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Background |
Types of musculoskeletal problems |
Causes and risk factors |
Signs and symptoms |
Complications |
Diagnosis |
Treatment |
Integrative therapies |
Prevention |
Author information |
Bibliography
Musculoskeletal Problems
The musculoskeletal system is a type of organ system that allows for movement and stability of the body and consists of bones, muscles, joints, tendons, cartilage, ligaments, bursae (fluid-filled sacs), and other connective tissue. Complications arising when individual parts of this bodily system are injured can range from minor discomfort to serious medical conditions. Symptoms of musculoskeletal disorders (MSDs) can be acute or chronic and may include inflammation, swelling, pain, fatigue, weakness, joint noises and stiffness, limited range of motion, and lack of coordination.The skeletal system serves many important functions, including providing structure, shape, form, support, and protection for the body. The skeletal system also allows for bodily movement, produces blood for the body, and stores minerals. The skeletal system consists of 206 bones that form a rigid framework as well as protect soft tissues and vital organs of the body. For example, the brain is protected by the skull which surrounds it and the heart and lungs are enclosed in the sternum and rib cage.
Bodily movement is made possible by the interaction of the muscular and skeletal systems. For this reason, they are often grouped together as the musculoskeletal system. Muscles are connected to bones by tendons. Bones are connected to each other by ligaments. Where bones meet one another is called a joint. Muscles that cause movement of a joint are connected to two different bones. The muscles contract and relax to cause movement. An example would be the contraction of the biceps and a relaxation of the triceps. This produces a bend at the elbow. The contraction of the triceps and relaxation of the biceps produces the effect of straightening the arm.
Muscles are very specialized tissues that have the ability to contract and to conduct electrical impulses. Muscles are classified functionally as either voluntary or involuntary and structurally as either striated or smooth. From this organization, there are three types of muscles: smooth (involuntary) muscles, striated voluntary (skeletal) muscles, and striated involuntary (cardiac) muscles.
Red blood cells are produced by the red marrow located in certain bones, including flat bones such as the hip bone, skull, and breastbone. An average of 2.6 million red blood cells is produced each second by the bone marrow to replace those damaged and destroyed by the liver.
Bones also serve as a storage area for minerals such as calcium and phosphorus. When an excess of these minerals is present in the blood, a buildup of the mineral will occur within the bones. When the supply of these minerals within the blood is low, it will be withdrawn from the bones to replenish the supply.
Background
The musculoskeletal system is a type of organ system that allows for movement and stability of the body and consists of bones, muscles, joints, tendons, cartilage, ligaments, bursae (fluid-filled sacs), and other connective tissue. Complications arising when individual parts of this bodily system are injured can range from minor discomfort to serious medical conditions. Symptoms of musculoskeletal disorders (MSDs) can be acute or chronic and may include inflammation, swelling, pain, fatigue, weakness, joint noises and stiffness, limited range of motion, and lack of coordination.The skeletal system serves many important functions, including providing structure, shape, form, support, and protection for the body. The skeletal system also allows for bodily movement, produces blood for the body, and stores minerals. The skeletal system consists of 206 bones that form a rigid framework as well as protect soft tissues and vital organs of the body. For example, the brain is protected by the skull which surrounds it and the heart and lungs are enclosed in the sternum and rib cage.
Bodily movement is made possible by the interaction of the muscular and skeletal systems. For this reason, they are often grouped together as the musculoskeletal system. Muscles are connected to bones by tendons. Bones are connected to each other by ligaments. Where bones meet one another is called a joint. Muscles that cause movement of a joint are connected to two different bones. The muscles contract and relax to cause movement. An example would be the contraction of the biceps and a relaxation of the triceps. This produces a bend at the elbow. The contraction of the triceps and relaxation of the biceps produces the effect of straightening the arm.
Muscles are very specialized tissues that have the ability to contract and to conduct electrical impulses. Muscles are classified functionally as either voluntary or involuntary and structurally as either striated or smooth. From this organization, there are three types of muscles: smooth (involuntary) muscles, striated voluntary (skeletal) muscles, and striated involuntary (cardiac) muscles.
Red blood cells are produced by the red marrow located in certain bones, including flat bones such as the hip bone, skull, and breastbone. An average of 2.6 million red blood cells is produced each second by the bone marrow to replace those damaged and destroyed by the liver.
Bones also serve as a storage area for minerals such as calcium and phosphorus. When an excess of these minerals is present in the blood, a buildup of the mineral will occur within the bones. When the supply of these minerals within the blood is low, it will be withdrawn from the bones to replenish the supply.
Types of musculoskeletal problems
Arthritis: Arthritis is a disorder that involves joint inflammation or swelling. More than 100 different diseases fall under the general category of arthritis. Arthritis conditions affect the joints, the tissues surrounding the affected joints, and other connective tissues. Common forms of arthritis include rheumatoid arthritis, osteoarthritis, and periarthritis.Muscular dystrophy: Muscular dystrophy (MD) is a group of rare inherited autoimmune muscle diseases in which muscle fibers are unusually susceptible to damage. Muscles, including primarily voluntary muscles, become progressively weaker due to muscle damage. In some types of muscular dystrophy, heart muscles, other involuntary muscles, and other organs are affected.
The most common types of muscular dystrophy have been found to be due to a genetic deficiency of the muscle protein dystrophin. A cure for muscular dystrophy has not been found, but medications and therapy can slow the course of the disease.
Fibromyalgia: Fibromyalgia, also known as fibromyositis or fibrositis, is a chronic (long-term) condition characterized by widespread, long-term pain in the muscles, ligaments, and tendons, as well as fatigue and multiple tender points (places on the body where slight pressure causes pain). In addition to muscular pain and fatigue, fibromyalgia can also cause sleep problems, depression, and an inability to think clearly.
Although fibromyalgia affects about four million Americans, the vast majority of them are women in their mid-30s to late-50s. An estimate of the prevalence of fibromyalgia is as high as 3-5% of the population in the United States, or approximately six million people. Fibromyalgia symptoms may never completely resolve, and their intensity can vary. Although the symptoms of fibromyalgia may be hard to live with, the condition is not considered progressive or life-threatening.
Joint stiffness: Joint stiffness is the feeling that motion of a joint is limited or difficult. Some people with joint stiffness are capable of moving the joint through its full range of motion, but some individuals cannot move the joint due to the pain they are experiencing. Joint stiffness is common with arthritis and usually occurs immediately when rising after lying or sitting still.
Joint noises: Joint noises, such as creaks and clicks, are common and harmless in many individuals, but they can also occur with specific problems of the joints. For example, the base of the knee cap may creak when it is damaged by osteoarthritis.
Temporomandibular joint disorder: Temporomandibular joint disorder (TMJD, TMJ, or TMD), or TMJ syndrome, is an umbrella term covering acute or chronic inflammation of the temporomandibular joint, which connects the lower jaw to the skull. TMJ can result in significant pain and impairment. TMJ may require surgical repair.
Causes and risk factors
General:Individuals who are more susceptible to musculoskeletal problems tend to maintain fixed positions (such as sitting in a chair or standing), perform repetitive movements of the limbs (such as athletes or factory workers), overload particular muscle groups, apply pressure on body parts, and use forceful movements (such as in sports).
Musculoskeletal problems and pain can be caused by damage or injury to bones, joints, muscles, tendons, ligaments, bursae, or nerves. If no injury has occurred or if pain persists for more than a few days, then another cause is often responsible.
Bone pain is usually deep, penetrating, dull, or sharp. It commonly results from injury. Other less common causes of bone pain include bone infection (osteomyelitis), vitamin A toxicity, and tumors.
Muscle pain is often less intense than that of bone pain but can be very unpleasant. For example, a muscle spasm or cramp (a sustained painful muscle contraction) in the calf is an intense pain that is commonly called a charley horse. Pain can occur when a muscle is affected by an injury, an autoimmune reaction (for example, polymyositis or dermatomyositis), loss of blood flow to the muscle, dehydration and resulting electrolyte imbalances, infection, or invasion by a tumor.
