, now widely manufactured in the form acetyl salicylic acid, is also known as “aspirin.”
Salicylic acid is one of a group of similar chemicals known as salicylates, which occur in a wide range of plants. In fact, part of the potency of the Imbue Pain Relief Patch comes from a common salicylate called methyl salicylate. Oil extracted from the wintergreen plant – a popular flavoring for mints, gum, toothpaste, and beverages – is almost pure methyl salicylate.
Salicylate-containing herbs, including willow bark, have been used at least since the time of the Egyptians for treating pain and reducing fevers. That’s 4,000 years of use. So, clearly, there’s some benefit. But this should come as no surprise, since aspirin is a hugely popular drug. Aspirin (and, really, the salicylate herbs it’s based on) is the original NSAID – non-steroidal anti-inflammatory drug. Meaning, it reduces inflammation, but isn’t a steroid.
While we’re on the topic, let’s talk a bit more about steroids. Steroids (more specifically “corticosteroids” – not the anabolic steroids weight lifters use to gain more muscle), such as the drug prednisone, are the strongest anti-inflammatory drugs we have. In a dire situation, the ability of a steroid to suppress inflammation may help save a life or knock down unbearable pain.
Inflammation is a process that is driven by our immune system, and steroids disrupt this process by suppressing the immune system. So, another application of steroids is the deliberate suppression of the immune system following an organ transplant or the implantation of certain synthetic materials into the body, like an artificial heart valve or joint. In such a case, a drug like prednisone might be prescribed (usually for the rest of one’s life) to prevent the body’s immune system from attacking the foreign tissue/material.
As you might guess, there are some unfortunate drawbacks to steroid use. Corticosteroid drugs are actually synthetic forms of a hormone called cortisol (hydrocortisone) that is produced by our adrenal glands, which sit on top of our kidneys. Our hormonal system is able to detect how much of these substances are circulating in the body, and in the presence of high amounts, the brain shuts down the adrenal glands. This often makes it very difficult for people to stop using steroids – their own capacity to produce cortisol has been negated.
Because hormones are usually produced in tiny amounts and have far reaching effects, being on prednisone or another corticosteroid often leads to a wide array of side effects. Many of these are part of a complex called Cushing’s syndrome which results from abnormally high levels of cortisol in the body. Symptoms include weight gain – especially of the face and trunk, including a puffy condition of the head, called “moon face,” and development of a fatty hump on the upper back, thin, fragile, unhealthy skin, muscle weakness, growth of hair on the face and loss of hair on the head, reduced sexual and reproductive function, insomnia, anxiety, depression, high blood pressure, diabetes, fatigue, heart disease, and osteoporosis. Also, you can’t suppress the body’s immune system without making it vulnerable to severe infections, so, these, too, are a possible side effect. So, in summary, you should avoid oral or injected steroid use except for the occasional short course in a serious case, or when there is no alternative.
If you have joint pain, you may have had a doctor recommend or perform a cortisone injection. This is a bit different than the steroid use I discussed above, since the injection is not intended to be systemic – that is, it isn’t meant to circulate broadly throughout the body. It’s a small amount injected in a focused way to target specific inflamed tissues – usually tendons, joints, and bursas (fluid-filled sacs around joints).
Cortisone injections have pros and cons. The local injection of a steroid is generally stronger and faster acting than taking any oral anti-inflammatory drug, and for someone who is sensitive to the gastric irritation that can accompany certain oral anti-inflammatories such as aspirin, this won’t occur from a cortisone injection.
Sometimes, for acute inflammation of the soft tissue in or around a joint, a cortisone injection can make a huge positive difference (I’m talking mainly about tendonitis and bursitis). Very occasionally, a single injection will resolve the inflammation associated with a certain incident and the problem will be completely resolved. This is highly unlikely to be the case with long-term pain though.
In my experience, if it doesn’t work or is only minimally effective the first time it’s done, additional injections are worthless. About two tries is all anyone should ever have done directly into a joint, since the steroid can cause degeneration of the bone and weakening of tendons when overused. In some cases, repeated cortisone injections can cause some of the same nasty systemic effects that are a risk of systemic corticosteroids, such as weight gain, puffy face, osteoporosis, high blood pressure, cataract formation, thinning of the skin, bruising, etc.
