Back and Neck Pain Relief
Glucosamine and Chondroitin
An increasingly popular way to address the problems of joint, back and neck pain, such as in spinal stenosis is to take supplements like glucosamine and chondroitin, but what are they, how can they help, and are there any safety issues with these substances?
What are Glucosamine and Chondroitin?
These are naturally occurring constituents of joint tissue, acting as protective cushioning agents in cartilage. The body synthesizes them by combining glucose and the amino acid glutamine, subsequently forming long chains of glycosaminoglycans, which are required for the repair and formation of cartilage. This natural process appears to decline with age and any injuries or extra stress on the joints may outstrip the body’s ability synthesize and repair.
These two glycosaminoglycans work synergistically, enhancing each other’s anti-inflammatory action. Chondroitin can boost the cushioning effect by drawing moisture into the joints and synovial fluid, thereby keeping cartilage and connective tissues supple. Glucosamine also boosts chondroitin’s natural hypermetabolic repair response.
The Main Effects of Glucosamine and Chondroitin
Just like non-steroidal anti-inflammatory drugs (NAIDs), glucosamine and chondroitin also have anti-inflammatory actions. Unlike NSAIDs though, they have few reported side-effects, such as gastrointestinal discomfort, bleeding, and toxicity; some reports show that NSAIDs may actually increase arthritic progression through toxicity, whereas glucosamine can slow down that degeneration by positively influencing chondrocytes.
Additionally, rather than just reducing inflammation and pain for the duration of the medication, like NSAIDs, glucosamine and chondroitin induce long-term improvements in joint health, making them ideal for degenerative conditions such as spinal stenosis. Reducing inflammation in the neck and spine not only helps relieve pain but can allow the body to better conduct repair processes utilizing substances, whether endogenous or exogenous, such as glucosamine and chondroitin.
When ingested orally glucosamine sulfate is readily absorbed and may only take a few hours to start working in the cartilage of the body. As such, its effects in terms of anti-inflammatory action and pain-relief may be felt very quickly by some, whereas the impact on repairing joint tissue, slowing down and/or preventing degeneration are likely to take longer to be noticeable (1).
Most research has found glucosamine effective in peripheral joints, but evidence so far seems to show that lower circulation to the lumbar region, and the spine in general, may make these types of substances less effective in centralized joint conditions such as spinal stenosis. Several researchers are now looking at direct injections of glucosamine and chondroitin into intervertebral discs. Although major reductions (90% and above) in inflammatory agents like prostaglandin-e-2 have been observed adverse effects on the viability of come cell-types following the injections has been noted; this appears to be due to the high dosages used with problems minimal at lower doses (2).
Some studies have also found that the benefits of these injections occur in the majority of patients, but unfortunately not for spinal stenosis sufferers (3). More research clearly needs conducting and it may be that products can be formulated which deliver these glycosaminoglycans to specific tissues more effectively without creating the adverse effect on cell viability.
Several studies have demonstrated glucosamine’s protective effect in inhibiting cartilage breakdown associated with osteoarthritis, and may in fact aid in rebuilding cartilage (4). Other double-blind, placebo-controlled trials have found effective pain relief in a significant majority of patients taking glucosamine and chondroitin in contrast to the placebo, as have animal studies where a placebo effect is considered absent (5).
Sources of Glucosamine and Chondroitin
Glucosamine and chondroitin occur naturally in the shells of crustaceans and in other animal connective tissue, such as bovine and shark cartilage. Most supplements tend to be from these sources, although its provenance should be checked to ensure purity of supply, particular if bovine (cow) tissue is being used. Quality manufacturers will be able to supply thorough details of sourcing, so be suspicious of cheap imitation products and ask in your health store which manufacturers provide assurance of quality.
The vegetarian form is glucosamine hydrochloride and is derived from a fungus-like organism Aspergillus niger. Unfortunately there is no vegetarian source of chondroitin. Due to the sulfate form being most commonly used, anyone self-medicating with these substances should consider if they have a shellfish allergy and choose sulfate or hydrochloride accordingly.
How much should I take?
Common doses for glucosamine at therapeutic levels are 1500mg per day, with doses divided into two or three capsules or tablets. Chondroitin is likely to be most effective at levels of 800mg per day and supplements containing both will normally be in a 500mg/400mg ratio.
In most cases there are no reported side-effects or issues with taking these products. However, glucosamine sulfate has, in some studies, had an effect on insulin resistance in the body; therefore diabetics should apply caution before using it. Also, those on high blood pressure medication may be unable to take the sulfate form as it can affect potassium levels in the body and thereby make medication more potent than is intended. Some people may experience mild gastrointestinal discomfort as a result of the shellfish-based sulfate form, although taking it with a meal generally alleviates this problem. Chondroitin has similar issues and may also interact with anticoagulants, such as Warfarin/heparin.
Patients with spinal stenosis may find glucosamine and chondroitin effective at relieving chronic pain associated with this condition. It may also help in the long-term to minimize the related degeneration in musculoskeletal health. Improvements in delivery mechanisms may make glucosamine and chondroitin even more effective in the future for those suffering from central spine conditions.
As always, consult your healthcare provider prior to using neutraceuticals, and ensure that you take a high quality supplement from a trusted manufacturer.
- Ruane, R., Griffiths, P., (2002), Glucosamine therapy compared to ibuprofen for joint pain, British Journal of Community Nursing, Vol.7, no.3, pp.148-52. PMID 11904551
- Walsh, J.A.L., O’Neill, C.W., Lotz, J.C., (2007), Glucosamine HCl alters production of inflammatory mediators by rat intervertebral disc cells in vitro, The Spine Journal, Vol.7, no.5, pp.601-608.
- Phillipi, A.F., Leffler, C.T., Leffler, S.G., Mosure, J.D.C., Kim, P.D., (1999), Glucosamine, chondroitin and manganese for degenerative joint disease of the knee or low back: a randomized, double-blind, placebo-controlled pilot study, Military Medicine, Vol.64, no.2, pp.85–91.
- Deal, C.L., (1999), Neutraceuticals as Therapeutic Agents in Osteoarthritis, Rheumatic Disease Clinics of North America, pp.379-395.
- Forsyth, R., Brigden, C., Northrop, A., (2006), Double blind investigation of the effects of oral supplementation of combined glucosamine hydrochloride (GHCL) and chondroitin sulphate (CS) on stride characteristics of veteran horses, Equine Veterinary Journal, Vol.36S, pp.622-5. PMID 17402494