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Capsaicin gel and SAMe improve pain in patients with DJD

Clinical Question:
Are any complementary and alternative medicines effective in treating patients with degenerative joint disease?

Bottom Line:
The available data for most complementary and alternative medicine (CAM) in treating patients with degenerative joint disease is limited. Topical capsaicin and S-adenosyl methionine (SAMe) appear to be effective in treating pain, but even these data are limited and potentially subject to bias in favor of publishing positive results. (LOE = 1a-)

Reference:
De Silva V, El-Metwally A, Ernst E, Lewith G, Macfarlane GJ; on behalf of the Arthritis Research UK working group on complementary and alternative medicines. Evidence for the efficacy of complementary and alternative medicines in the management of osteoarthritis: a systematic review. Rheumatology (Oxford) 2011;50(5):911-920.  [PMID:21169345]

Study Design:
Systematic review

Funding:
Government

Setting:
Various (meta-analysis)

Synopsis:
The authors searched multiple databases for English-language publications reporting randomized trials of CAM in treating patients with degenerative joint disease. They excluded studies of glucosamine or chondroitin sulfate since those have already been studied to death and widely reported. Two authors independently determined study inclusion. One reviewer extracted data from the studies and a second reviewer double-checked the work. Ultimately, they included 56 studies. They found at least 1 study for 25 separate substances! The authors don't try to pool data and only qualititatively summarize the various treatments. Overall, the quality of studies for most substances is limited and there is substantial potential for publication bias. The authors report that the data on topical capsaicin and SAMe to be more robust. The authors identified 5 randomized controlled trials of capsaicin gel (with between 14 and 200 patients). In all the trials, capsaicin (range of concentration from 0.015% to 0.075%) was better than placebo in relieving pain. Six trials have evaluated SAMe (with between 36 and 493 patients), all using 1200 mg per day. Only one trial included placebo, the rest used traditional pharmaceuticals for comparison. SAMe was equally effective as active treatments and more effective than placebo for pain and function. SAMe was better tolerated than active treatment and than placebo. Although most compounds studied were free of major adverse effects, willow bark and du huo ji sheng wan were associated with increased blood pressure and dizziness.

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