So, back to the willow bark. In the same way that aspirin alleviates pain and inflammation, which may benefit joint pain, willow can indeed be helpful. Regarding plant-derived drugs, although the drug tends to be stronger and faster-acting than the plant it came from, it also tends to be less balanced and more likely to cause side effects.
The plant itself is the natural milieu the drug came from, and in my opinion, is usually a more complete medicine. Such is the case with willow, which has less of a tendency to cause gastric upset than aspirin does (aspirin is quite well known for causing stomach bleeding in some people), and may even be tolerable by certain folks who can’t handle aspirin. However, if you have a known allergy to aspirin, you should only try willow bark under a doctor’s supervision. The benefits of willow bark tend to come on more slowly than aspirin, but are reported to last for longer.
As with all new drugs and supplements, please consult your healthcare provider first.
Consider Cetyl Myristoleate. Cetyl myristoleate, or CMO for short (also known as Myristin), is a fat that appears to benefit joint health. It was discovered in 1972 by Dr. Harry Diehl, a researcher who studied arthritis in mice. He found that a certain breed of mouse never developed arthritis, even when injected with a bacterial substance that virtually guaranteed arthritis in other breeds. His research eventually revealed that – unlike rats and humans – these mice’s bodies produced CMO, which seemed to make them “immune” to arthritis. Diehl then went on to develop a way to synthesize CMO (most now comes from beef fat). When he injected CMO into rats, it protected them against the development of arthritis. Later in life, Diehl developed osteoarthritis and administered CMO to himself. It essentially cured him of his joint pain.
In three notable studies, a majority of participants experienced significant improvements in pain and range of motion while taking CMO. It appears to lubricate joints, to reduce inflammation, and to assist in the repair of cartilage. Also, unlike many other common joint supplements, which typically provide benefit only to osteoarthritis (due to joint wear) but not rheumatoid arthritis (due to a problem with the immune system), CMO shows some promise in the treatment of rheumatoid arthritis and other auto-immune conditions.
A typical dose of cetyl myristoleate is 500 mg, taken two or three times a day on an empty stomach. Some users experience digestive discomfort from CMO. This can usually be alleviated by taking it with a digestive enzyme pill. Studies have advised participants to restrict the use of nicotine, caffeine, and alcohol while taking CMO, or at least avoiding these substances within five hours of taking CMO, as they can reportedly interfere with its absorption. Absorption seems to be an issue with CMO. Remember that Diehl was injecting it when he got such fabulous results. Oral use of CMO tends to be less dramatic. If you find a CMO preparation that contains “absorption enhancers,” this may improve how much of it you actually get.
As I have explained previously, with joint supplements, you sometimes have to try a few things to determine what works for you. Certain substances work wonders for some but not for others. CMO is a nice alternative for people who haven’t gotten any benefit from glucosamine sulfate. However, if, after trying it for a few months, you don’t notice any improvement, don’t bother continuing with it. Save your money for something else.
Consider ASU (Avocado Soy Unsaponifiables). ASU is a combination extract from avocado and soybean oils. Its potential to benefit joint pain lies in its ability to increase a substance called aggrecan – a major constituent of cartilage, especially the kind that covers the ends of our bones where they form joints. Aggrecan is especially vital for keeping this cartilage moist and cushy. Studies have shown that in addition to promoting aggrecan production, ASU reduces the production of chemicals that contribute to joint inflammation and appears to protect the joint from damage. The result is decreased joint pain, repair of damaged cartilage, and slowing of the progression of osteoarthritis.
ASU is extracted from the fibers of avocado and soybean in a way that our bodies could not accomplish; thus, eating avocados and soybeans will not confer the same benefits. A typical daily dose is 300 milligrams, and it must be taken for at least two months to experience its full benefit. If you’re interested in trying it, make sure you don’t buy a product that just contains avocado and/or soybean oil. It must specifically contain the “unsaponifiable” fraction of the oil, and will be referred to as ASU.
If you give ASU or CMO a shot, I’d love to hear about your experience. You can post about it on our blog. As these are relatively new supplements, I haven’t had many patients use them yet, and I am eager to collect more firsthand data.
