The Impact of Alternative and Complementary Treatment for Arthritis
Musculoskeletal Care of the Mature Patient
Complementary and alternative medicines (CAM) are widely marketed and used by orthopedic patients. Herbal supplements can have a negative impact on the perioperative period and may interact with conventional medicines used to manage chronic conditions. One third of the US population uses CAM. The greatest usages is in the over 65 population or those with chronic pain. An estimated $33.9 billion was spent on CAM in 2007. Many forms of CAM exist including herbal, nutritional, and megavitamin supplements; physical manipulation (e.g., massage, chiropractic); and other modalities, e.g., aromatherapy, self help organizations, folk and ayurvedic remedies, hypnosis, energy healing). Unlike conventional medicines, the FDA does not regulate herbal remedies. The Dietary and Supplement Health and Education Act of 1994 classified herbal remedies as dietary supplements, which rendered them exempt from the safety and efficacy regulations required of prescription and over-the-counter medications. Compounding the matter, herbal remedies are marketed to consumers as “natural” and “homeopathic”. These labels do not assure safety. At the same time, the Tuesday, October 11, 2011 AMA Member Communication Headline: “Vitamins associated with increased risk of death in older women.”
What about those medications approved by the FDA for the management of osteoarthritis? The news here is of concern as conventional medicines prescribed for OA are prone to produce their own set of undesirable side effects. While Non Steroidal Anti-Inflammatories reduce inflammation, pain and stiffness in arthritic joints, the side effects may include GI ulcers and bleeding, renal failure, and worsening of congestive heart failure.
I believe that the lesson here is that all medicines must be monitored by a patient’s primary care physician including those falling under the Complimentary and Alternative Treatment Modalities in addition to standard over the counter and prescription medications. While I do not view myself as an expert in pharmacology, I have spent a lifetime avoiding drugs when possible. The alternative for well-being and the care and treatment of arthritis? Try weight reduction, stretching, strengthening, hydrating and aerobic exercising with some exposure to sunshine. When progression of arthritis limits your functional capacities, start with physical rehabilitation and investigate platelet rich plasma. Continue to monitor advances in stem cell treatment of arthritis
Mitchell B. Sheinkop, M.D.
1565 N. LaSalle Street, Chicago, Illinois 60610