Tendon and ligament pain is also often less intense than bone pain. This type of pain is often worse when the affected tendon or ligament is stretched or moved. Common causes of tendon pain include tendonitis, tenosynovitis, lateral and medial epicondylitis, and tendon injuries. Common causes of ligament pain include injuries (sprains).
Arthritis:
The exact causes of osteoarthritis and rheumatoid arthritis remain unknown. Most researchers believe that several factors, including obesity, age, joint injury or stress, genetics, and muscle weakness, may contribute to the development of osteoarthritis. Some researchers believe that cartilage damage may occur when too many enzymes that allow for the natural breakdown and regeneration of cartilage are released.
Rheumatoid arthritis is considered an autoimmune disorder because the immune system does not function properly and attacks the body's own cells. Some researchers believe that this autoimmune process is triggered by an infection with a virus or bacterium. Heredity may also play a role in the development of rheumatoid arthritis.
Periarthritis typically occurs after a joint becomes injured, which causes scarring, thickening, and shrinkage of the joint. It may also occur after exposure to cold temperatures. Periarthritis typically affects the shoulder. Individuals who have other types of long-term arthritis that affect the shoulders have an increased risk of developing periarthritis of the shoulder.
Fibromyalgia:
Gender: Although fibromyalgia may develop in men or women, statistics indicate that women are seven times more likely to develop the condition than men. Nine out of 10 fibromyalgia patients are women, and an estimated 3.4% of American women have the condition. Women's symptoms also tend to be more severe than men's. Women may be more prone to develop fibromyalgia during menopause.
Age: Individuals between the ages of 20 and 60 are at the highest risk of developing fibromyalgia, although it may occur at any age.
Genetic factors: There is some indication that genetic factors may be involved in the development of fibromyalgia. Studies have shown that individuals with family members who have fibromyalgia are at a higher risk of developing it themselves.
Specific lifestyle factors: People who have recently experienced a traumatic physical or emotional event (such as a divorce, car accident, or death of a family member) may be at a higher risk of developing fibromyalgia.
Psychiatric illness: While the majority of individuals with fibromyalgia report a history of psychiatric symptoms, such as depression or anxiety, many patients do not. There is no clear evidence that psychiatric illness causes fibromyalgia.
Aggravating factors: Changes in weather, cold or drafty environments, infections, allergies, hormonal fluctuations (premenstrual and menopausal states), stress, depression, and anxiety may all contribute to fibromyalgia.
Muscular dystrophy:
Muscular dystrophy refers to a number of diseases that are caused by genetic mutations that involve progressive weakness, degeneration, and wasting of muscles. The Duchenne and Becker types of muscular dystrophy (DBMD) have similar signs and symptoms, are caused by the same genetic mutation (dystrophin mutation), and occur more frequently in males than in females.
The particular gene that causes DBMD is found on the X chromosome, and so it is called "X-linked." Females carry two X chromosomes. Males carry one X chromosome and one Y chromosome. Because males have only one X chromosome, a male carrying a copy with a DBMD mutation will have the condition. However, because females have two copies of the X chromosome, a female can have one copy with a DBMD mutation and one functional copy. Because the functional copy is usually enough to compensate, a female with a DBMD mutation usually has few or no symptoms. However, because she can pass the mutation on to her children, she is called a "carrier."
Each son born to a woman with the dystrophin mutation on one of her two X chromosomes has a 50% chance of inheriting the mutated gene and having DBMD. Each of her daughters has a 50% chance of inheriting the mutation and being a carrier. While most cases of DBMD occur by inheritance from the mother, in approximately one-third of boys with DBMD, there is a new mutation that forms in the egg, and so the mother is actually not the carrier of the mutation.
Temporomandibular joint disorder:
The cause of most TMJ disorders remains unknown. Some types of temporomandibular joint (TMJ) disorders appear to be caused by injury to the joint from a severe blow to the jaw or arthritis. Many behaviors, including frequently clenching the jaw or grinding the teeth (which may occur during sleep), poor posture that puts strain on the muscles and bones near the jaw, or other habits that overwork the jaw muscles (e.g. constantly chewing gum), may contribute to the development of TMJ disorders. However, further research is needed to definitively determine if these behaviors cause TMJ disorders.
Signs and symptoms
General:Pain is the chief symptom of most musculoskeletal disorders. The pain may be dull, sharp, radiating, or local and may be mild or severe. Although pain may be acute (short-lived), as is the case with most injuries, it may become chronic (ongoing) with illnesses such as rheumatoid arthritis. Muscle pain is known as myalgia.
Arthritis:
Common symptoms of osteoarthritis include joint pain, swelling and/or stiffness in a joint (especially after use), joint discomfort before or during a change in the weather, bony lumps on the fingers, and loss of joint flexibility. The joints that are most often affected by osteoarthritis include the fingers, spine, and weight-bearing joints, such as the hips, ankles, feet, and knees.
Rheumatoid arthritis often affects many joints at the same time, and the severity of symptoms varies among patients. Symptoms, which may come and go, typically include pain and swelling in the joints (especially in the hands and feet), generalized aching or stiffness of the joints and muscles (especially after periods of rest), loss of motion of the affected joints, weakness in the muscles near the affected joints, low-grade fever, and general feeling of discomfort. Early in the disease, the joints in the hands, wrists, feet, and knees are most frequently affected. Over time, arthritis may develop in the shoulders, elbows, jaw, hips, and neck. In addition to the joints, rheumatoid arthritis may cause swelling in the tear ducts, salivary glands, the lining of the heart, the lungs, and occasionally, blood vessels.
Periarthritis causes swelling and pain in the joints. Most patients develop periarthritis of the shoulder. When the shoulder is affected, the joint's mobility is significantly or completely reduced and aggressive treatment is started.
Muscular dystrophy:
Signs and symptoms of muscular dystrophy vary according to the type of muscular dystrophy. In general, they may include muscle weakness, apparent lack of coordination, and progressive crippling, resulting in contractures of the muscles around the joints and loss of mobility.
Fibromyalgia:
The primary symptoms of fibromyalgia include widespread musculoskeletal pain, severe fatigue (tiredness), and sleep disturbances. Fibromyalgia may cause pain in the muscles, tendons, or ligaments. The pain is usually in multiple locations and may be difficult to describe precisely.
Most individuals with fibromyalgia complain of a total body "ache." Their muscles may feel like they were pulled or overworked or feel as if they are burning. Other symptoms associated with fibromyalgia include irritable bowel syndrome (IBS). Symptoms of IBS include fluctuations between constipation and diarrhea, frequent abdominal pain, abdominal gas, and nausea. Symptoms of IBS are frequently found in roughly 40 to 70% of fibromyalgia patients.
Acid reflux, or gastroesophageal reflux disease (GERD), also occurs with the same high frequency. Recurrent migraine or tension-type headaches are seen in about 70% of fibromyalgia patients and can pose a major problem in coping for this patient group.
Temporomandibular joint disorder (TMJ) causes tremendous jaw-related face and head pain in one-quarter of fibromyalgia patients.
Other common symptoms of fibromyalgia include premenstrual syndrome (PMS) and painful periods, chest pain, morning stiffness, cognitive or memory impairment, numbness and tingling sensations, muscle twitching, irritable bladder, the feeling of swollen extremities (hands and feet), skin sensitivities, dry eyes and mouth, dizziness, and impaired coordination. Fibromyalgia patients are often sensitive to odors, loud noises, bright lights, and sometimes even the medications they are prescribed.
Temporomandibular joint (TMJ) disorder:
Common symptoms of TMJ disorders include pain and soreness of the jaw (which may worsen when the individual chews food, talks, or yawns), pain in and around the ear, facial pain, an uneven bite or change in the way the lower and upper teeth fit together, jaw muscle stiffness, a clicking sound or grating sensation when the mouth is opened and closed (sometimes called jaw clicking), headache, tired facial muscles, and locking of the joint, which may temporarily limit the movement of the jaw.
It is important to note that jaw clicking affects many individuals who do not have TMJ disorders. Individuals who do not experience pain or limited movement of the jaw when the jaw clicks most likely do not have TMJ disorders.
