Glucosamine for Back Pain?

From Medscape Orthopaedics & Sports Medicine > Viewpoints
Joseph K. Lee, MD

Effect of Glucosamine on Pain-Related Disability in Patients With Chronic Low Back Pain and Degenerative Lumbar Osteoarthritis: A Randomized Controlled Trial
Wilkens P, Scheel IB, Grundnes O, Hellum C, Storheim K
JAMA. 2010;304:45-52

Article Summary
Glucosamine has been routinely recommended help treat peripheral joint osteoarthritis.[1]
Its use has been advocated in chronic low back pain (LBP) conditions, too. However, its effect in patients with LBP has not been well studied. In this double-blinded, randomized, controlled study by Wilkens and colleagues, 250 patients older than 25 years of age with a history of chronic LBP (> 6 months) and degenerative lumbar osteoarthritis were given either 1500 mg of oral glucosamine or placebo for 6 months. Patients were evaluated at the end of the 6 months, and then at 12 months. No statistically significant difference was seen with any of the outcome measures (Roland Morris Disability Questionnaire, LBP at rest, LBP during activity, and EuroQol-5 Dimensions) at 6 or 12 months.

Viewpoint
Studies of glucosamine in patients with osteoarthritis have shown modest-to-no significant benefits.[1-4] According to the findings in this particular study, glucosamine does not appear to show any significant benefit in patients with chronic LBP.
Study limitations included patient screening criteria, which did not exclude those with concomitant leg symptoms, allowance of other adjunct treatments, and variability in patient adherence to the glucosamine treatment.

Because of the complex nature of diagnosing and treating chronic low back pain, it can be quite difficult to isolate the pain generator.
At times, there may be more than one pain generator causing a patient's symptoms. Future studies focused on LBP and osteoarthritis may benefit from identifying patients based on specific clinical signs and symptoms of osteoarthritis, rather than on x-ray evidence alone.