Ask the Doctors August 2007 Issue

Ask The Doctors: 08/07

Iím aware that glucosamine hasnít enjoyed universal support from the medical community, but it has been effective in controlling my arthritis pain. Iíve learned that itís now available in liquid form. Is the liquid form more effective than the pill form, which Iíve been taking?

A 2006 study, the Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT), evaluated the effectiveness of glucosamine for pain relief in hip and knee osteoarthritis. The study turned up largely negative resultsómost participants experienced no pain relief compared to placebo, though a subsequent analysis suggested that patients with moderate to severe pain did experience some relief. We are awaiting further data from this trial to determine whether glucosamine slows cartilage loss.

The glucosamine you use was not the supplement tested in the GAIT trial. Products used in the study were specifically developed for that study and subject to the pharmaceutical regulations of the U.S. Food and Drug Administration (commercially available glucosamine was not up to FDA specifications). As a result, it is not known if products that are commercially available would have the same effect as the product tested. Since the liquid form of glucosamine you take was not tested in this trial, its effectiveness compared to the pill form of the supplement could not be determined.

Do knee braces provide enough stability and comfort for an arthritic knee while the wearer is engaged in strenuous athletic activity?

Knee braces, also called "unloader braces," do provide significant stability by controlling the amount of load on your knee and supporting your knee in motion These lightweight braces, which can be made from a variety of materials (though plastic is most common) tend to be more rigid and use a hinge designóenabling them to withstand strenuous activityóas opposed to most over-the-counter braces that are made of soft materials, like neoprene.

Since knee pain is often related to abnormal patellar (knee cap) tracking, which can cause pain in the femoral groove, some of the softer braces with a patellar cutout can help keep the knee cap tracking properly.

The choice, and effectiveness, of any brace will depend not only on the brace but on the particular sport or activity that youíre involved in.

Iíve read that acupuncture isnít recommended in situations where a patient wears a pacemaker. Is this because of the mild electric current that is sometimes run along the skin as an adjunct to the acupuncture procedure? If so, is acupuncture permissible when electric current is not used? If it is the electric current that is the problem with a pacemaker, does it make any difference if the pacemaker contains a defibrillator?

Electro-acupuncture is considered to be a stronger form of acupuncture that often is used when normal manual stimulation has failed to improve a patientís condition. Because there have been reports of fatalities caused by electro-acupuncture interfering with the electrical signals from implanted pacemakers, most acupuncture practitioners do not recommend this form for patients with pacemakers.

Although several institutions with acupuncture programs similarly do not recommended electro-acupuncture for patients with pacemakers, they cite no problems in the use of manual acupuncture in patients wearing a pacemaker, with or without a defibrillator.