Complications
Depression: Some individuals with musculoskeletal problems may suffer from depression. This may happen if the musculoskeletal disorder interferes significantly with the patient's lifestyle, including causing pain. Individuals should consult their healthcare providers if they experience feelings of sadness, low self-esteem, loss of pleasure, apathy, and difficulty functioning for two weeks or longer with no known underlying cause. These may be signs of depression and suicidal thoughts.Joint damage: In some cases, musculoskeletal disorders can lead to severe joint damage. In such cases, surgery, such as a joint replacement, may be necessary. Individuals should regularly visit their healthcare providers to monitor their conditions.
Limited mobility: Patients with musculoskeletal disorders may have limited mobility in their joints. Joint mobility decreases as the joint becomes more damaged.
Diagnosis
A clinician can often diagnose a musculoskeletal disorder based on symptoms and the results of a physical examination. Laboratory tests, imaging tests, and other diagnostic procedures are sometimes necessary to help the clinician make or confirm a diagnosis.Physical examination: When a person complains of muscle weakness, the clinician checks muscles for bulk, texture, and tenderness. Muscles are also checked for twitches and involuntary movements, which may indicate a nerve disease rather than a muscle disease. Clinicians look for wasting away of muscle (atrophy), which can result from damage to the muscle or its nerves or from lack of use, as sometimes occurs with prolonged bed rest. Clinicians look for muscle enlargement (hypertrophy), which normally occurs with exercise such as weight lifting. However, when a person is ill, hypertrophy may result from one muscle working harder to compensate for the weakness of another. Muscles can also become enlarged when normal muscle tissue is replaced by abnormal tissue (increasing the size but not the strength of the muscle), which occurs in certain inherited muscle disorders, such as Duchenne's muscular dystrophy.
Clinicians try to establish which (if any) muscles are weak as well as the degree of weakness involved. The muscles can be tested systematically, usually beginning with the face and neck, then the arms, and finally the legs. Normally, a person should be able to hold the arms extended, palms up, for one minute without them sagging, turning, or shaking. Downward drift of the arm with palms turning inward is one sign of weakness. Strength is tested by pushing or pulling while the clinician pushes and pulls in the opposite direction. Strength is also tested by having the person perform certain maneuvers, such as walking on the heels and tiptoes, rising from a squatting position, or getting up and down from a chair rapidly 10 times. To assess eye muscle strength, the person is asked to look in all directions; if double vision develops, one or more eye muscles may be weak.
The clinician tests a joint's range of motion by moving the limb around a joint while the person is completely relaxed (passive movement). The clinician will check muscle tone by testing passive movement. Resistance to such movement (passive resistance) may be decreased when the nerve leading to the muscle is damaged. Resistance to such movement may be increased when the spinal cord or brain is damaged. If a person is weak, clinicians also tap the person's muscle tendon with a rubber hammer to assess reflexes. Reflexes may be slower than expected when the nerve leading to the muscle is damaged. Reflexes may be more rapid than expected when the spinal cord or brain is damaged.
Laboratory tests: Laboratory tests are often helpful in making the diagnosis of a musculoskeletal disorder. A test called an erythrocyte sedimentation rate (ESR) test measures the rate at which red blood cells settle to the bottom of a test tube containing blood. The ESR is increased when inflammation is present. However, because inflammation occurs in so many conditions, the ESR alone does not establish a diagnosis. The level of creatine kinase (a normal muscle enzyme that leaks out and is released into the bloodstream when muscle is damaged) may also be tested. Levels of creatine kinase are increased when there is widespread and ongoing destruction of muscle. In rheumatoid arthritis, a blood test to identify rheumatoid factor or anti-cyclic citrullinated peptide (anti-CCP) antibody is helpful in making the diagnosis. In systemic lupus erythematosus (lupus), a blood test to identify autoimmune antibodies (antinuclear antibodies) is helpful in making the diagnosis.
Nerve tests: Nerve conduction studies help determine whether the nerves supplying the muscles are functioning normally. Nerve conduction studies, together with electromyography, help indicate whether there is a problem primarily in the muscles (such as myositis or muscular dystrophy); in the nervous system, which supplies the muscles (such as a stroke, spinal cord problem, or polyneuropathy); or with the neuromuscular junction (such as myasthenia gravis). Electromyography, often performed at the same time as nerve conduction studies, is a test in which electrical impulses in the muscles are recorded to help determine how well the impulses from the nerves are reaching the connection between nerves and muscles (neuromuscular junction).
X-rays: X-rays are most valuable for detecting abnormalities in bone and are taken to evaluate painful, deformed, or suspected abnormal areas of bone. Often, X-rays can help to diagnose fractures, tumors, injuries, infections, and deformities (such as congenital hip dysplasia). Also, X-rays may be helpful in showing changes that confirm a person has a certain kind of arthritis (for example, rheumatoid arthritis or osteoarthritis). X-rays do not show soft tissues such as muscles, bursae, ligaments, tendons, or nerves. To help determine whether the joint has been damaged by injury, a clinician may use an ordinary (non-stress) X-ray or one taken with the joint under stress (stress X-ray).
Arthrography is an X-ray procedure in which a dye is injected into a joint space to outline the structures, such as ligaments inside a joint. Arthrography can be used to view torn ligaments and fragmented cartilage in the joint.
Dual-energy X-ray absorptiometry (DEXA): The most accurate way to evaluate bone density, which is necessary when screening for or diagnosing osteoporosis, is with dual-energy X-ray absorptiometry (DEXA). In this test, low-dose X-rays are used to examine bone density at the lower spine, hip, wrist, or entire body. Measurements of bone density are very accurate at these sites. To help differentiate osteoporosis (the most common cause of an abnormal DEXA scan) from other bone disorders, doctors may need to consider the person's symptoms, medical conditions, medication use, and certain blood or urine test results as well as the DEXA results.
Computed tomography (CT) and magnetic resonance imaging (MRI): Computed tomography (CT) and magnetic resonance imaging (MRI) give much more detail than conventional X-rays. CT and MRI may be performed to determine the extent and exact location of musculoskeletal damage. These tests can also be used to detect fractures that are not visible on X-rays. MRI is especially valuable for imaging muscles, ligaments, and tendons. MRI can be used if the cause of pain is thought to be a severe soft-tissue problem (for example, rupture of a major ligament or tendon or damage to important structures inside the knee joint). The amount of time a person spends undergoing CT is much less than for MRI.
Bone scanning: Bone scanning is an imaging procedure that is occasionally used to diagnose a fracture, particularly if other tests, such as plain X-rays and CT or MRI, do not reveal the fracture. Bone scanning involves the use of a radioactive substance (technetium-99m-labeled pyrophosphate) that is absorbed by any healing bone. The technique can also be used when a bone infection or a metastasis (from a cancer elsewhere in the body) is suspected. The radioactive substance is given intravenously and is detected by a bone-scanning device, creating an image of the bone that can be viewed on a computer screen.
Joint aspiration: Joint aspiration is used to diagnose certain joint problems. A needle is inserted into a joint space and fluid (synovial fluid) is drawn out (aspirated) and examined under a microscope. A doctor can often make a diagnosis after analyzing the fluid. For example, a sample of synovial fluid may contain bacteria, which confirms a diagnosis of infection. Joint aspiration is usually performed in a doctor's office and is generally quick, easy, and relatively painless. The risk of joint infection is minimal.
Arthroscopy: Arthroscopy is a procedure in which a small (diameter of a pencil) fiber optic scope is inserted into a joint space, allowing the doctor to look inside the joint and to project the image onto a television screen. The skin incision is very small. A person receives local, spinal, or general anesthesia. During arthroscopy, doctors can take a piece of tissue for analysis (biopsy) and, if necessary, perform surgery to correct the condition. Disorders commonly found during arthroscopy include inflammation of the synovium lining a joint (synovitis); ligament, tendon, or cartilage tears; and loose pieces of bone or cartilage. Such conditions affect people with arthritis or previous joint injuries, as well as athletes. All of these conditions can be repaired or removed during arthroscopy. There is a very small risk of joint infection with this procedure.
