Effect of Glucosamine on Pain-Related Disability in Patients With Chronic Low Back Pain and Degenerative Lumbar Osteoarthritis
Authors: Philip Wilkens, Inger B. Scheel, Oliver Grundnes, Christian Hellum, Kjersti Storheim
Journal: JAMA (2010)

STEOARTHRITIS (OA) IS A common condition that currently affects more than 20 million individuals in the United States, and this number is expected to increase. 1 Like the peripheral joints, the spine demonstrates osteoarthritic (facet joint changes) and degenerative alterations (disk area changes). 2These findings are often present independently of low back pain (LBP). 3Nevertheless, studies indicate that such findings may cause LBP. 2 Low back pain is widespread and is the second most common concern expressed by patients in primary care. 3It poses a diagnostic and therapeutic challenge to clinicians due to the unclear etiology and the range of interventions with limited effect. 3][6][7][8][9][10][11] Meta-analyses and systematic reviews have reported potential mild effect of glucosamine on knee and hip OA. [4][5][6][7][8]10,11 Glucosamine is also increasingly taken by LBP patients. 9 Gluosamine is hypothesized to restore cartilage and have anti-inflammatory properties.12 Degenerative lum-bar OA is associated with cartilage destruction and inflammatory processes, 13,14 and glucosamine could therefore provide benefit. Aew trials of the See also p 93 and Patient Page.Context Chronic low back pain (LBP) with degenerative lumbar osteoarthritis (OA) is widespread in the adult population.Although glucosamine is increasingly used by patients with chronic LBP, little is known about its effect in this setting.Objective To investigate the effect of glucosamine in patients with chronic LBP and degenerative lumbar OA.Design, Setting, and Participants A double-blind, randomized, placebocontrolled trial conducted at Oslo University Hospital Outpatient Clinic, Oslo, Norway, with 250 patients older than 25 years of age with chronic LBP (Ͼ6 months) and degenerative lumbar OA.Interventions Daily intake of 1500 mg of oral glucosamine (n = 125) or placebo (n=125) for 6 months, with assessment of effect after the 6-month intervention period and at 1 year (6 months postintervention). Main Outcome MeasuresThe primary outcome was pain-related disability measured with the Roland Morris Disability Questionnaire (RMDQ).Secondary outcomes were numerical scores from pain-rating scales of patients at rest and during activity, and the quality-of-life EuroQol-5 Dimensions (EQ-5D) instrument.Data collection occurred during the intervention period at baseline, 6 weeks, 3 and 6 months, and again 6 months following the intervention at 1 year.Group differences were analyzed using linear mixed models analysis. ResultsAt baseline, mean RMDQ scores were 9.2 (95% confidence interval [CI], 8.4-10.0)for glucosamine and 9.7 (95% CI, 8.9-10.5)for the placebo group (P=.37).At 6 months, the mean RMDQ score was the same for the glucosamine and placebo groups (5.0; 95% CI, 4.2-5.8).At 1 year, the mean RMDQ scores were 4.8 (95% CI, 3.9-5.6)for glucosamine and 5.5 (95% CI, 4.7-6.4)for the placebo group.No statistically significant difference in change between groups was found when assessed after the 6-month intervention period and at 1 year: RMDQ (P=.72),LBP at rest (P=.91),LBP during activity (P=.97), and quality-of-life EQ-5D (P=.20).Mild adverse events were reported in 40 patients in the glucosamine group and 46 in the placebo group (P=.48).Conclusions Among patients with chronic LBP and degenerative lumbar OA, 6-month treatment with oral glucosamine compared with placebo did not result in reduced painrelated disability after the 6-month intervention and after 1-year follow-up.