By Karta Purkh Singh Khalsa

REMEDIES FOR OSTEOARTHRITIS

This condition can be as painful as stepping on broken glass, but herbal and complementary treatments, combined with massage, can work wonders.

Photos By Leonard Gertz

Nothing could be more miserable than the prospect of facing the rest of your life with round-the-clock, increasing pain, leading eventually to a slow slide into disability. Yet for millions of osteoarthritis sufferers, that's what the future holds.

According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, the term arthritis literally means "joint inflammation," but it also is used to refer to a diverse collection of more than 100 rheumatic diseases. These conditions can cause pain, stiffness and swelling in joints, and may also affect other parts of the body, primarily other sites of connective tissue. One form or another of the disease afflicts nearly 43 million Americans.1 Arthritis is the most prevalent cause of disability in people 65 and older. Musculoskeletal disorders are responsible for $149 billion in direct and indirect U.S. medical costs each year.²

Osteoarthritis (OA), or degenerative joint disease (DJD), is the most common form of joint disease. The disorder affects an estimated 20.7 million Americans, most of whom are over the age of 45.

With nearly 12,000 baby boomers turning 50 every day in the United States, health concerns of the aging community are top priority for all facets of the wellness industry. This 78-million-strong aging population is focused on remaining fit, fending off typical geriatric health concerns and keeping their bodies as healthy and active as their minds.1 With OA looming, they are eager to try natural therapies to stay active and pain-free.

OA is typified by erosion of joint cartilage. As people age, the water portion of cartilage increases while the protein composition degenerates, causing the cartilage to form tiny crevasses. The result is that cartilage surfaces fray, wear, ulcerate and, in extreme cases, wear away completely, leaving the joint to slide bone-on-bone, causing pain and limiting joint mobility. Bony spurs may form at joint edges.

The disease increases in prevalence with age. About 5 percent of Americans are affected with hip or knee osteoarthritis, while 9.5 percent of adults over 62 have osteoarthritis of the knee. Because of its high rate of occurrence and associated pain and dysfunction, osteoarthritis accounts for much of the disability in lower extremities in the elderly. Osteoarthritis accounts for more than 70 percent of total hip and knee replacements.³

In the long run, OA causes joint pain, loss of function, reduced joint motion and deformity. OA most often affects the knees, hips, spine and hands, and sometimes other joints. Ultimately, disability may result from disease in the spine, knees and hips.⁴

In primary OA, no obvious causative factor can be identified. In secondary OA, the arthritis appears be the result of trauma, repetitive joint use, congenital or developmental defects, or metabolic disorders. Symptoms of OA include pain, stiffness and reduced range of joint motion. In advanced cases, there may be significant disability. In the United States, 100,000 people are unable to walk because of severe OA of the hip or knee.

Previously, OA was thought to be a progressive, degenerative disorder, and was widely known as "wear-and-tear arthritis." It was presumed that everyone, if they lived long enough, would fall prey to OA. It is now known, however, that the disease can be arrested or reversed.⁵ Recent evidence changed the thinking about disease progress of OA. We now know that the joint cartilage of patients with OA is highly metabolically active. The damaged cartilage tissue actually tries to remodel and repair itself. Though once thought to be impossible, arresting or reversing the disease occurs spontaneously in some OA patients.

Conventional medicine considers arthritis to be incurable but manageable. Most treatment programs include medication, exercise, rest, heat and cold therapies, joint protection techniques, and sometimes surgery.

Pharmacological treatments for all forms of arthritis are fairly similar, and include the use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, and painkillers, including salicylates, such as acetaminophen or aspirin. They effectively decrease joint pain and increase mobility.

These drugs relieve symptoms, but they are far from perfect. NSAIDs, especially, cause serious side effects, including ulcer, liver or kidney failure. In fact, more than 100,000 patients are hospitalized, and 16,500 die each year in the United States from NSAID-related gastrointestinal problems.⁶ It is because of these adverse effects that sufferers of arthritis are turning to alternative and nutritional therapy.

These herbs are among the ones most commonly used to treat osteoarthritis.