Treatment
General: Musculoskeletal problems are generally managed with medications that reduce pain and inflammation. In severe cases, surgery may be necessary to repair damage.In order to properly manage pain and prevent joint damage, individuals should take their medications as prescribed by their healthcare providers. Individuals with musculoskeletal problems should also tell their healthcare providers if they are taking any other drugs (prescription, over-the-counter, or dietary supplements) because they may interfere with treatment.
Corticosteroids: Corticosteroids, such as prednisone (Deltasone®) and methylprednisolone (Medrol®), are occasionally used to reduce inflammation and pain and slow joint damage caused by musculoskeletal problems. These drugs are generally very effective when used short-term. However, if used for many months to years, these drugs may become less effective and serious side effects may develop. Side effects may include easy bruising, thinning of bones, cataracts, weight gain, a "moon" face, and diabetes.
Corticosteroids are usually prescribed for a certain amount of time, and then the individual is gradually tapered off the medication. Individuals should not stop taking corticosteroids suddenly or change their dosages without first consulting their healthcare providers.
Nonsteroidal anti-inflammatory drugs (NSAIDs): Nonsteroidal anti-inflammatory drugs (NSAIDs) have been used to relieve pain and inflammation caused by musculoskeletal problems. Commonly used over-the-counter NSAIDs include ibuprofen (Advil® or Motrin®) and naproxen sodium (Aleve®). Higher doses of these drugs are also available by prescription. Commonly prescribed NSAIDs include diclofenac (Cataflam® or Voltaren®), nabumetone (Relafen®), and ketoprofen (Orudis®). NSAIDs may be taken by mouth, injected into a vein, or applied to the skin. These medications are generally taken long term to manage symptoms.
The frequency and severity of side effects vary among NSAIDs. The most common side effects include nausea, vomiting, diarrhea, constipation, decreased appetite, rash, dizziness, headache, and drowsiness. The most serious side effects include kidney failure, liver failure, ulcers, heart-related problems, and prolonged bleeding after an injury or surgery. About 15% of patients who receive long-term NSAID treatment develop ulcers in the stomach or duodenum.
Pain relievers: Over-the-counter (OTC) pain relievers used in the treatment of musculoskeletal disorders include acetaminophen (Tylenol®). Prescription pain relievers, including tramadol (Ultram®), have been used to reduce pain caused by musculoskeletal problems. Although this drug, which is available by prescription, does not reduce swelling, it has fewer side effects than NSAIDs. Tramadol is generally taken as a short-term treatment to reduce symptoms of flare-ups.
Narcotic pain relievers, such as acetaminophen/codeine (Tylenol with Codeine®), hydrocodone/acetaminophen (Lorcet®, Lortab®, or Vicodin®), or oxycodone (OxyContin® or Roxicodone®), may be prescribed to treat severe musculoskeletal pain. However, they do not reduce swelling. These medications are only used short-term to treat flare-ups. Common side effects include constipation, drowsiness, dry mouth, and difficulty urinating. Narcotic pain relievers should be used cautiously because individuals may become dependent upon them.
Selective COX-2 inhibitors: Celecoxib (Celebrex®) has been taken by mouth to reduce pain and inflammation caused by musculoskeletal problems such as osteoarthritis. Celecoxib is currently the only COX-2 inhibitor that is approved by the U.S. Food and Drug Administration (FDA). Celecoxib is generally taken long-term to manage symptoms.
COX-2 inhibitors have been linked to an increased risk of serious heart-related side effects, including heart attack and stroke. Selective COX-2 inhibitors have also been shown to increase the risk of stomach bleeding, fluid retention, kidney problems, and liver damage. Less serious side effects may include headache, indigestion, upper respiratory tract infection, diarrhea, sinus inflammation, stomach pain, and nausea.
Topical pain relievers: Topical pain relievers are creams, ointments, gels, and sprays that are applied to the skin. Many over-the-counter (OTC) pain relievers may temporarily help reduce pain caused by osteoarthritis. Products such as Aspercreme®, Sportscreme®, Icy Hot®, and Ben-Gay® may help reduce arthritis pain. Capsaicin cream, which is made from the seeds of hot peppers, may reduce pain in joints that are close to the skin surface, such as the fingers, knees, and elbows. Lidocaine patches (Lidoderm®) may also be used. Lidocaine is an anesthetic when applied topically and may decrease pain associated with musculoskeletal problems.
Antidepressants: Some individuals with musculoskeletal problems may also suffer from depression. Commonly prescribed anti-depressants for arthritis patients include amitriptyline, nortriptyline (Aventyl®, Pamelor®), and trazodone (Desyrel®). These drugs may also help with nerve pain associated with musculoskeletal disorders. Side effects of antidepressant medications include drowsiness, fatigue (excessive tiredness), constipation, dry mouth, and blurred vision.
Lifestyle changes: Many lifestyle changes, including regular exercise, weight management, and consumption of a healthy diet may help reduce symptoms of musculoskeletal problems. A healthcare provider may recommend a physical therapist, nutritionist, or registered dietician to help determine the best treatment plan for the individual.
Individuals with musculoskeletal problems such as osteoarthritis or rheumatoid arthritis should wear comfortable footwear that properly supports their weight. This may reduce the amount of strain put on the joints during walking.
Individuals with musculoskeletal problems may require canes, walkers, or other devices to help them get around. If the hands are severely affected, braces may be beneficial. Individuals should talk to their healthcare providers about assistive devices that are available.
Individuals with musculoskeletal problems should maintain good posture. This allows the body's weight to be evenly distributed among joints.
Cool compress or ice pack: Applying a cool compress or ice pack to the affected joint during a flare-up may help reduce swelling and pain.
Heat: Applying a hot pack to affected joints may help reduce pain, relax muscles, and increase blood flow to the joint. It may also be an effective treatment before exercise. Alternatively, individuals may take a hot shower or bath before or after exercise to help reduce pain.
Fusing bones: If there is serious joint damage, the bones of a joint, such as the ankle, may be surgically fused together in a procedure called arthrodesis. This surgery helps increase stability and reduces pain. However, the joint no longer has any flexibility and cannot bend or move.
Joint replacement surgery: In some cases, individuals with osteoarthritis suffer from permanent joint damage. In such instances, joint replacement surgery may be necessary. During the procedure, the damaged joint is surgically removed, and it is replaced with a plastic or metal device called a prosthesis. The most commonly replaced joints are the hip and knee, but other joints, including the elbow, shoulder, finger, or ankle joints can be replaced as well.
Joint replacement surgeries are generally most successful for large joints, such as the hip or knee. Researchers estimate that hip or knee replacements last at least 20 years in 80% of patients. After a successful surgery and several months of rehabilitation, individuals are able to use their new joints without pain.
As with any major surgery, there are risks associated with joint replacements. Patients should discuss the potential health risks and benefits of surgery with their healthcare providers.
Integrative therapies
Strong scientific evidence:Chondroitin: Multiple clinical trials have examined the use of oral chondroitin in patients with osteoarthritis of the knee and other locations (spine, hips, and finger joints). Most of these studies have reported significant benefits in terms of symptoms (such as pain), function (such as mobility), and reduced medication requirements (such as anti-inflammatories). The weight of scientific evidence points to a beneficial effect when chondroitin is used for six to 24 months. Longer-term effects are not clear. Preliminary studies of topical chondroitin have also been conducted.
Chondroitin is frequently used with glucosamine. Glucosamine has independently been demonstrated to benefit patients with osteoarthritis (particularly of the knee). It remains unclear if there is added benefit of using these two agents together compared to using either alone. Chondroitin is currently manufactured from natural sources (shark/beef cartilage or bovine trachea) or by synthetic means.
Glucosamine: Glucosamine is a natural compound that is found in healthy cartilage. Based on human research, there is good evidence to support the use of glucosamine sulfate in the treatment of mild-to-moderate knee osteoarthritis. Most studies have used glucosamine sulfate supplied by one European manufacturer (Rotta Research Laboratorium), and it is not known if glucosamine preparations made by other manufacturers are equally effective. Although some studies of glucosamine have not found benefits, these have either included patients with severe osteoarthritis or have used products other than glucosamine sulfate. More well-designed clinical trials are needed to confirm safety and effectiveness and to test different formulations of glucosamine.
