Midterm 2 Flashcards
How do glucosamine and chondrotin compare as options for treating osteroarthritis?
Final trials are yet to be done but both seem moderately effective for reducing symptoms and slowing the progression of OA (primarily of the knee) as well as reducing the need for NSAIDs.
Glucosamine has better bioavailability and dosages recommended are different.
Glucosamine may affect blood insulin levels (Watch with diabetics) and is made with shellfish (watch for allergies)
How does MSM compare to glucosamine and chondroitin?
MSM does not have as much information and research behind it as GS and CS do. It has not been shown to be an efficient replacement for CS or GS. GS and CS are both proteoglycan precursors while MSM may facilitate proteoglycan synthesis as it is an organic sulfur compound (plankton and the sky)
Besides glucosamine and chondroitin, which supplements have the best scientific support for treating osteoarthritis? Which popular treatments have relatively little support?
Supplements associated with helping OA-
Niacinamide: improved symptoms and joint motion
Vitamin C: less cartilage damage is noted with VitC is high
Vitamin D: Slows progression
Vitamin E: may improve symptoms and delay progression
SAMe: expensive but natural methyl donor and is comparable to a Cox-2 inhibitor
What is the rationale for the nightshade free diet? What foods must be eliminated?
Nightshades contain a natural toxin called SOLANINE that is capable of causing joint symptoms
Nightshades: tomatoes, white potatoes, peppers, eggplant, tobacco
Distinguish between vitamins that may be useful in the management of osteoarthritis symptoms and those that may be useful for preventing progression of osteoarthritis. Which seem to be necessary to take in megadose amounts?
Improve symptoms: Niacinamide & SAMe
Preventing progression: Vit C&D (vit E is inconsistent)
Megadoses: Vit E? C&D also higher than normal intake
What is the mechanism for the effects of DL-phenylalanine on chronic pain?
x
What botanicals appear most effective for treating osteoathritis according to published evidence?
Capsaicin ointment, Curcumin Devil's claw Ginger Willow Bark
Of all the supplements studied for treating osteoarthritis, which is the only one with evidence for reducing the need for total joint replacement?
Glucosamine
How many times per day should capsaicin ointment be applied to duplicate succsessful protocols used in clinical trails?
Four times daily (0.025%-0.075%)
What is the evidence for nutritional and botanical treatment options for chronic low back pain?
x
What type of preparation of Devil’s claw appears to be most effective?
x
Most important known modifiable risk factor for OA
Weight loss.
Capsaicin: Common and Scientific Names
Common name: Cayenne
Scientific name: Capsicum annuum, C. frutescens
Capsaicin: Parts of the plant used
Fruit (the hot pepper)
Active constituents: Capsaicinoids
Capsaicin: Physiological Effects
Need purified capsaicin
Stimulates C-nociceptors through canilloid receptor.
Desensitization of C nociceptors by depleting substance P (makes it hard for the nociceptor to fire because the substance P leaks out of the neuron)
May have indirect effects on inflammation
Capsaicin: Clinical evidence of effectiveness for indicated uses
Most helpful for OA, small effects for fibromyalgia, chronic neck pain & chronic low back pain
May also be beneficial for neuropathy in diabetes, shingles (post herpetic neuralgia), postsurgical pain, psoriasis and migraine or cluster headaches.
Capsaicin: Extraction and standardization criteria for effective preparations
creams and ointments must contain at least 0.025% capsaicin. 4 times daily, may take 2-3 weeks of therapy to respond
Plasters should have at least 11mg per lumbar spine plaster and should be applied for 4-12hrs/day
Capsaicin: Necessary cautions and precautions
wash hands, avoid breathing it in, some people may be too sensitive to handle it.\contraindications: open skin lesions
transient burning, some inflame skin conditions
Willow: Common and Scientific Names
Salix alba aka Willow bark, white willow
Willow: Parts of the plant used
Bark used
Actives: salicylates including salicin (half life=2.5hrs)
Willow: Physiological Effect
Anti inflammatory (cox-1&2 inhibitor) Analgesic (slower onset but longer lasting that aspirin) Antipyretic
Willow: Clinical evidence of effectiveness for indicated uses
Willow bark is used to treat OA and RA (pain reduced but not always better than placebo)
Low back pain (Better than placebo-reduces pain about 33%)
rated A for OA and B for LBP
Willow: Extraction and standardization criteria for effective preparations
need 40-80mg salicin TID
Willow: Necessary cautions and precautions
Similar to those of aspirin: hypersensitivity, anticoagulation drugs, Reye’s syndrome (kids-no info on this but may be concern), no info on pregnancy
Devil’s Claw: Common and Scientific Names
Common: Devil’s claw
Scientific: Harpagophytum procumbens
Devil’s Claw: Parts of the plant used
Tubers
Devil’s Claw: Physiological Effects
Proposed activities: iridoid glycosides: harpagoside, harpagide and procumbide
anti inflame (cox-2)
Analgesic
Chondroprotective (maybe)
Devil’s Claw: Clinical evidence of effectiveness for indicated uses
Evidence of B for both OA and LBP
OA-spine hip/knee
Chronic and specific LBP
Devil’s Claw: Extraction and standardization criteria for effective preparations
preparations tested: crude powdered herb, extract using water or extract using ethanol
Best when use at least 50mg/day of harpagoside (aqueous extracts have the most concentrated harpgoside)
Devil’s Claw: Necessary cautions and precautions
Possible interaction with anticoagulants, possible exacerbation of peptic ulcer,
Safety unknown in pregnancy and lactation.
infrequent and mild GI symptoms may be a side effect
What kind of benefits has exercise been shown to have on fibromyalgia patients? Which type of exercise has the most evidence?
