Bee-venom therapy too risky for treating osteoarthritis, RA ...

The name alone is enough to make most of us shy away from this very unusual therapy. It seems counterintuitive to consider that something seen as poisonous could actually be curative. However, the sting of bees has been used for centuries to treat and cure a wide array of ailments. Just one member of the group of therapies known as apitherapy (the use of any product from or part of a bee), bee venom is actively researched for its treatment potential in conditions involving inflammation and autoimmune dysfunction.
Background
Bee-venom therapy (BVT) became popular in the United States as long as 100 years ago. Pioneered by Bodog F. Beck, MD, BVT began not in the frontiers but in a medical office in New York City.1 Bee venom is considered the oldest-known treatment for arthritis.1
This discussion will focus on the use of bee venom as a palliative or curative measure and not as a desensitization technique in bee-sting-allergy therapy.
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Composed of peptides, enzymes, and biologically active amines that include histamine, dopamine, and epinephrine,2 BVT can be administered by application of a topical bee-venom compound, use of acupuncture needles to inject minute amounts of bee venom, ingestion of a bee-venom compound, or iontophoresis after topical application of the extract. It can also involve allowing a live bee (or bees) ordered from a bee breeding center to sting the affected body area, after testing the patient for potential allergies.
Science
The most documented benefit of BVT is in the reduction of pain and inflammation in both osteoarthritis (OA) and rheumatoid arthritis (RA). Several randomized, placebo-controlled trials have considered the safety and efficacy of BVT for OA and RA by measuring levels of joint stiffness in the morning, pain and swelling in the joints, and laboratory values for erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP).
One trial involved 80 patients with RA who were assigned to either BVT or control therapy.3 In the treatment group, injections of bee venom were administered twice weekly for 2 months at the proximal and distal phalangeal joints. Baseline assessments of the pain parameters and laboratory data were then compared between the 2 groups. In all outcome measures, BVT showed statistical significance over control therapy.3 Another trial examined the effect of BVT in OA of the knee; 60 patients were randomized to either BVT or traditional acupuncture.4 Treatments were performed twice weekly for 4 weeks. More than 82% of the patients who had been treated with bee venom reported substantial pain relief, compared with 55% of the patients who had been treated with traditional acupuncture.
Bee venom is theorized to reduce musculoskeletal pain by acting on 2 specific pathways. Both in vitro and in vivo studies have found that bee venom blocks the production of pro-inflammatory substances, such as cytokines, tumor necrosis factor-2, and cyclooxygenase-2.5 Bee venom also acts to inhibit the formation of rheumatoid synovial cells, thereby reducing swelling, pain, and joint deformity.5
Research is also active on the use of bee venom for other conditions that have an inflammatory source, including atherosclerosis, diabetes-related endothelial damage, cancer, and autoimmune diseases such as multiple sclerosis.6-9
Safety, interactions, side effects
Bee venom and bee-venom products should be considered potentially dangerous. In the United States, an estimated 2 million people are allergic to bee stings, and an average of 100 Americans experience fatal reactions to bee stings every year.10 Patients should have an epinephrine injection pen with them if they plan to attempt the therapy at home, but this is not advised due to the potential risk for serious reaction.
Cost, how supplied, dose
The cost of BVT is difficult to ascertain and depends on the source of the therapy. Traditional health insurance does not cover BVT, since this treatment is still considered experimental in the United States.
For acupuncture-based BVT, purified bee venom is used. Many proponents of natural medicine recommend using a live bee to sting the site, but this can increase the risk of infection.
Some products are capsules of lyophilized bee venom, taken orally. This formulation is, however, not as well-studied as are techniques that deliver the venom via injection or acupuncture.
Summary
In spite of some impressive statistics, BVT is still very low on the list of safe and effective treatments. The risks and discomfort associated with these therapeutic methods greatly outweigh the potential benefits.
Clinicians should discourage patients from using BVT in general but they should especially discourage the use of BVT without professional medical oversight.
Sherril Sego, FNP-C, DNP, is a staff clinician at the VA Hospital in Kansas City, Mo., where she practices adult medicine and women’s health. She also teaches at the nursing schools of the University of Missouri and the University of Kansas.
References
Ali MA. Studies on bee venom and its medical uses. IJOART. 2012;1(2):69-83. Available at ijoart.org/docs/studies-on-bee-venom-and-its-medical-uses.pdf
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