Avoid if allergic or hypersensitive to shellfish or iodine. Some reports suggest a link between glucosamine/chondroitin products and asthma. Use cautiously with diabetes or with a history of bleeding disorders. Avoid if pregnant or breastfeeding.
Willowbark: Willowbark (Salix alba) contains salicin and has been used to treat many different kinds of pain. Willow bark is a traditional analgesic (pain relieving) therapy for osteoarthritis and musculoskeletal disorders. Several studies have confirmed this finding. Additional study comparing willow bark to conventional medicinal agents for safety and effectiveness is warranted.
Avoid if allergic/hypersensitive to aspirin, willow bark (Salix spp.), or any of its constituents, including salicylates. Use cautiously with gastrointestinal problems (e.g. ulcers), hepatic disorders, diabetes, gout, hypertension, or hyperlipidemia. Use cautiously with a history of allergy, asthma, or leukemia. Use cautiously if taking antihyperlipidemia agents, alcohol, leukemia medications, beta-blockers, diuretics, phenytoin (Dilantin®), probenecid, spironolactone, sulfonylureas, valproic acid, or methotrexate. Use cautiously if taking tannin-containing herbs or supplements. Avoid use when operating heavy machinery. Avoid in children with chickenpox and any other viral infections. Avoid with blood disorders and renal disorders. Avoid if taking other NSAIDs, acetazolamide, or other carbonic anhydrase inhibitors. Avoid with elevated serum cadmium levels. Avoid if pregnant or breastfeeding.
Good scientific evidence:
5-HTP: There is a small amount of research evaluating the use of 5-HTP for fibromyalgia and early evidence suggests that 5-HTP may reduce the number of tender points, anxiety, and intensity of pain and may improve sleep, fatigue, and morning stiffness. Additional studies with larger numbers of people are needed to determine what dose may be safe and effective.
Acupuncture: Acupuncture is commonly used throughout the world. According to Chinese medicine theory, the human body contains a network of energy pathways through which vital energy, called chi, circulates. These pathways contain specific "points" that function like gates, allowing chi to flow through the body. Needles are inserted into these points to regulate the flow of chi. There has been substantial research into the efficacy of acupuncture in the treatment of osteoarthritis (OA). Most studies focus on knee, cervical, and hip OA symptoms. In recent years, the evidence has improved and is now considered strong enough to recommend trying acupuncture in OA of the knee, which is one of the most common forms of this condition. There is also evidence from several studies suggesting that acupuncture may help with pain relief in fibromyalgia.
Avocado: A combination of avocado/soybean unsaponifiables (ASU) has been found beneficial in osteoarthritis of the knee and hip. Additional study using avocado (Persea Americana) alone in OA is needed.
Borage seed oil: Borage (Borago officinalis) is an herb native to Syria that has spread throughout the Middle East and Mediterranean. Borage flowers and leaves may be eaten and borage seeds are often pressed to produce oil that is very high in gamma-linolenic acid (GLA). GLA has known anti-inflammatory effects that may make it beneficial in treating rheumatoid arthritis. A few human studies have generally found positive results, and side effects were not reported. However, more research is needed to determine the optimal dose and administration.
Avoid if allergic or hypersensitive to borage, its constituents, or members of the Boraginaceae family. Avoid with a weakened immune system. Use cautiously with bleeding disorders, epilepsy, or if taking drugs used to treat these disorders. Avoid if pregnant or breastfeeding.
Chlorella: Clinical evidence indicates that chlorella may reduce the tenderness associated with fibromyalgia. Although the results are promising, more high quality studies are needed to confirm these findings.
Devil's claw: Devil's claw (Harpagophytum procumbens) originates from the Kalahari and Savannah desert regions of South and Southeast Africa. There is increasing scientific evidence suggesting that devil's claw is safe and beneficial for the short-term treatment of pain related to degenerative joint disease or osteoarthritis (taken for 8-12 weeks) and may be equally effective as drug therapies such as non-steroidal anti-inflammatory drugs like ibuprofen (Advil®, Motrin®) or may allow for dose reductions or discontinuation of these drugs in some patients. However, most studies have been small with flaws in their designs. Additional well-designed trials are necessary.
Glucosamine: Several human studies and animal experiments report benefits of glucosamine in treating osteoarthritis of various joints of the body, although the evidence is less plentiful than that for knee osteoarthritis. Some of these benefits include pain relief, possibly due to an anti-inflammatory effect of glucosamine and improved joint function. Overall, these studies have not been well-designed. Although there is some promising research, more study is needed in this area before a firm conclusion can be made.
Omega-3 fatty acids (fish oils): Multiple studies report improvements in morning stiffness and joint tenderness in patients with rheumatoid arthritis with the regular intake of fish oil supplements for up to three months. Benefits have been reported as additive with anti-inflammatory medications, such as nonsteroidal anti-inflammatory drugs (such as ibuprofen). However, because of weaknesses in study designs and reporting, better research is necessary before a strong, favorable recommendation can be made. Effects beyond three months of treatment have not been well evaluated.
Avoid if allergic or hypersensitive to fish, omega-3 fatty acid products that come from fish, nuts, linolenic acid, or omega-3 fatty acid products that come from nuts. Avoid during active bleeding. Use cautiously with bleeding disorders, diabetes, low blood pressure, or if taking drugs, herbs, or supplements that treat any such conditions. Use cautiously before surgery. Pregnant and breastfeeding women should not consume doses of omega-3 fatty acids that exceed the Recommended Dietary Allowance (RDA).
Physical therapy: The goal of physical therapy is to improve mobility, restore function, reduce pain, and prevent further injuries. Several techniques, including exercises, stretches, traction, electrical stimulation, and massage, are used. Physical therapy for osteoarthritis of the knee may provide short-term benefits, but long-term benefits do not appear better than standard treatments. Physical therapy, either as an individually delivered treatment or in a small group format, appears effective. Only one available study compared physical therapy to a sham group (subtherapeutic ultrasound) and found that a combination of manual physical therapy and supervised exercise was beneficial for patients with osteoarthritis of the knee. One method of physical therapy, infrared, short-wave diathermy-pulsed patterns and interferential therapy, showed more effectiveness than intra-articular hyaluronan drugs in two studies. More research using consistent treatment protocols and outcomes measures are needed.
Not all physical therapy programs are suited for everyone, and patients should discuss their medical history with their qualified healthcare professionals before beginning any treatments. Based on the available literature, physical therapy appears generally safe when practiced by a qualified physical therapist. Physical therapy may aggravate pre-existing conditions. Persistent pain and fractures of unknown origin have been reported. Both morning stiffness and bone erosion in patients have been reported, although the cause is unclear. All therapies during pregnancy and breastfeeding should be discussed with a licensed obstetrician/gynecologist before initiation.
Psychotherapy: Psychotherapy is an interactive process between a person and a qualified mental health professional. The patient will explore thoughts, feelings, and behavior to help with problem solving. Although group therapy may somewhat decrease pain in people with rheumatoid arthritis and depression, individual therapy coupled with antidepressants may be more effective.
Rose hips: Rose hips have traditionally been used by herbalists as an anti-inflammatory and antiarthritic agent. A constituent isolated from dried and milled fruits of Rosa canina has demonstrated anti-inflammatory properties, and Hyben Vital®, a standardized rose hips extract, has been shown to have anti-oxidant properties. Rose hip extracts have been studied in patients with osteoarthritis, with some evidence of benefit. Additional high quality clinical research is needed in this area to confirm these results.
SAMe: SAMe has been studied extensively in the treatment of osteoarthritis. SAMe reduces the pain associated with osteoarthritis and appears to be well tolerated in this patient population. Although an optimal dose has yet to be determined, SAMe appears as effective as non-steroidal anti-inflammatory drugs (NSAIDS). Additional study is warranted to confirm these findings.
TENS (transcutaneous electrical nerve stimulation): Transcutaneous electrical nerve stimulation (TENS) is a non-invasive technique in which a low-voltage electrical current is delivered through wires from a small power unit to electrodes located on the skin. Electrodes are temporarily attached in various patterns, depending on the specific condition and treatment goals. Preliminary studies of TENS in rheumatoid arthritis report improvements in joint function and pain. However, most research is not well designed or reported, and better studies are necessary before a clear conclusion can be reached.