Neither of these types of medications cures the underlying cause of the disease. Evidence suggests, in fact, both in animals and in humans, that NSAIDs may actually accelerate joint destruction. Test-tube studies indicate that, in addition, some of these drugs adversely affect protein metabolism of articular cartilage. NSAIDs suppress proteoglycan (the slippery molecules in synovial fluid) synthesis by the cartilage cell (chondrocyte). Animal studies further suggest that salicylate drugs may accelerate cartilage damage in osteoarthritis. Since depletion of cartilage matrix proteoglycans appears to be a major factor in the increased vulnerability of chondrocyte in degenerating cartilage, it looks like, despite the symptomatic improvement that these drugs produce, they don't slow the progression of the disease, and they probably accelerate cartilage degeneration.⁷

Another possible approach is corticosteroid drugs, even used as injection, to reduce inflammation, but these also carry serious side effects.

Arthritis Pain
Arthritis pain is caused by several factors.8 Inflammation is the process that causes the redness and swelling in joints. Damage to joint tissues results from the disease process or from stress, injury or pressure on the joints. Fatigue results from the disease process, which can make the pain seem worse and more difficult to tolerate. Depression and/or stress results from limited movement or no longer being able to participate in enjoyable activities.

Each facet of joint pain must be approached in a distinctive and appropriate way. One way to reduce pain is to build a life around wellness, not pain or sickness.

The mind plays an important role in how a person feels pain and responds to illness. Relating to pain as a signal to take positive action as opposed to an ordeal can help with learning to manage pain. Many OA patients manage this by thinking positive thoughts, having a sense of humor, eating a balanced diet, exercising regularly and enjoying activities with friends and family. 

Alternative Practices For OA
Not surprisingly, when faced with a future of powerful drugs and major surgery, many arthritis patients wonder if alternative health-care practices can help. According to a recent study, 10 percent of respondents sought out chiropractors, more than 67 percent relied on rest and almost 52 percent offered prayers. More than 16 percent tried biofeedback, meditation or counseling, and 7.3 percent wore therapeutic jewelry or ate special foods.²

With some investigation, OA sufferers discover that most holistic practitioners believe that natural remedies can provide dramatic relief from OA. From the natural therapy point of view, the "energy" of OA is cold and dry.

OA usually occurs in "hypometabolic" people--those with low body temperature and slow metabolic rate. These bodies have difficulty retaining fluids in the tissues, so there is a general lack of lubrication, including the joint surfaces. The overall result is stiffness and pain.

Following this reasoning, the overall treatment strategy for OA is to warm the tissues, increase mobility, and enhance moisture and lubrication throughout the body. A comprehensive program of bodywork, diet and herbal medicine can be very effective.

Massage For OA
Massage therapy can be a pillar in an effective holistic management program. According to the Arthritis Foundation, massage improves function, relieves stress, moderates the immune system and benefits pain, stiffness, fatigue, anxiety and depression.9 The Arthritis Foundation suggests "massage brings warmth and relaxation to the painful area."8 Massage seems to be popular among arthritics, because 44 percent rely on heat, cold or massage treatments, according to a recent survey.2 

A good study on massage for arthritis deals with the juvenile rheumatoid type, but displays a positive outcome.10 The children's anxiety and stress hormone (cortisol) levels were immediately decreased by the massage, and over the 30-day period, the pain decreased by all measures.

Massage for OA should be done in a warm room, with warming oils. The focus should be on gentle increase of joint range of motion. Since OA patients have a lack of oily, lubricating "slime" in the tissues, lubricating oil should be used liberally. The patient should not feel any pain.

Ayurveda teaches that olive oil is a particularly good medium for OA. Mustard oil, a warming preparation, is also a good choice. "Narayan Oil," a classical Ayurvedic formula with eucalyptus and clove, is a centuries-old remedy for arthritis massage.

Of course, pain is the first symptom that comes to mind when most people think about the misery of arthritis, but is not the case for those who have the disorder.11 Lost sleep is among the main grievances of arthritis victims, according to a new study from University of North Carolina researchers.¹² In fact, it's the leading reason sufferers seek medical care. Sleep disruption overshadows problems, such as reduced mobility, fewer visits to family and friends, and missing work or favorite recreational activities.

