A Closer Look At Homeopathic Modalities For Joint Pain
- Volume 20 - Issue 12 - December 2007
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Podiatric physicians and surgeons have a wide array of modalities to choose from when it comes to the treatment of chronic joint disease and the pain related to these conditions. These modalities include oral analgesics that are opioid-based, nonsteroidal antiinflammatories (NSAIDs) and various forms of glucocorticoids that patients can take both orally and in injection form. There are also various forms of injectable hyaluronic acid to rehydrate and cushion the joint.
Due to the chronic nature of the disease involving the joints, efficacy and side effects are important considerations when choosing a suitable long-term therapy. In particular, NSAIDs, which are the most commonly utilized drug group, have well-documented histories of adverse reactions that include abdominal pain, diarrhea, nausea and more serious side effects of bronchospasm, gastrointestinal bleeding and ulcers.
Most recently, COX-2 inhibitors have demonstrated severe cardiovascular adverse reactions. This resulted in the FDA removing a couple of products from the market.1-3
Nonsteroidal antiinflammatory drugs exert their antiinflammatory, anti-pyretic and analgesic actions by inhibiting the synthesis of prostaglandins by cyclooxygenase COX-1 and COX-2. The COX-2 form is induced by pro-inflammatory agents such as cytokines, bacterial stimuli and tumor promoting factors.4 The preferential inhibition of COX-1 by traditional NSAIDs is thought to be responsible for their gastrotoxic effects by affecting the regulation of homeostatic functions in the gastric mucosa.
Researchers are currently studying a new generation of antiinflammatory drugs that specifically target COX-2 induced prostaglandin production without influencing the homeostatic functions. However, while COX-2 medications may reduce the risk of gastropathy, recent research revealed cardiovascular events with long-term use and adverse renal effects like sodium, potassium and water retention as well as decreases in renal function similar to those of nonselective NSAIDs.5,6
In addition, prostaglandin synthesis by NSAIDs is also associated with an increased production of leukotrienes by 5-lipooxygenase. Since the COX isoenzymes and 5-LOX share the same substrate, arachidonic acid, the COX pathway can lead to a reduction of leukotrienes by 5-LOX due to increased substrate availability.
Leukotrienes contribute to inflammatory processes and are implicated in the development of gastrointestinal ulcers.7 Leukotrienes are also potent bronchoconstrictors that contribute to the NSAID-induced “aspirin asthma” in susceptible patients.8
Researchers have also reported in the literature that long-term NSAID use may exacerbate degenerative changes in the cartilage.9,10
Looking For Alternatives To NSAIDs For Chronic Joint Pain
Having seen these adverse reactions in my own patients when I utilized long-term NSAID therapy and/or steroids for long-term care of painful joints in the foot and ankle, I looked for a safer alternative for long-term management of chronic joint pain.
After doing an extensive literature review of alternative therapies for chronic joint pain management several years ago, it was clear that homeopathic injections specific for joint pain are uniformly efficacious and have very little adverse reactions for patients with arthritis. I have been using homeopathic injections in my office for several years and have found that patients tend to have greater acceptance of this modality for the treatment of their joint pain as opposed to NSAIDs and steroids. Most of the lay public have now heard about or understand the adverse sequelae to long-term NSAID and steroid use, and are seeking alternative therapies.
Homeopathic Combination Injections: Can They Have An Impact?
Researchers have assessed a German homeopathic combination injection and compared it to NSAIDs in regard to efficacy in the reduction of joint pain for patients with degenerative joint disease. Several head-to-head studies have compared these two modalities and they have found uniform improvement in patient symptoms.11