Avoid with implantable devices, such as defibrillators, pacemakers, intravenous infusion pumps, or hepatic artery infusion pumps. Use cautiously with decreased sensation (such as neuropathy) or with seizure disorders. Avoid if pregnant or breastfeeding due to insufficient evidence of safety.
Unclear or conflicting scientific evidence:
Arnica: Arnica (Arnica montana) gel has been used on the skin for osteoarthritis pain and stiffness, due to its anti-inflammatory constituents. Although early study is promising, additional study is needed.
Ashwagandha: The use of ashwagandha in osteoarthritis has been suggested based on its reported anti-inflammatory and anti-arthritic properties. Well-designed human research is needed to confirm these results.
Astaxanthin: Astaxanthin is found in microalgae, yeast, salmon, trout, krill, shrimp, crayfish, crustaceans, and the feathers of some birds. Astaxanthin has been suggested as a possible treatment for rheumatoid arthritis. However, further research is warranted.
Avoid if allergic or hypersensitive to astaxanthin or related carotenoids, including canthaxanthin or an astaxanthin algal source. Use cautiously if taking 5-alpha-reductase inhibitors (used in prostate conditions), hypertensive agents, asthma medications, drugs that are broken down by the liver, menopausal agents, birth control pills, or medications that are used to treat Helicobacter pylori infections. Use cautiously with high blood pressure, parathyroid disorders, or osteoporosis. Avoid with hormone-sensitive conditions, immune disorders, or if taking immunosuppressive therapies. Avoid with previous experience of visual changes while taking astaxanthin and with low eosinophil levels. Avoid if pregnant or breastfeeding.
Beta carotene: Beta-carotene is a member of the carotenoid family, which contains highly pigmented (red, orange, yellow), fat-soluble compounds naturally present in many fruits, grains, oil and vegetables (green plants, carrots, sweet potatoes, squash, spinach, apricots, and green peppers). Beta-carotene supplementation does not appear to prevent osteoarthritis, but it might slow progression of the disease. Well-designed clinical trials are needed before a conclusion can be drawn.
Supplemental beta-carotene may increase the risk of lung cancer, prostate cancer, intracerebral hemorrhage, and cardiovascular and total mortality in people who smoke cigarettes or have a history of high-level exposure to asbestos. Beta-carotene from foods does not seem to have this effect.
Preliminary study has found that synthetic beta-carotene may increase cardiovascular mortality in people who smoke. In men who smoke and have had a prior myocardial infarction (MI), the risk of fatal coronary heart disease increases by as much as 43% with low doses of beta-carotene. There is some evidence that beta-carotene in combination with selenium, vitamin C, and vitamin E might lower high-density lipoprotein 2 (HDL2) cholesterol levels. HDL levels are protective so this is considered to be a negative effect. Dizziness, reversible yellowing of palms, hands, or soles of feet and to a lesser extent the face (called carotenoderma) can occur with high doses of beta-carotene. Loose stools, diarrhea, unusual bleeding or bruising, and joint pain have been reported.
Beta-sitosterol: Beta-sitosterol is found in plant-based foods, such as fruits, vegetables, soybeans, breads, peanuts, and peanut products. It is also found in bourbon and oils, such as olive oil, flaxseed, and tuna. Beta-sitosterol has been shown to reduce inflammation and it has therefore been suggested as a possible treatment for rheumatoid arthritis. Further research is needed to confirm these claims.
Avoid if allergic or hypersensitive to beta-sitosterol, beta-sitosterol glucoside, or pine. Use cautiously with asthma or breathing disorders, diabetes, primary biliary cirrhosis (destruction of the small bile duct in the liver), ileostomy, neurodegenerative disorders (such as Parkinson's disease or Alzheimer's disease), bulging of the colon, short bowel syndrome, celiac disease, or sitosterolemia. Use cautiously with a history of gallstones. Avoid if pregnant or breastfeeding.
Black cohosh: Although it has been suggested that black cohosh (Actaea racemosa) may help relieve joint pain associated with rheumatoid arthritis and osteoarthritis, further research is needed. High doses of black cohosh may cause frontal headache, dizziness, perspiration, or visual disturbances.
Use cautiously if allergic to members of the Ranunculaceae family, such as buttercup or crowfoot. Avoid with hormone conditions (e.g. breast cancer, ovarian cancer, uterine cancer, endometriosis). Avoid if allergic to aspirin products, nonsteroidal anti-inflammatory drugs (such as ibuprofen), or blood-thinners (such as warfarin). Avoid with a history of blood clots, stroke, seizures, or liver disease. It is recommended to stop use of black cohosh two weeks before and immediately after surgery/dental/diagnostic procedures with bleeding risks.
Boron: Boron is a trace element that is found throughout the environment. Based on human population research, in a boron-rich environment, people appear to have fewer joint disorders. It has also been proposed that boron deficiency may contribute to the development of osteoarthritis. However, there is no clear human evidence that supplementation with boron is beneficial as prevention against or as a treatment for osteoarthritis.
Boswellia: Resin extracts from the Boswellia serrata tree have been found to have anti-inflammatory effects. Due to boswellia's potential anti-inflammatory properties, boswellia has been suggested as a potential treatment for osteoarthritis. Further research is needed in this area. Boswellia may increase bleeding in sensitive individuals, such as those taking blood thinning medications including warfarin (Coumadin®).
Bromelain: Bromelain is an herb that contains a digestive enzyme that comes from the stem and the fruit of the pineapple plant (Ananus comosus). When taken with meals, bromelain may aid in the digestion of proteins. When taken on an empty stomach, it acts as an anti-inflammatory agent. In one study of the combination product ERC (enzyme-rutosid combination; rutosid, bromelain, trypsin), results showed that ERC may be considered as an effective and safe alternative to prescription anti-inflammatory drugs (NSAIDs), such as diclofenac, in the treatment of painful episodes of OA of the knee. Further well-designed clinical trials of bromelain alone are needed to confirm these results.
Avoid if allergic to bromelain, pineapple, honeybee, venom, latex, birch pollen, carrots, celery, fennel, cypress pollen, grass pollen, papain, rye flour, wheat flour, or other members of the Bromeliaceae family. Use cautiously with a history of bleeding disorders, stomach ulcers, heart disease, liver disease, or kidney disease. Use cautiously before dental or surgical procedures or while driving or operating machinery. Avoid if pregnant or breastfeeding.
Cat's claw: Cat's claw is widely used in the United States and Europe, and it is one of the top herbal remedies sold despite a lack of high-quality human evidence. In Germany and Austria, cat's claw is only available by prescription. Several laboratory and animal studies suggest that cat's claw may reduce inflammation and this has led to research of cat's claw for inflammatory conditions, such as arthritis. Early research also suggests that cat's claw may reduce pain from knee osteoarthritis. Large, high-quality human studies are needed comparing the effects of cat's claw alone vs. placebo before a conclusion can be drawn.
Avoid if allergic to Cat's claw, Uncaria plants, or plants in the Rubiaceae family (such as gardenia, coffee, or quinine). Avoid with a history of conditions affecting the immune system (such as AIDS, HIV, some types of cancer, multiple sclerosis, tuberculosis, or lupus). Use cautiously with bleeding disorders or with a history of stroke. Use cautiously if taking drugs that may increase the risk of bleeding. It is recommended to stop use of cat's claw two weeks before and immediately after surgery/dental/diagnostic procedures with a bleeding risk. Avoid if pregnant or breastfeeding. Cat's claw may be contaminated with other Uncaria species. Reports exist of a potentially toxic, Texan-grown plant, Acacia gregii, being substituted for cat's claw.
Chiropractic: Chiropractic is a healthcare discipline that focuses on the relationship between musculoskeletal structure (primarily the spine) and body function (as coordinated by the nervous system), and how this relationship affects the preservation and restoration of health. Promising results were obtained in the treatment of osteoarthritis using manual physical therapy and exercise. However, presently there is insufficient evidence to support the use of chiropractic manipulation for this condition.
