Joint Pain: Scams, Lies, and Exaggerations, Part 1
March 18, 2015
Dr. Harriet Hall has occasionally reviewed some of these myths for Science-Based Medicine, she has made a few minor errors on some subjects and in my opinion been uncharacteristically generous with her opinion of glucosamine and chondroitin supplementation. Since this is my field of expertise, I felt it was finally time to dole out some advice and data on some of the more commonly marketed joint pain treatments.As an Orthopedic Nurse Practitioner I see a constant stream of joint pain complaints. They stem from a variety of sources: injury, age related changes, lifestyle issues and autoimmune disorders. Patients will often Google their problems and/or their symptoms, and like most medical issues you can find truth on the Internet, but it is never easy or quick. A lot of what I do with patients is teaching, with a good deal of that time spent addressing long-standing myths or marketing scams. I find the most prevalent and pervasive pseudoscience in orthopedics revolves around joint pain. Although
Knee osteoarthritis is a difficult condition to treat and it is by far the biggest woo category. With conditions like chronic pain, the more difficult to treat and subjective a problem is, the more woo laden it is likely to become. Knee arthritis has good treatments, but no cures. Nonetheless, persistent knee-pain opportunists try to take advantage of people. I will try to focus on some of the more common questions related to knee pain.
To have a discussion about what is effective I will have to review some basic anatomy and describe, in simplified terms, the workings of the knee. Your functional knee is made up of essentially six structures: bone, cartilage, ligaments, tendons, muscle, and synovium. For the purposes of this discussion we will ignore other essential anatomical structures such as lymphatic and vascular structures. Your knee has three basic working surfaces: the medial compartment (where your knees touch each other), lateral compartment (outside of the knee), and the patellofemoral (under the kneecap). Minor injuries commonly involve inflammation of the tendons and muscles. Moderate injuries are usually to the soft and hard cartilage and, to a lesser extent, the bursa. Severe knee injuries usually involve broken bones, torn ligaments and tendons.
Treatment is complex, partly based upon the injury, but there are many factors in deciding treatment choices, including your age, your weight, lifestyle, athleticism, your type of work, and your pain. You don't treat granny's injuries with the same regimen used to treat her grandson, even if their injuries are identical. Although I work in a surgical practice, I strongly believe that surgery should often be the last option, not the first. Most people think of themselves as a machine—if something's broken, it must be fixed to work correctly. But we're humans, not machines, and why we hurt and what type of treatment we need is far more complex than "fixing a problem."
Knee pain is a complex disorder. Sometimes it is due to specific injury, sometimes it's due to slow, degenerative changes, or a combination of both. There are no hard and fast rules to treatment. And just as the injury is specific to the patient, the treatment should also be customized to them as well. I am eternally dismayed by the quick and easy answers often spread on the Internet and television. For instance: despite what quack websites say, you can cure pain, bones can heal completely, you can reconstruct the joint, but degenerative changes are irreversible. Anyone or any product that promises knee restoration be very suspicious.
Lets start with one of the more current popular knee pain fads.
Copper-woven compression stockings/braces provide better knee pain relief.
Marketing claims include alleging that some products are:
"designed to provide excellent support to the muscles and joints of the elbow and knee. Built to reduce lactic acid buildup, improve circulation and send more oxygen to the heart, Copper sleeves help you perform better, and reduce the chance of stiffness and soreness. Wear your sleeves during exercising, regular activity or sports and you'll experience the difference."That was for Copper Fit brand, marketed by As Seen on TV, which is better known for promoting cheap plastic googaws than sophisticated medical devices. Vendors will often make suggestive claims about the qualities of copper, such as, "Copper is an essential trace element vital to all living organisms." That's true, but only as far as we consume copper; wearing copper doesn't provide any nutrition. Woo purveyors will also often lean heavily on anecdotes such as this, from Copper Wear: "Colleen has been practically pain free. She no longer needs pain killers or physical therapy. She feels comfortable and amazing!" That's good news for Colleen, but we don't know if she's just a paid actor, and it's not scientific evidence of the product's efficacy.
The makers and marketers of such products aren't allowed to say their copper-woven merchandise directly treats any condition, but they do try to strongly imply it. In typical crank fashion they produce anecdotes and science-y sounding words hoping to provoke an implausible conclusion by you, the consumer. Tried and true scam quackery.