Not only does arthritis disrupt sleep, but also sleep disruption makes pain worse, report the scientists. In a survey of nearly 1,000 arthritis patients over 65, one in three patients expressed that discomfort from their arthritis kept them awake at night and prevented them from pursuing leisure activities. But it was the lost sleep, not other symptoms, that spurred most to seek medical care. Going without sleep "drove them to desperate means."

Sleep loss among arthritis patients is a problem that has serious consequences. It causes fatigue, poor functioning and fibromyalgia, the painful condition that often accompanies various forms of arthritis. Doctors believe this unexpected finding is important because sleep loss is not well recognized in contemporary OA treatment. If care is not taken of their sleep disruption, they may not get any better, despite all the anti-inflammatory drugs in the world.

Since massage therapy is renowned for promoting sleep, it can have a dramatic benefit in sleep loss from OA.

Essential Oils, Salves And Ointments For OA
Topical treatments are very popular with OA patients. The Arthritis Foundation reports that almost 45 percent apply ointments or rubs.² If selected and used properly, ointments and rubs can be very beneficial.

Herbalist Chanchal Cabrera, NIMH, of Vancouver, British Columbia, suggests that with salves, it "may be possible to get better access to a poorly vascularized area from the outside (e.g., capsicum over an arthritic joint)."¹³

Since, as previously discussed, OA is a "cold" disease, most salves and packs for the disorder have a warming effect on the tissue, increasing circulation in the joint, promoting increased movement and enhancing the delivery of nutrients.

Marsha Aker's feet hurt so bad, she thought she had "pieces of glass cutting into my feet." Barely into middle age, Aker, a massage therapist, who had to stand on her feet all day long, thought her career was over. Finally, she was medically diagnosed as having bone spurs.

Desperate to try anything, Aker soaked her feet in a warm salve of castor oil each night for 30 minutes. The relief was immediate, and continued to increase each night. Two weeks later, she was pain-free for the first time in months.

Now, nine years later, Aker's pain hasn't returned. She feels great, and best of all, she still keeps going full time in her busy Gresham, Oregon, massage practice, where she's known for her liberal use of--you guessed it--castor oil salve!

Many therapists will be familiar with the use of castor oil as a pack. Castor oil (Rincinis communis) is widely used in Western herbalism, Ayurveda and Chinese medicine. According to noted herbalist Michael Tierra, the oil is recommended in Ayurveda, externally and internally, to relieve all vata (cold and dry, nervous system-oriented) derangements, including pains, constipation and arthritis. The Chinese also use it for joint pain.¹⁴

Though Saint-John's-wort (Hypericum perforatum) has become trendy for depression, this herb may be better known in Europe as an external remedy, which is where it really excels. It is one of the most popular European remedies, as an oily preparation, such as an ointment for wounds, muscle pain, bruises, varicose veins and burns, all of which are confirmed by German Commission E, the body that regulates herbal medicines.¹⁵ Saint-John's-wort flowers, which are yellow, contain red pigments, so the oil is a beautiful deep red color. (Warning: Be sure your client isn't on another anti-depressant drug before you recommend the use of this herb.)

Arnica flower (Arnica montana) salve is clearly the winner in the sore joint category. This remedy is widely respected in Europe and North America. As an excellent remedy for sprains, bruises and injured tissues, widely esteemed German herb authority Rudolf Fritz Weiss, M.D., claims, "Arnica has excellent pain relieving properties."¹⁶ For traumatic injury to the tissues of all kinds, this is the one.

My personal experience with arnica is very extensive. In my two decades of concocting herbal salves, the absolute standout has been a formula of arnica flower, witch hazel, turpentine, pine tar and sulfur. This combination is a general trauma healing salve, which is used for bruises, sprains, strains, rashes, wounds and eczema.

Cayenne peppers have become one of the hottest arthritis remedies around. When applied topically, capsaicin, the active compound in hot peppers, is a widely available and an effective treatment for arthritis pain.