Consider Boswellia. Boswellia serrata is a form of frankincense – a fragrant plant resin – that has long been known, even in the scientific community, to possess anti-inflammatory properties. It is considered particularly beneficial for joint pain and stiffness (of both osteoarthritis and rheumatoid arthritis) and it may improve flexibility. There are a handful of studies on animals and humans backing this up. Plain frankincense (or the Ayurvedic form, guggul) is not especially potent, and also has some potential to irritate the stomach (though it won’t cause bleeding of the stomach lining). You would need to take quite a lot of it to get much effect from it. Concentrated extracts are preferred, both for strength and reduced risk of gastric upset. The best ones maximize the content of a compound called AKBA (acetyl-11-keto-beta-boswellic acid), such as a patented extract called 5-LOXIN, or at least list the percentage of boswellic acids they contain. Look for these terms in the ingredients of any boswellia supplement you purchase. You may still need to take a lot to get really stellar benefits from it. This is why boswellia wasn’t at the top of my list. However, in combination with other joint supplements, it can be worth taking, especially since it may actually help inhibit the breakdown of connective tissues. 150 mg of boswellic acids three times a day is a usual starting dose.
Consider Ginger. Some of the strongest prescription pain relievers work by inhibiting an enzyme known as COX-2 that is integral in the inflammatory process. However, these drugs can have some severe side effects (such as increased risk of heart attack and stroke). Ginger blocks the very same enzyme, and is about as benign as a medicine can get. Many research studies have proven ginger’s effectiveness at alleviating muscle and joint pain. Unless you love ginger so much that you intend to use it multiple times a day, you might wish to consider getting an extract of it in pill form – especially one that has been standardized to maximize content of gingerols, the compounds most closely associated with pain relief. I don’t tend to think of ginger on its own for pain relief, but it’s a valuable synergist with other supplements.
Consider Collagen II: Type II collagen is the main protein in the cartilage that makes our joints smooth and shock absorptive. While you might think the purpose of supplementing with collagen would be to supply more of this basic material to the joint so new cartilage can form, this is not where its real value lies. In auto-immune joint degeneration – e.g., rheumatoid arthritis – the body’s immune system is attacking its own type II collagen due to an error whereby it mistakes collagen for some kind of foreign matter. Taking small amounts of collagen acts to “tolerize” the body to this substance. It corrects the immune system’s perception of collagen as a disruptive substance that must be attacked.
Multiple clinical studies, including two by Harvard University, have proven collagen’s effectiveness for rheumatoid arthritis. This effect occurs only when very small amounts of collagen are used. Anything over 20 milligrams a day won’t work. Since this is an exceedingly expensive substance, this is good news. You need only 10 milligrams a day. Look for undenatured type II chicken collagen. It is important that the collagen is refined using a low heat process that doesn’t denature it (cause it to lose its original protein formation), since once it’s denatured, it isn’t recognizable by the immune system in a way that corrects its perception of our own cartilage. Ideally, the source of this collagen should be the sternum cartilage of chickens 6-8 weeks old.
I’m very curious to hear what your experience is with these supplements. Much of the information I encounter on the claims of supplements is very theoretical. Only by having my patients try these things and hearing their feedback do I start to get a more accurate sense of their merits (or lack thereof).
As we have seen, there is no shortage of natural treatment options for joint pain. My intention isn’t to overwhelm you – eleven parts?! – but to present you with plenty of informed choices for pain relief. This week I have just a few more, which will nearly conclude this series. Next week, for your convenience and sanity, I will present you with a brief recap of all the approaches I’ve covered.
Consider Nettle Leaf. Stinging nettle has a long history of use as a pain reliever. The main way it was used was by brushing, rubbing, or whacking the painful area with it, whereupon the stinging hairs would cause an intense burning sensation. This acted as a “counter-irritant” which would block the deeper pain signals and help alleviate local inflammation. If you’ve never been stung by nettle, I encourage you to try it sometime – perhaps while picking its leaves to steam for dinner. It’s not so bad, but the pain can last for quite a long time.
Once nettle leaves are dried or cooked, the stinging goes away, and they can be eaten without discomfort. And there are many good reasons to eat them. They are full of vitamins, good for the urinary tract, and help regulate the immune system. A number of disorders that involve an over active immune system or persistent inflammation are benefited by consumption of nettle, and joint pain is one of them.
