A month ago I started having problems in my left knee, especially during long walks. My philosophy on most chronic health issues is to start very early and see if there is a safe and simple way that might control or at least delay the problem. Ignoring a painful knee is likely to be a mistake, because the damage can snowball by building on itself. Osteoarthritis (OA) is very common, especially in older people. It affects about 30 million U.S. adults - more than 9% of the entire adult population.
There are various natural remedies that people find in drugstores, health food stores, or on Amazon etc. - for example, you may have seen glucosamine and chondroitin pills in the vitamins section. (Usually "natural" means that the substance is already in the human diet or the human body; such supplements are regulated much less severely than drugs that are new chemicals, especially in the United States.) So I looked for medical articles that reviewed the available evidence on whether or not some common remedies work. The short answer is that the evidence isn't great, but suggests that some popular remedies have a modest benefit, providing relief comparable to low-dose ibuprofen (Advil, etc.), not only relieving pain but also reducing inflammation, which may help to prevent further damage.
But the real picture is somewhat better than the research evidence suggests, both for "alternative" and "mainstream" remedies. That's because in practice, when there is a low risk in doing so, patients try one treatment after another to see what works for them - with or without a physician's direction. That's a good strategy because there are huge biochemical differences between people; medical research habitually reports averages, but you are not an average. If you look at reviews patients put online, some say a treatment is a miracle for them (allowing them to get off opioids, for example), while others say the same drug or supplement was useless. Sometimes a small average benefit means a life-changing improvement for some, and no help at all for others. When you can't predict in advance, trial and error makes sense.
A recent brief review, Dietary Supplements for Osteoarthritis as an Alternative to NSAIDS: Commentary of the Available Research, published December 2018, looked at several non-prescription remedies: ginger, glucosamine, chondroitin, curcumin, SAM-e (S-adenosylmethionine), and devils claw (an herb). The reviewer found indications of modest benefit with all of them.
Many other foods and supplements have also shown some anti-inflammatory benefit in small, inconclusive human studies.
For basic backgrounds on OA (or almost any common disease or condition), see the U.S. CDC (Centers for Disease Control and Prevention), www.cdc.gov/arthritis/basics/osteoarthritis.htm.
For reports of recent research, the U.S. National Library of Medicine provides excellent tools for searching medical-research articles. To start, visit www.pubmed.gov. Or it might be better to start at the Clinical Queries section, which you can click from the PubMed page, or visit directly at www.ncbi.nlm.nih.gov/pubmed/clinical.
From there, a search for "osteoarthritis" (quotation marks not necessary) finds more than 20,000 peer-reviewed medical articles. Or a search for "anti-inflammatory" finds more than 30,000. A search for both together ("osteoarthritis anti-inflammatory" - without the quotation marks) gives links to over 6,000 research papers, starting with the most recent.
I tried SAM-e (pronounced "sammy"), and it seems to be working. I started with that arbitrarily - because an acquaintance said it had stopped OA of his hand for 5 years and counting ,and also because I had tried SAM-e when it was a fad years ago (and discontinued it then, because I had no health problems or symptoms to indicate whether or not it had any benefit for me).
When my knee has problems I take one 200-mg tablet between meals, as recommended on the box (Doctor's Best SAM-e 200mg). Otherwise I don't take any.
A drawback of using it this way is that I like to go for long walks (a mile or more), and the knee pain often begins only after I have walked a block or two. So I walk where it's easy to get off the knee right away for an hour or more if necessary. Then I can do the rest of the walk without any problem. If necessary I might switch to taking the supplement a couple hours in advance of the walk - or to taking it every day.
SAM-e is often believed to take a long time to start working, as long as a month. How could it work for me within two hours? My guess is that clinical trials get run on people with much more advanced disease, and even if benefit starts quickly it may not be noticed until some healing has taken place.
If the natural remedies are not enough, I will ask my doctor about a prescription drug, diclofenac gel (the best know brand name is Voltaren topical gel). A key advantage is that it applied directly where needed, not to the whole body as with a pill. Diclofenac is not addicting; it is an NSAID (same class as Advil, Tylenol, or aspirin), but available in the U.S. only since 2007; it is sold over the counter in many countries. When I was reporting about AIDS treatments, in the late 20th century, some doctors were quite interested in Voltaren for their patients, because it worked very well for certain inflammation and pain relief. But it didn't catch on because it was hard to get in this country; in those days you had to order it abroad and hope it got through customs. I remember reading about a long-distance foot race in South Africa, where runners could stop at stations along the way to get the gel and apply it for joint, muscle, or skin pain (apparently a promotion by the manufacturer). So it must work quickly, as racers who wanted to stay in the race could not wait around for hours or weeks for relief.
You can check current diclofenac prices at www.HealthWarehouse.com (search for Voltaren gel); as of 2019-05-25, the generic is half the price of the brand-name, $35.20 vs $71.00 for a 100-gram tube. You can find lower prices with various coupon and membership deals; for example, see Webmd.com, or GoodRX.com.
For basic information about the diclofenac, see www.webmd.com/drugs/2/drug-150270/voltaren-topical/details.
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