Capsaicin formulations have increased in just a few years to capture almost 20 percent of the topical analgesics category because of their efficacy in providing relief.¹⁷

A double-blind clinical study found that topical capsaicin reduces the pain of arthritis by depleting nerves of "substance P," a neurotransmitter that carries pain sensations to the brain. Researchers of the study had 70 patients with osteoarthritis of the knee apply a 0.025 percent capsaicin cream or a placebo to their diseased knee four times daily. After four weeks, those using capsaicin cream reported significant improvements in pain.¹⁸

Another double-blind, randomized, controlled trial showed that 0.025 percent capsaicin cream applied four times daily was effective in pain management of osteoarthritis of the knee, ankle, wrist and shoulder.¹⁹

Cayenne ointments do not provide immediate pain relief. Often, they take several applications to penetrate to the nerve and block the substance P. It's important not to give up too soon. I often suggest two to three daily applications for at least two weeks to expect results.

At first, capsaicin might produce a mild burning sensation, but this discomfort quickly fades, as does the pain. Wash your hands after applying capsaicin cream, as it can be painful if residual cream comes into contact with your eyes or other sensitive tissues.

Counterirritation, the experience of "fooling" pain by generating a superficial feeling of cold or heat over a sore area, has been known for centuries. Counterirritants include menthol, wintergreen oil, camphor, eucalyptus oil, turpentine oil and methylnicotinate, which arouse or irritate nerve endings, distracting the body's attention from musculoskeletal pain. Generally quite safe, counterirritants sometimes cause rashes and blisters. Be careful of sensitive areas, such as behind the knees.

Warming preparations are generally better for OA. In my experience, clove oil preparations, when applied topically, are superb for enhancing the neurological response of the muscle, and can also be used in neuromuscular diseases. Ginger oil is the counterpart to clove, suppressing the nerve signal, and is used on muscles in spasm.

Exercise For OA
If a person is suffering from OA, the last thing he or she often feels like doing is exercising. But, experts say, that's precisely what could help ease the pain.²⁰ About 50 percent of OA patients swim or exercise in other ways.²

Through exercise, patients can improve overall health and fitness, as well as arthritis symptoms. Regular exercise can help manage pain, as well as keep joints moving. Other positive effects include strengthening muscles around joints, increasing energy, improving sleep, controlling weight and strengthening the heart. Authorities suggest that the program should include range-of-motion exercises to keep joints flexible. It also should include fitness exercises, such as water exercise or walking.

Regular exercise may be the best way to prevent pain from occurring in arthritic joints in the first place. Those who exercise regularly also recover faster from existing arthritic pain.²⁰ Without movement, general deconditioning leads to increased fatigue in even normal day-to-day activity, resulting in more pain and a downward spiral. Further, exercise triggers a process that protects and helps repair joints damaged by arthritis. It increases the pumping action of synovial fluid that protects, provides nutrients and takes away waste products from the articular cartilage.

A regime of physical therapy and home workouts considerably reduces the pain and stiffness of osteoarthritis of the knee, says a recent study from U.S. military researchers. The combination of physical therapy and modest exercise also helped delay or prevent knee replacement surgery, say the scientists.²¹ The program consisted of hands-on physical therapy twice a week for a month, plus custom exercise routines tailored to each patient. After one and two months of follow-up, patients who received the bodywork showed significantly fewer signs of arthritis than those who had no treatment. These patients could walk about 13 percent faster, and they had more than a 55 percent improvement in pain, function and joint stiffness.

Yoga and relaxation techniques are used by nonmedical practitioners to help ease musculoskeletal symptoms. A recent study looked at the effect of yoga on the hands of patients with OA. Individuals with OA of the hands were assigned to receive either the yoga program or no therapy. The scientists measured pain, strength, motion, joint circumference, and hand tenderness and function. The yoga-treated group improved significantly more than the control group in pain during activity, tenderness and finger range of motion. This yoga program was effective in providing relief in hand OA, said the researchers.²²

Patients with OA should continue to do activities that don't injure the joint. An activity such as stationary bicycling can keep the joints active and mobile, as well as conditioning the thigh muscles to protect the knee joint against further injury. Swimming is a good alternative activity, and the weightless water environment can contribute to the perfect exercise.

OA sufferers should avoid high-impact exercises that put sudden, sharp or very high forces across the joint (i.e., running and jumping).