A German study found that an extract of nettle leaf inhibits certain compounds that are instrumental in the inflammatory process. One of these, called TNF-alpha, happens to be the same compound suppressed by the prescription rheumatoid arthritis drug, Enbrel. Another study, published in the Journal of Rheumatology, concluded that nettle “may inhibit the inflammatory cascade in autoimmune diseases and rheumatoid arthritis.” As with ginger, I wouldn’t rely on nettle as a sole medicine for joint pain, but it can be a valuable player in combination with other natural supplements for joint pain. Often, a formula that includes some organic things, such as nettle and ginger, with appropriate vitamins and minerals (such as vitamin C and zinc) plus essential fats (such as fish oil) yields the best results.
Consider Vitamin B5: Vitamin B5, also known as pantothenic acid, may be beneficial for arthritis, particularly the rheumatoid form. Studies – old studies, mainly – have shown that people with rheumatoid arthritis tend to have low levels of this vitamin in their blood, and that supplementation with B5 may alleviate joint swelling and pain.
Pantothenic acid is vital in protein synthesis, metabolism, the manufacture of hormones and red blood cells, and other processes. Related to its possible effect on arthritis is the fact that it is used in large amounts by our adrenal glands. The adrenals produce hormones that work to suppress inflammation, and they are activated – sometimes habitually, to the point of exhaustion – when we are stressed. Chronic pain is a recipe for adrenal fatigue (and is often the consequence of fatigued adrenals). Although the evidence for B5’s use in arthritis is kind of flimsy, I believe it’s worth considering for chronic joint pain because of its value in supporting the adrenal glands. Pantothenic acid, like all B vitamins, is water soluble, so you will urinate out any excess. This means both that it is safe, and that dividing your total daily dose into two or three servings is likely to yield better results than taking it all at once.
Consider Rosehips: Rosehips are the tangy, reddish fruits of rose bushes. Recent research on rosehips in the treatment of arthritis has shown promising results. A study conducted in Germany and Denmark resulted in significant improvements for patients with rheumatoid arthritis who were taking a rosehip extract called LitoZin. This and other studies have shown reduced pain and improved function in patients with rheumatoid and osteoarthritis, a reduced number of affected joints, and a reduced need for conventional medications. LitoZin is produced using a “special patented process” to dry the fruits in order to maximize the content of a compound known as GOPO, a naturally occurring anti-inflammatory. It is unclear whether plain powdered rosehip capsules would work as well as LitoZin, but all rosehips are rich in vitamin C and other anti-oxidants, and vitamin C is a useful anti-inflammatory in it’s own right. Given its relative affordability and the side benefits of extra vitamin C, rosehip capsules are a supplement that seems worth trying.
Try the Dragontree Muscle Melt line of products. I have had great results with them, and my patients love them.
30 Things to Try for Your Pain
Over the past few months, I’ve written eleven articles about joint pain and what can be done about it without resorting to drugs or surgery. If you’re suffering from joint pain, I encourage you to read (or at least browse) all of them.
Through personal experience and that of my friends, family, and patients, I know that being in pain can change your whole perspective of your life. You can get cranky, you can get despondent, you can feel hopeless. You can feel like you’ll never be able to do certain things that are fun or give your life purpose – at least not without pain or pain killers. You can feel like you’re going to get out of shape because your pain limits your ability to exercise, and that your health will go downhill. It’s amazingly unfortunate how far-reaching its repercussions can be. For this reason, although I prefer a natural and holistic approach to pain management, I completely understand when someone decides to resort to drugs or surgery.
I know that no single product is the answer for everyone, and I believe that nearly all cases of muscle and joint pain respond best to a combination of internal and external therapies. So, while you’re using our patch or getting massage, or doing another external therapy, you can enhance the healing process with appropriate supplements, such as those that reduce inflammation, help restore the cartilage at your joints, or support your adrenal glands.
In case you don’t remember everything I’ve said in the previous eleven installments, or if you just don’t have time to read eleven articles, I’m going to give a recap of the treatments I’ve discussed. I’ll try to keep it short and sweet. If there’s a treatment you’re interested in, I encourage you to read more about it in the article in which it was originally discussed (or elsewhere). For a refresher on the basics of joint pain, read Part One.
Here they are, folks – 30 non-drug, non-surgical approaches for joint pain.
I know that’s a lot to consider! So, please work with your natural healthcare provider to come up with a plan. Did I miss anything? Have any questions? Have you tried any of these and want to share your experience? Post a comment on our blog! I want to hear from you.