I am often asked if there are alternative treatments available to conventional medication for the treatment of arthritic conditions before they require surgical intervention. There are numerous advertisements and promotions for all sorts of products which claim to offer the elixir of the “fountain of youth” and provide wonderful results, however, there is little good clinical evidence or support for these products and their popularity tends to wane as quickly as it waxes. In addition to the pain from arthritic joints and the inflammatory swelling that this causes, other muscle aches and pains can come from issues such as cramp, iron deficiency and anaemia as well as the popular use of statins which can cause significant periarticular joint pain particularly in the lower limbs. The aim of this section is to look at alternatives to the use of “conventional” medication for these conditions which some patients may find useful. This is not my field and therefore a discussion with a qualified naturopath or herbalist is important to ensure that treatment is focused well and appropriate for you.
CBD appears to work well for most people and has few, if any, side effects. This is different to using cannabis which is neither regulated nor tested and contains THC. CBD has no psychotropic effects and is non-addictive. CBD still cannot be purchased over-the-counter and so a prescription is required for this. I am happy to provide prescriptions for CBD and the pharmacists at Anglesea clinic will fill the prescription, however, patients should be warned that the results can be variable and that the cost of medication including import is high. Quotes should be obtained before committing to that purchase. I prefer the use of sublingual CBD gel capsules since the mode of distribution is in keeping with a slow release into the sublingual mucosa (lining of the mouth) preventing first pass metabolism through the stomach which can occur with the oils. An alternative is to vape CBD oil, in its pure form, however, I, as a doctor, have significant concerns about the safety of inhaling substances into the lungs. Please feel free to discuss this with me should you wish to.
An alternative to CBD is the use of hemp and its products. This is part of the cannabis family and is legally available in New Zealand. Hemp is an extraordinary plant which can provide so much, not just medicinally. I tend to get hemp based products from the Hemp Brokers in Rotorua and I am happy to provide a discount code for my patients so that a wholesale prices can be obtained rather than paying the online price. This can be used either as an oil, a “heart” or husk, which is the seedpod which retains some benefit, or as a powdered version of the seeds. The seeds themselves are not available in New Zealand for sale. Hemp provides a significant amount of fibre, iron and is rich in omega-3, 6 and 9. It is truly a super food and provides significant benefits beyond what it can do to help joint and limb pain. It should be noted that because of its high omega content, it should be stopped at least a week prior to surgery to prevent bleeding at the time of operation. A link to the Hemp Brokers is provided.
In addition, glucosamine and chondroitin, preferably not in combination, can be helpful. There are some low powered studies suggesting the benefit of glucosamine, however results are anecdotal but for many this is an effective, low risk supplement. Use it in the high strength form (1500mg) without chondroitin. Results will be better when taken over longer periods, like many supplements, the effect increases with use. In addition Green lipped muscle extract can be beneficial and works well for some people. New Zealand produces some of the best mussel extract in the world & locally produced is best. Again, look for it as a single item & not in combination. Glucosamine tablets can be taken with green lipped mussel extract. Eating the mussels, whilst recommended, is not a substitute for the product concentrate.
Much has been made recently about the anti-inflammatory and analgesic properties of turmeric. The standard over-the-counter preparations have been so adulterated, however, that there may be little benefit in their use and this may put this useful medication into a poor light. Freeze-dried or fresh turmeric, however, provides excellent anti-inflammatory properties and is the method that should be utilised for delivery of its most potent effects. Turmeric can be grown in New Zealand, with care, and the tuber can be harvested and then should be grated and made into a tea which can then be drunk. It can also be found in some Asian foodstores. Turmeric can be combined with ginger as it does have quite a potent taste. Freeze-dried turmeric may be an easier option, both in terms of handling & use. It may be available online from certain stores, however, care should be taken when ordering that the freeze-dried product is being used.
In addition, from a herbalist, Devil’s claw may provide good anti-inflammatory effects and if added to cherry juice may with help gout, as the cherry juice is helpful for clearing uric acid. This is an option that should be discussed with a herbalist.
Clearly, the best method of controlling cholesterol levels is through diet and regular exercise. Where this fails, the addition of a statin can help to reduce cholesterol levels and lipid (fat) ratios to a safer level reducing the risk of heart attacks and strokes. Alternatives to statins, which have few muscle side effects, include the use of soya lecithin which helps to metabolise fat and can be added to garlic to improve the effects. Plant sterols such as those found in Benicol can also help to reduce cholesterol levels in some patients. Vitamin B3 can also be a useful adjunct but should be used with care as it can cause flushing, so the “no flush” form should be used. In addition, discussions with herbalist and naturopath may identify alternatives such as red yeast rice in combination with coenzyme Q10.
If a statin has to be used, then the addition of coenzyme Q10 at 200 mg, can help to reduce any muscular cramping and aching that the statin may produce.
PRP and stem cells
I have no great knowledge of the use of stem cells but have been advised, whilst incredibly expensive, they might have had an effect on joint function in joints that have been affected by arthritic changes. I have never really been clear whether this is the consequence of the financial commitment or the effect of the stem cells themselves. We do know, however, that regeneration of articular cartilage is unlikely to occur and the outcome of intra-articular injections of either PRP or stem cells, would seem to slow down the inflammatory effect and stabilise the area within the joint. During surgical procedures, PRP has been used as an adjunct therapy to assist with healing of structures such as cartilage tears during repairs or added to bone graft to improve fusion rates in fusion surgery.
Since I have no experience of the use of stem cells, I would prefer to focus on the use of PRP since this is something I have worked with. PRP stands for platelet rich plasma and is obtained by drawing blood out of the arm and then centrifuging the blood sample. This separates off the red cells from the plasma and platelets. For orthopaedic surgery, some of the separated plasma has to be removed so that the platelet layer becomes more concentrated. This is then drawn out of the test tube and is used either as an injection into joint or added to bone graft at the time of surgery. In an outpatient setting, I advocate the use of PRP for mildly arthritic joints such as knees and ankles where 3 injections are given at four weekly intervals. Anti-inflammatories, such as ibuprofen or diclofenac. have to be stopped just prior to the injection and for at least 3 days afterwards since these will counteract the effectiveness of the PRP – specifically, platelet function. There is no “road to Damascus moment” with PRP injections and their effect increases slowly over a period of time. The injections are often mixed, for joint injections, with hyaluronic acid which is a protein found in joint fluid. The injections are currently being done by one of the Radiologists at Pacific Radiology under ultrasound control.
Funding for PRP will not be available through ACC and, presently, most insurance companies do not provide funding for this, although it is something that you could discuss with your insurance company. Current studies, which are generally low powered, are showing that PRP is more effective and steroid injections out to 6 months and as effective as arthroscopy out to a year. Given that this is part of you going back to support you, to me it makes a lot of sense and is a better option than steroid injections, if possible.
PRP for tendon injuries and intrasubstance tears in tendons is more controversial, I believe, and more hard research evidence needs to be provided before I would advocate this on a regular basis. As an alternative to steroid injections around tendons, which have been injured, it is a much better option, however, since it will not cause tendon rupture and may help to ameliorate symptoms within the tendon sheath.
PRP should be safe to use in combination with CBD, hemp and the alternatives to “conventional” medication discussed before.