Evening primrose oil: Evening primrose oil contains an omega-6 essential fatty acid called gamma-linolenic acid (GLA), which is believed to be the active ingredient. Benefits of evening primrose oil in the treatment of arthritis have not been clearly shown. More information is needed before a recommendation can be made.
Avoid with seizure disorders. Use cautiously if taking mental illness drugs. It is recommended to stop use two weeks before surgery with anesthesia. Avoid if pregnant or breastfeeding.
Guggul: Guggul (gum guggul) is a resin produced by the mukul mirth tree. There is insufficient evidence to support the use of guggul or guggul derivatives for the management of rheumatoid arthritis. Avoid if allergic to guggul. Avoid with a history of thyroid disorders, anorexia, bulimia, or bleeding disorders. Signs of allergy to guggul may include itching and shortness of breath. Avoid if pregnant or breastfeeding.
Guided imagery: Guided imagery refers to a number of techniques, including metaphor, storytelling, fantasy, game playing, dream interpretation, drawing, visualization, active imagination, and direct suggestion using imagery. Therapeutic guided imagery may be used to help patients relax and focus on images associated with personal issues they are confronting. Cognitive-behavioral interventions for pain may be an effective adjunct to standard pharmacologic interventions for pain in patients with osteoarthritis. Further research is needed to confirm these results.
Guided imagery is usually intended to supplement medical care, not to replace it, and guided imagery should not be relied on as the sole therapy for a medical problem. Contact a qualified healthcare provider if mental or physical health is unstable or fragile. Never use guided imagery techniques while driving or doing any other activity that requires strict attention. Use cautiously with physical symptoms that can be brought about by stress, anxiety, or emotional upset because imagery may trigger these symptoms.
Magnet therapy: Magnetic fields play an important role in Western medicine. For instance, they are used for magnetic resonance imaging (MRI), pulsed electromagnetic fields, and experimental magnetic stimulatory techniques. Several studies have evaluated the use of magnetic field therapy applied to areas affected by osteoarthritis or degenerative joint disease. In particular, this research has focused on knee osteoarthritis. However, most studies have been small or poorly designed or reported. Efficacy remains unclear. Notably, one promising small study published in 2004 by Wolsko et al. reported some benefits. Larger and better quality studies are needed before a recommendation can be made in this area.
Initial evidence has failed to show improvements in knee pain with the use of magnet therapy. However, due to methodological weaknesses with this research, the conclusions cannot be considered definitive.
Avoid with implantable medical devices, such as heart pacemakers, defibrillators, insulin pumps, or hepatic artery infusion pumps. Avoid with myasthenia gravis or bleeding disorders. Avoid if pregnant or breastfeeding. Magnet therapy is not advised as the sole treatment for potentially serious medical conditions and should not delay the time to diagnosis a condition. It should not replace treatment with more proven methods. Patients are advised to discuss magnet therapy with their qualified healthcare providers before starting treatment.
MSM: Methylsulfonylmethane, or MSM, is a form of organic sulfur that occurs naturally in a variety of fruits, vegetables, grains, and animals. MSM is a normal oxidation product of dimethyl sulfoxide (DMSO). Preliminary study has used MSM, alone or in combination with glucosamine, in the treatment of osteoarthritis. The combination may provide pain relief and reduction in inflammation. Further studies on MSM and its effects on patients with osteoarthritis are warranted.
Niacin: Vitamin B3 is made up of niacin (nicotinic acid) and its amide, niacinamide, and can be found in many foods, including yeast, meat, fish, milk, eggs, green vegetables, and cereal grains. Preliminary human studies suggest that niacinamide may be useful in the treatment of osteoarthritis. Further research is needed.
Pantothenic acid (vitamin B5): Pantothenic acid is found in many foods including meats, liver, kidney, fish/shellfish, chicken, vegetables, legumes, yeast, eggs, and milk. It has been reported that pantothenic acid levels are lower in the blood of patients with rheumatoid arthritis compared to healthy individuals. However, it is unclear if this is a cause, effect, or a beneficial adaptive reaction. There is currently insufficient scientific evidence in this area in order to form a clear conclusion.
Panthothenic acid has also been suggested as a possible treatment for osteoarthritis. However, further research is needed to determine whether or not this treatment is effective.
Avoid if allergic or hypersensitive to pantothenic acid or dexpanthenol. Avoid with gastrointestinal blockage. Pantothenic acid is generally considered safe in pregnant and breastfeeding women when taken at recommended doses.
Probiotics: Probiotics are beneficial bacteria that are sometimes called friendly germs. They help maintain a healthy intestine and aid in digestion. They also help keep harmful bacteria and yeasts in the gut under control. Most probiotics come from food sources, especially cultured milk products. Probiotics can be taken as capsules, tablets, beverages, powders, yogurts, and other foods. In a small study, Lactobacillus GG was associated with improved subjective well-being and trends in reduced symptoms of rheumatoid arthritis. However, the results were not statistically significant. More studies on the effects of probiotics on rheumatoid arthritis are needed.
Probiotics are generally considered safe and well-tolerated, but may cause diarrhea in sensitive individuals. Use cautiously if lactose intolerant.
Relaxation therapy: Relaxation techniques include behavioral therapeutic approaches that differ widely in philosophy, methodology, and practice. The primary goal is usually non-directed relaxation. In a randomized study of patients with osteoarthritis pain, relaxation therapy was reported to lower the level of subjective pain over time. The study concluded that relaxation might be effective in reducing the amount of analgesic medication taken by participants. Further well-designed research is needed to confirm these results.
Limited preliminary research reports that muscle relaxation training may improve function and well-being in patients with rheumatoid arthritis. Additional research is necessary before a conclusion can be reached.
Avoid with psychiatric disorders, such as schizophrenia or psychosis. Relaxation therapy, which involves flexing and relaxing specific muscles, should be used cautiously with illnesses, such as heart disease, high blood pressure, or musculoskeletal injury. Relaxation therapy is not recommended as the sole treatment approach for potentially serious medical conditions, and it should not delay the time to diagnosis or treatment with more proven techniques
Tai chi: Tai chi is a system of movements and positions believed to have developed in 12th Century China. Tai chi techniques aim to address the body and mind as an interconnected system and are traditionally believed to have mental and physical health benefits to improve posture, balance, flexibility and strength. A small trial in women with osteoarthritis reported that treatment with tai chi significantly decreased pain and stiffness compared with a sedentary lifestyle. Women in the tai chi group also reported fewer perceptions of difficulties in physical functioning. Additional research is needed in this area.
Thymus extract: Thymus extracts for nutritional supplements are usually derived from young calves (bovine). Thymus extract is commonly used to treat primary immunodeficiencies, bone marrow failure, autoimmune disorders, chronic skin diseases, recurrent viral and bacterial infections, hepatitis, allergies, chemotherapy side effects, and cancer. Further research is needed to determine whether or not thymus extract can effectively treat symptoms of rheumatoid arthritis.
Avoid if allergic or hypersensitive to thymus extracts. Use bovine thymus extract supplements cautiously due to potential for exposure to the virus that causes "mad cow disease." Avoid use with an organ transplant or other forms of allografts or xenografts. Avoid with thymic tumors, myasthenia gravis (neuromuscular disorder), or untreated hypothyroidism. Avoid if taking immunosuppressants or hormonal therapy. Avoid if pregnant or breastfeeding. Thymic extract increases human sperm motility and progression.
Turmeric: The rhizome (root) of turmeric (Curcuma longa Linn.) has long been used in traditional Asian medicine. Turmeric has been used historically to treat rheumatic conditions. Laboratory and animal studies show anti-inflammatory activity of turmeric and its constituent curcumin, which may be beneficial in people with osteoarthritis. Reliable human research is lacking. Turmeric may increase bleeding in sensitive individuals, such as those taking blood thinning medications including warfarin (Coumadin®).
Yoga: Yoga is an ancient system of relaxation, exercise, and healing, with origins in Indian philosophy. Yoga is often practiced by healthy individuals with the aim to achieve relaxation, fitness, and a healthy lifestyle. Based on a pilot study, yoga may help reduce pain and disability caused by knee osteoarthritis (OA) in some patients. Further research is needed.