Copper woven into elastic material has no plausibility as a joint pain treatment. It has been studied. The debunked copper bracelet is an example of a previous copper scam. It was researched and consistently failed. The best study was done on 70 people with rheumatoid arthritis symptoms. They wore four different devices over a five-month period and reported on their pain, disability, and medication use throughout. Participants also provided blood samples after wearing each device for five weeks so the researchers could look for changes in inflammation. The devices tested included a standard magnetic wrist strap, a demagnetized wrist strap, a weakened wrist strap, and a copper bracelet. Participants were told the purpose of the trial was to test the effects of magnetic and copper bracelets, and that one or more of the devices might be a placebo. The research, published in the journal PLOS ONE, shows that both the standard magnetic wrist strap and the copper bracelet provided no meaningful effects.
The manufacturers have provided no meaningful reason to believe that this reincarnation of copper for joint pain will be in anyway different. Copper is flexible but it is not inherently elastic, it has no plausible mechanism to improve the performance of the compression part of the compression stocking. Perhaps it can improve the device's durability, but I'm not a materials scientist and consequently can't aver a guess. Even if it does, however, that hardly correlates with the marketed benefits.
So what you have is a simple compression stocking with impressive marketing. Prior research shows that sleeve braces do help joint pain slightly, but not in all cases. Severe osteoarthritis does not seem to benefit from braces of any kind, including compression stockings. At best, copper-woven sleeves are a sexy-sounding symptom reliever. Probably not worth the premium price of $30.00-$40.00 each. If you want to try compression for your joints buy a simple sleeve brace at your local pharmacy.
Stem cell injections to the knee repairs degenerative conditions
The next myth is even sexier sounding, plus it is marketed by medical doctors. Stem cells are harvested from your bone marrow and injected into your knee. The stem cells are then supposed to "reverse" degenerative changes in the knee. This expensive treatment has some plausibility. It has minimal research, which is always suspicious. It lacks a clear mechanism of action. Use seems to only produce subjective results with no objective improvements. Despite tons of marketing suggesting restoration of knee structures from these injections there is no evidence for that.
The current evidence shows that the treatment may have an anti-inflammatory effect. There is no compelling reason to believe that it is a better anti-inflammatory than cortisone injection, which is certainly less traumatic. In my opinion, stem cell injections provide subjective results, as determined by a paucity of research, and there's no plausible mechanism, all of which are qualities consistent with sham treatments. It doesn't matter if the treatment is offered by a doctor or not: no one has shown any good data showing structural improvement in the joint. Also the marketed mechanism of activity is very shaky. Although injecting stem cells into a joint may sound impressive, using stem cells as a medical treatment is very complicated, especially non-pluripotent stem cells, such as those harvested from bone marrow. While pluripotent stem cells (like those obtained from embryos and other procedures) can easily turn into many kinds of specialty cells, non-pluripotent cells harvested from bone marrow are not as flexible in their differentiation and consequently have even less likelihood of showing useful results.
Plus, injecting them into the joint and hoping they know what to fix is implausible and highly unlikely. Your knee is a joint, not bone marrow and not a repair shop. Those cells taken from the marrow generate your blood cells. Most successful stem cell treatments require pluripotent cells properly encouraged into a useful form and implanted directly into the tissue. What we have here is an expensive, implausible, under-researched, hypothetical treatment. Save your money. When anyone, even a doctor, rushes a treatment without properly vetting, more often than not it is useless.
Arthritis supplements do all sorts of things.
Supplements have tons and tons of marketing and the list of supplements grows longer all the time. The oldest and best known for joint pain are glucosamine and chondroitin. And, given the success of those two, supplement companies have steadily tried to add more substances. Each added compound puts an additional spin on the benefits of the supplement. I will list a few here but the list gets longer every week:
In my opinion, even if you throw out every objection I just gave, supplementation is unlikely to produce useful therapeutic results. A pill that cures joint pain probably won't be found on the shelf of your local grocery store or pharmacy for a very simple reason: profit motive. The same companies that make and market those substances would understand the immediate immense value of their pills, and charge for them accordingly. They could produce unequivocal data supporting treatment with their substance, verifiable by independent analysis; they would patent their drug and get FDA approval and would make a fortune. It would literally be a license to print money: the demand for daily doses would never end and money would just keep on rolling in. The reason why these supplements remain supplements and not drugs is because the manufacturers know they just don't work. So they don't want to check it out. There's no incentive to spend millions of dollars studying and developing a drug that shows no real promise of effectiveness.
Joint pain, backaches, headaches—we all get them. If anyone is offering simple solutions to complex problems you have good reason to be skeptical. Talk to your doctor; if he/she thinks you need to see a specialist then do so. Please don't just Google it and self treat. You're wasting your time, money, and maybe doing something dangerous.
Part 2 will focus on some of the common alternative/complementary joint pain modalities.
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