Exercise has been shown to reduce pain and improve fitness, function and well being. Aerobic exercise has shown to be the most effective but other activities may help as well. Some people may have to start very gradually to avoid worsening symptoms.
(Fibromyalgia) What issues should educational and counseling interventions address?
Teach life skills, address fears, address stress and mood disturbances.
Which formal counseling technique has the best evidence (fibromyalgia)?
x
Describe the evidence for mind-body therapies and other alternative therapies for treating fibromyalgia and related symptoms?
Massage therapy- pain and mood stress reduction awareness and relaxation, acupuncture may be beneficial, electro acupuncture may be better moist heat can be beneficial
What mechanisms might explain the effects of different symptomatic treatment of fibromyalgia syndrome according to the following therapeutic goal:
Improved pain?
SAMe (improved disease activity pain, fatigue, mood) also used to treat depression and OA
Melatonin (improves sleep and therefore improves pain, fatigue, sleep, mood and other symptoms)
Capsaicin (improves pain and may help treat OA and LBP)
What mechanisms might explain the effects of different symptomatic treatment of fibromyalgia syndrome according to the following therapeutic goal:
Improving sleep?
5-HTP and melatonin
Valerian root extract or tryptophan may also help
What mechanisms might explain the effects of different symptomatic treatment of fibromyalgia syndrome according to the following therapeutic goal:
Improving mood?
SAMe, 5HTP (also known to help with mood disorders, sleep disturbances and migrane headaches) and melatonin
St. John’s Wort and kava kava may also help
What mechanisms might explain the effects of different symptomatic treatment of fibromyalgia syndrome according to the following therapeutic goal:
Improving cognitive function?
improve sleep (5 HTP, melatonin) and fatigue (CoQ10) pain/fatigue/mood (SAMe) ginko biloba
List and describe the types of diets that have been shown to help patients with fibromyalgia
Weight loss is important, it improves pain and other symptoms/quality of life. Elimanation diets may help (gluten, MSG, NutraSweet, typical allergies)
Strict plant based diets have helped, although may be due to weight loss/reduced allergens or placebo
What types of interventions are typically included in multidisciplinary/multicomponent programs for treating fibromyalgia patients?
Support groups, information and mind body resources
What is RA?
Rheumatoid arthritis is an autoimmune inflammatory disorder that has a younger onset than OA
Dietary approaches to RA (diets and supplements)
It has been shown that 5-40% of patients with RA have food intolerances, including a possible elevated amount of antibodies to milk and/or wheat.
Allergy elimination diet, gluten free diet, or nightshade free diet may help some people
prostaglandin-modifying diet may also help some people (vegan, low arachidonic acid or Mediterranean diet)
Supplements: Fish oil and borage oil (prostaglandin modification)
Vit E (antioxidant effects)
Curcumin (botanical)
maybe selenium, copper or zinc & iron only if they are low
Dietary recommendations for Lupus
Avoid milk and other food allergens
Low fat diet plus 6 grams omega 3
flaxseed
and DHEA
Dietary recommendations for Psoriatic arthritis
Zinc 150mg/day
Gluten sensitivity common and elimination may help
Ankylosing Spondylitis & dietary recommendations
Dairy product elimination may be effective
Ginko Biloba: Common and scientific names
Common name: Maidenhair tree
Ginko Biloba: Parts of the plant used
Leaf
Active constituents: Falvone glycosides & Terpene lactones. It is highly concentrated so must remove harmful constituents. Activity may not persist for more than half a day.
Ginko Biloba: physiological effects
Affects neurotransmitter and blood flow characteristics. It is neuroprotective (it inhibits neuronal damage from some pathological mechanisms).
It changes brain wave activity and increases blood flow to some tissues
Ginko Biloba: Clinical effectiveness for indicated uses
Improves cognitive function in alzheimers disease (shows stabilization for up to a year), age related cognitive decline (fairly consistent results), “cerebral insufficiency” (good results, bad research design) and in healthy people (in some studies).
Others: increases pain-free walking distance in people who suffer with intermittent claudication.
Ginko Biloba: extraction and standardization criteria for effective preparations
Standardized leaf extracts: 6% terpene lactones and 24% flavone glycosides
180-240 mg/day in divided doses
may need up to 6 weeks to see cognitive improvement
Ginko Biloba: Necessary cautions and precautions
contraindications: kids under 12
Side effects: transient headach, occasional GI upset, occasion skin reaction
May increase bleeding, may react with drugs