Herbal Medicine For OA
Because arthritis and related osteoporosis are among the leading ailments affecting aging baby boomers, the search for alternative methods of combating this looming duo is leading this group to dietary supplements in droves. According to research conducted by Prevention magazine, 48 percent of consumers who regularly use specialty supplements are between the ages of 45 and 73. Arthritis/osteoporosis best-sellers glucosamine sulfate, chondroitin and soy isoflavones alone generated $414 million in sales last year.¹

Herbal medicine can be quite effective in treating OA, and there is evidence that some of these medicines may improve the course of the disease. Scientific evidence is building for these remedies.

COX-2 Inhibition
In 1999, the two most celebrated introductions in the pharmaceutical arena were the COX-2 inhibitor drugs celecoxib (Celebrex) and rofecoxib (Vioxx). Used to treat the pain and inflammation of arthritis, their financial successes have already stimulated the development of natural alternatives.

COX-2 is short for cyclooxygenase-2. This key enzyme helps the body produce the inflammatory compounds prostaglandins and cytokines. The COX-2 enzyme is activated when tissue is injured or inflamed, and is vital for fighting infections and healing injuries. When the body overproduces COX-2, though, the result is chronic inflammation and pain.

NSAIDs, such as ibuprofen and aspirin, ease inflammation by inhibiting the activity of COX-2. Certain herbs contain components that seem to safely and appreciably inhibit COX-2. Turmeric, holy basil (Ocimum sanctum) and green tea (Camellia sinensis) are examples.²³

Noted herbalist James A. Duke, Ph.D., suggests more easy ways to up your intake of COX-2:

1. Replace some or all of your coffee with green tea and/or chamomile infusion. Spice them up with clove, lavender, marjoram, rosemary, sage and thyme.
2. Eat more cabbage, celery, chives, currants and rhubarb.
3. Use more celery seed, ginger and turmeric in your teas and cooking.
4. Enjoy grape juice or red wine for their resveratrol. Better yet, enjoy stuffed grape leaves.24

Salai Guggul Gum (Boswellia Serrata)
This herb has become well known in North America over the last decade for its pronounced effects on joint disorders. The medicine is a gum resin that exudes from the bark of a large branching tree that grows in semiarid areas of South Asia. Extracts of this gummy exudate have been traditionally used in the Ayurvedic system of medicine as an antiarthritic. In Ayurvedic herbalism, medicinal preparations of gum are known as "gugguls."

This gum contains components, or boswellic acids, which inhibit inflammation-producing substances (leukotrienes) in the body. In fact, boswellia gum inhibits inflammation through several mechanisms in the body. Scientific experiments showed that the herb "was found to exhibit marked sedative and analgesic effects."^25,26

Boswellia gum treats pain, another reason it should be used for OA. While Ayurveda recommends this herb for arthritis, studies in humans for this disease are lacking. Boswellia has been shown to reduce inflammatory processes in humans with colitis, however, which is a step in the right direction.²⁷ Animal studies also demonstrate a generalized anti-inflammatory effect.²⁸

Boswellia is usually administered as a purified extract. For the initial treatment dose, 400 milligrams three times per day is suggested.

Turmeric Root (Curcuma Longa)--Nature's Remedy For Inflammation
Turmeric, the herb that gives the yellow color to curry powder, is far more than a simple cooking spice. This herb has profound anti-inflammatory properties, and is a staple in Ayurvedic arthritis treatment.²⁹

The active ingredient, curcumin, has been shown to be equivalent to NSAIDs, cortisone and phenylbutazone as an anti-inflammatory.^30,31,32,33 Curcumin is nonsteroidal, so it has none of the destructive side effects of steroid anti-inflammatories.³⁴ Recently, turmeric has been shown to enhance wound healing, further evidence of its potential benefit in OA.³⁵

Curcumin directly treats pain, as well. Like cayenne, another medicinal spice, it depletes substance P, the pain receptor neurotransmitter, in the nerve endings.³⁶ Research now shows that curcumin and related compounds suppress pain through a mechanism similar to many drugs (COX-1 and COX-2 enzymes).³⁷ Historically, turmeric has been used externally as a poultice for sprains and sore joints. But before you try an Ayurvedic-style turmeric pack, remember that turmeric is bright yellow. Yellow skin may be a fashion statement elsewhere, but, if so, the fad hasn't made it to the United States yet.