Fair negative scientific evidence:
Arnica: Homeopaths believe that arnica may be effective in relieving pain due to delayed onset muscle soreness, which is defined by exercise to which subjects are unaccustomed. Currently, it is not recommended to give arnica for this indication, although it does not appear to be unsafe for use.
Chondroitin: Chondroitin sulfate is often used as an anti-inflammatory and pain reliever for osteoarthritis, so chondroitin was thought to be beneficial for delayed onset muscle soreness. However, early research does not support this use. More research is needed in this area to confirm these results.
DHEA: DHEA does not seem to improve quality of life, pain, fatigue, cognitive function, mood, or functional impairment in postmenopausal patients with fibromyalgia.
Phenylalanine: In clinical study, D-phenylalanine has not been shown to affect symptoms in patients with chronic pain. Additional high quality clinical research is needed to confirm these results.
Selenium: Selenium is a trace mineral found in soil, water, and some foods. It is an essential element in several metabolic pathways. Selenium-ACE, a formulation containing selenium with three vitamins, has been promoted for the treatment of arthritis. Research has failed to demonstrate significant benefits, with a possible excess of side effects compared to placebo.
Willowbark: There is good evidence that willow bark may be effective in treating chronic pain from osteoarthritis; however, willow bark extract did not show efficacy in treating rheumatoid arthritis. Additional study is needed to confirm these results.
Traditional or theoretical uses lacking sufficient evidence:
Integrative therapies used in pain or related conditions causing pain and that have historical or theoretical uses but lack sufficient clinical evidence include: homeopathic aconite (Aconitum napellus), acupressure (shiatsu), black currant (Ribes nigrum), black tea (Camellia sinensis), celery (Apium graveolens), chelation (EDTA) therapy, hellerwork, horse chestnut (Aesculus hippocastanum), kundalini yoga, licorice (Glycyrrhiza glabra), mangosteen (Garcinia mangostana), massage, meadowsweet (Filipendula ulmaria), polarity therapy, rhubarb (Rheum officinale, Rheum palmatum), rutin, shark cartilage, and vitamin E.
Prevention
Preventing sports injury: Some musculoskeletal problems associated with injuries may be preventable. Care should be taken in sports and physical activities to prevent injuries, sprains, and the overuse of joints, such as in the ankle, wrist, knee, shoulder, and spine. Individuals participating in sports activities such as football, swimming, gymnastics, baseball, basketball, tennis, skiing, wrestling, and soccer may be at a greater risk of developing musculoskeletal problems.Preventing occupational injury: Any job or activity that requires a fixed position over a long period of time can cause musculoskeletal discomfort. Poor job and workplace design appears to contribute to many reported discomforts. Important methods of preventing such discomfort include assuming a range of comfortable positions and having adjustable furniture, such as chairs, tables, and keyboard supports. However, the degree of adjustability for any furniture and visual display depends on how long and for what purpose they will be used. Prolonged work in the same position, whether seated or standing, can cause discomfort. Where possible, movement should be incorporated into the task to prevent discomfort and fatigue.
It is best to avoid standing still in one place for long periods of time. The activity of the leg muscles acts as a pump and assists the veins in returning blood to the heart. Prolonged standing stops this pumping action and this may cause swelling of the lower extremities. Using a rubber or padded mat where prolonged standing cannot be avoided is recommended by healthcare providers. Mats help reduce fatigue and improve comfort. For those individuals who sit for long periods of time, a well-designed chair is very important.
Dietary modification: Nutritional changes, along with the addition of supplements (vitamins, minerals and herbs), may be effective in reducing symptoms associated with musculoskeletal problems.
It is best to limit caffeine and other stimulants, as well as alcohol, and to stop smoking. It may also be beneficial to eliminate potential food allergens, including dairy (milk, cheese and sour cream), eggs, nuts, shellfish, wheat (gluten), corn, preservatives, and food additives (such as dyes and fillers). Additionally, it may be helpful to avoid refined foods such as white breads and pastas and foods with high levels of sugar or refined sugar, such as donuts, pastries, candy, and soft drinks.
Exercise: Maintaining physical fitness is important to those suffering from musculoskeletal problems. Those with musculoskeletal problems who exercise according to their healthcare professional's recommendations tend to do better, with less symptoms and a slower disease progression, than those who do not. A daily regimen of exercise can help the person feel better physically and mentally. Individuals should walk as much as possible, even if assistance is necessary.
Regular exercise may also help individuals control their weight and decrease stress on the musculoskeletal system. There are many ways for people to exercise including gardening, walking, sports activities, and dancing. Individuals who are beginning an exercise program should choose activities that fit their levels of strength and endurance. The type of exercise is not as important as a consistent exercise schedule. Most experts today agree that burning calories should not be the goal of exercise. Exercise that causes extreme pain or discomfort is considered by many experts as unhealthy, and may even cause permanent damage to the body.
Pilates is a body conditioning routine that seeks to build flexibility, strength, endurance, and coordination without adding muscle bulk. In addition, pilates may increase circulation and may help to sculpt the body and strengthen the body's "core" (torso). People who engage in pilates regularly report that they have better posture, are less prone to musculoskeletal injury, and experience better overall health.
It is recommended for the patient to consult with their healthcare providers before beginning any exercise program.
Author information
Natural Standard is an international research collaboration that aggregates and synthesizes data on complementary and alternative therapies. Using a comprehensive methodology and reproducible grading scales, information is created that is evidence-based, consensus-based, and peer-reviewed, tapping into the collective expertise of a multidisciplinary Editorial Board. The mission of this collaboration is to provide objective, reliable information that aids clinicians, patients, and healthcare institutions to make more informed and safer therapeutic decisions. Natural Standard is widely recognized as one of the worlds premier sources of information in this area.Bibliography
Centers for Disease Control and Prevention. www.cdc.gov. Accessed June 20, 2007.
Barr KP. Review of upper and lower extremity musculoskeletal pain problems. Phys Med Rehabil Clin N Am. 2007;18(4):747-60. View Abstract
Chakrabarty S, Zoorob R. Fibromyalgia. Am Fam Physician. 2007;76(2):247-54. View Abstract
Clark KL. Nutritional considerations in joint health. Clin Sports Med. 2007;26(1):101-18. View Abstract
Cossu G, Sampaolesi M. New therapies for Duchenne muscular dystrophy: challenges, prospects and clinical trials. Trends Mol Med. 2007; [Epub ahead of print]. View Abstract
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). www.niams.nih.gov. Accessed June 20, 2007.
Natural Standard: The Authority on Integrative Medicine. www.naturalstandard.com. Copyright © 2008. Accessed June 20, 2007.
Staud R. Treatment of fibromyalgia and its symptoms. Expert Opin Pharmacother. 2007;8(11):1629-42. View Abstract
Related Terms
Anti-cyclic citrullinated peptide antibody, arthritis, arthroscopy, Becker's muscular dystrophy, computed tomography, connective tissue, convulsions, CT, depression, dermatomyositis, DEXA, dual-energy X-ray absorptiometry, Duchenne muscular dystrophy, Dupuytren's contracture, electromyography, epicondylitis, erythrocyte sedimentation rate, ESR, fibromyalgia, fibromyositis, fibrositis, gastroesophageal reflux disease, GERD, IBS, involuntary muscle, irritable bowel syndrome, joint noises, joint stiffness, magnetic resonance imaging, MD, MRI, MSDs, muscle atrophy, muscular dystrophy, myalgia, myofascial pain, myofascial release, osteoarthritis, osteomyelitis, PMS, polymyositis, premenstrual syndrome, proximal myopathy, rheumatoid arthritis, spinal muscular atrophy, synovial fluid, temporomandibular joint disorder, tendonitis, tenosynovitis, TMJ, voluntary muscle.
Natural Standard Bottom Line Monograph, Copyright © 2009 (www.naturalstandard.com). Commercial distribution prohibited. This monograph is intendedfor informational purposes only, and should not be interpreted as specific medical advice. You should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.
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