Recently, a study looked at a combination of these exceptional herbs. Forty-two patients with OA were randomly assigned to receive an Ayurvedic preparation, containing (per capsule) 450 milligrams of ashwaganda, 100 milligrams of Boswellia, 50 milligrams of turmeric, and 50 milligrams of a zinc complex, or a placebo, for three months. The dosage was two capsules three times per day after meals. The treatments were then crossed over. Compared with the placebo, the herb combination significantly reduced the severity of pain and the disability score. No side effects required discontinuation of treatment.³⁸

Turmeric is a mild herb. It has very low toxicity, and is, after all, a common food spice, so the dose can be quite large. Generally, patients find that the larger the dose, the greater the relief. Start with a dose of 2-3 grams per day, and adjust as necessary.

For acute inflammation, such as a sore knee after exercise, the dose can be as high as 1 ounce (4 tablespoons) per day. Stir the powder into water and swallow, or make it into a paste with honey or a bite of oatmeal. For continuing health benefit, use 1 gram per day as a spice or in capsules. Standardized extract is available. The dose is 1,500 milligrams of total curcumin content per day.

California Poppy Aerial Parts (Leaf, Flower And Stem) (Eschscholtzia Californica)--Nature's Remedy For Arthritis
This charming backyard plant is, in fact, potent medicine. A Native American herb, it is a distant relative of opium poppies. California poppy contains pain-relieving isoquinoline alkaloids. In Europe, the German Commission E lists it as an antispasmodic and sedative,³⁹ and the herb has become a popular pain medicine.⁴⁰

Since California poppy is relaxing, it works particularly well for people experiencing pain with nervousness and sleeplessness. A French animal study from 1991 indicated a clear-cut antianxiety effect; higher doses were sedative.⁴¹ A German test-tube study indicated that the plant extract had analgesic properties.⁴² A key alkaloid (chelerthyrine) inhibits a body protein (kinase C) that contributes to persistent pain.^43,44

California poppy is calming and promotes sleep, so don't take it when driving; surpass the recommended dose only with care. Raise the dose gradually until you are accustomed to the pain-relieving and sedative effects.

As a tea, a usual dose is 3-5 teaspoons of chopped dry herb, brewed and taken when necessary. As a tincture, start with 5 milliliters when pain begins, and then adjust as effective.

Willow Bark (Salix Alba And Other Species)--Nature's Aspirin For Joint Pain
A traditional pain reliever, willow has an outstanding reputation. It contains salicin and other related compounds (salicylates), which are the herbal predecessors of aspirin.⁴⁵ Plant salicylates relieve pain, reduce fever and curb inflammation. The American Herbal Pharmacopoeia says, "in modern herbal therapy, willow is predominantly used as an anti-inflammatory for symptomatic relief of gouty arthritis and as an analgesic for mild neuralgic pains, toothaches and headaches."⁴⁹

In Europe, willow is extensively used for low back pain treatment. An Israeli study from 2000 substantiated this benefit. The 191 back pain sufferers took a willow extract, standardized to contain either 120 milligrams or 240 milligrams of salicin, per day. The herb turned out to be a great deal more effective than a placebo in this trial, with the higher dose being considerably more effective. In the high-dose group, the response was apparent after only one week of treatment.⁴⁶

A 2001 German study looked at willow bark for OA. It assessed the clinical efficacy of a standardized willow bark extract. A dose corresponding to 240 milligrams of salicin per day was compared with a placebo in a two-week, double-blind, randomized controlled trial. The main outcome measured was pain, along with stiffness and physical function. The investigators concluded that the willow bark extract showed a moderate analgesic effect in osteoarthritis, and appeared to be well tolerated.⁴⁷

Herbs often work effectively in combination. A combination of willow, black cohosh and other herbs, given for two months, produced a significant decline in pain scores in a 1996 study of chronic arthritic pain.⁴⁸

Willow bark does not thin the blood like aspirin, so don't use it for heart disease.⁴⁹ Fortunately, though, it won't cause the bleeding problems common with aspirin. You won't go through aspirin's characteristic digestive disturbance when using willow.

Use a tea brewed from up to 1 ounce, dry weight of the raw herb per day, or an extract containing 240 milligrams total salicin per day. Use willow for as long as necessary.

continued on next page.............