This is the second post in a series of posts about the potential benefits of complementary therapies for people living with chronic pain. In case you missed it, you can find the first post here.
This post focusses on research related to several complementary therapies and rheumatoid arthritis. As reported in a review article in the British Medical Journal.
Acupuncture and rheumatoid arthritis
Rheumatoid arthritis is an autoimmune disease of the joints, that involves chronic inflammation, deformity and chronic pain. People with rheumatoid arthritis usually take long term medication, such as NSAIDs and anti-rheumatics for pain, swelling and stiffness. These conventional treatments are associated with significant side effects and risks.
Yet, there are hundreds of studies investigating the mechanism and efficacy of acupuncture for acute and chronic pain. With several randomised controlled trials showing that acupuncture is a promising treatment for rheumatoid arthritis.
Several scientific reviews show improvements with acupuncture, not just in pain, but also in other symptoms such as mobility and fatigue.
In fact, researchers say the trials show acupuncture is as effective as drugs, without major adverse events. Reducing pain and joint inflammation whilst improving quality of life. Results that were supported by clinical diagnostic tests.
Electroacupuncture and rheumatoid arthritis
Electroacupuncture is a form of acupuncture that uses small electric pulses between pairs of acupuncture needles. In practice it is a safe and particularly effective way to reduce pain using acupuncture. The review researchers discuss a scientific study that compared electroacupuncture alongside drug treatment with medication alone, for patients with rheumatoid arthritis. The combination of acupuncture plus medication produced a better result than drug treatment alone.
Mind-body medicine and chronic pain of rheumatoid arthritis
Mind-body medicine concerns all the therapies that use the mind to promote health. These include techniques such as meditation, yoga or tai chi. As well as progressive muscle relaxation, breathing techniques and qi gong.
Some of these therapies have plenty of research to support their use while others do not. The review provides information on the available research with regard to these therapies and chronic pain of rheumatoid arthritis.
Meditation and rheumatoid arthritis
Three randomised controlled trials found mindfulness meditation alleviated psychological distress and improved the wellbeing of patients with rheumatoid arthritis. The first of these studies compared the symptoms of a group using a mindfulness based stress reduction program, with the symptoms of a group of people that were on the treatment waiting list. After two to six months, people on the stress reduction program had greater sense of wellbeing but no change in their disease symptoms.
The second trial was on people with a moderate level of rheumatoid arthritis. After two, four and six months, the people on the stress reduction program had significantly less disease activity and pain compared to the waiting list control group.
While the third trial was a twelve month study of people with different inflammatory joint diseases including rheumatoid arthritis. The technique being studied was a group based intensive mindfulness intervention compared to routine care plus a home based CD with instructions in mindfulness meditation. The study showed that mindfulness meditation in a group setting was more beneficial in terms of emotional wellbeing, distress and fatigue. Whilst there was only a slight difference in pain reduction between the groups.
Yoga and rheumatoid arthritis
In a small study on women with rheumatoid arthritis, a six week yoga therapy was compared to normal care. The yoga therapy involved postures and relaxation poses for 90 minutes, twice a week. The women reported significant improvements for pain acceptance, disability and quality of life, but without a difference in pain intensity.
A second, lower quality trial, studied yoga therapy that included postures, breathing techniques, meditation and lifestyle advice, for 90 minutes, six times a week for seven weeks. In comparison with usual care yoga significantly reduced the women’s pain.
However, researchers suggest that there was a high capacity for bias in these studies and they could only suggest a weak recommendation for yoga as a theory for rheumatoid arthritis.
Diet and fasting for rheumatoid arthritis
Many studies support the idea that plant based diets may decrease inflammation by their influence on the gut microbiota and by increasing intake of antioxidants.
In fact a small study tested the effects of a low fat, strict vegan diet on people with mild to moderate rheumatoid arthritis. After four weeks on the diet rheumatic symptoms were improved and pain was reduced.
Mediterranean diet and rheumatoid arthritis
The review discusses two clinical trials using the Mediterranean diet for people with rheumatoid arthritis. The first trial, was a 12 week trial comparing the Mediterranean diet with the patients normal diet. The Mediterranean diet group had greater reduction in disease activity and a significant reduction in pain intensity.
The second, similar but larger trial of women with rheumatoid arthritis, again compared eating the Mediterranean diet with women eating their ordinary diet, for six months. Findings suggest that although the amount of pain was unchanged, women in the Mediterranean diet group had a better quality of life and wellbeing. In comparison, women in the ordinary diet group had an increase in their pain.
Fasting and rheumatoid arthritis
Though researchers admit that little is known about the long term effects of fasting on the progression of rheumatoid arthritis, there is evidence, they say, to suggest benefits. A group of people with rheumatoid arthritis fasted for 7 to 10 days and then ate a vegan diet that was free of sugar and gluten for three months. Followed by a lactose-vegetarian diet for nine months. In comparison to another group of people with rheumatoid arthritis that continued to eat their usual diet, the fasting followed by vegetarian diet led to a significant improvement, with reduced pain and less tenderness and soreness of joints.
Elimination diet and rheumatoid arthritis
It is difficult to conduct a trial to investigate the use of an elimination diet on disease. Simply because the foods that require elimination often depend very much on the individual. Foods that may be associated with an increase in rheumatic disease include meat, dairy, gluten, citrus and alcohol. At least one study found that the pain of rheumatoid arthritis was significantly reduced during the elimination phase of the diet.
Herbal medicine and rheumatoid arthritis
The review mentions several herbal remedies that have been studied in patients with rheumatoid arthritis.
Borage seed oil
Two small trials found significant improvement in pain intensity after using borage seed oil, also known as starflower oil. Borage seed oil is a rich source of gamma-linolenic acid or GLA which has anti-inflammatory properties. Other rich sources of GLA include blackcurrant seed oil, hemp seed oil and evening primrose oil.
Thunder god vine
The root of thunder god vine is a traditional Chinese herbal medicine often used for autoimmune and inflammatory diseases such as rheumatoid arthritis and ankylosing spondylitis.
A randomised controlled trial comparing 180mg thunder god vine extract with conventional medicine sulfasalazine in rheumatoid arthritis patients found after 24 weeks that the herbal extract was superior to sulfasalazine, with less adverse events.
Another larger trial comparing 60mg thunder god vine, daily, methotrexate or a combination of thunder god vine with methotrexate in rheumatoid arthritis patients found a 50% clinical response in 44% of the methotrexate group, 55% of thunder god vine group, and 77% of the combination group.
Researchers point out that thunder god vine extracts must be correctly prepared and that the use of the herb has been associated with changes in male fertility and menstrual changes in women.
Curcumin is the pigment responsible for the bright yellow colour of turmeric. Both turmeric and curcumin have been extensively researched and have profound anti-inflammatory effects.
The review discusses a study in which patients with rheumatoid arthritis took either 500mg of curcumin, twice a day, or the anti-inflammatory drug diclofenac, or a combination of the two. After eight weeks there was no difference in treatment outcome between the groups. In other words all the treatments were equally effective.
Black cumin seed
Nigella sativa, also known as black cumin seed is a herbal medicine that has received a great deal of research attention. Unfortunately, although the review lists Nigella sativa among the herbal medicine section, researchers actually go on to discuss blackcurrant seed oil under this heading. Blackcurrant seed oil is a completely different medicinal to Black cumin seed oil.
Several recent trials suggest that Nigella sativa or its essential oil thymoquinone have potential benefits for rheumatoid arthritis patients, due to its broad anti-inflammatory and antioxidant effects.
Chronic inflammation and, or oxidative stress due to free radicals, plays a major role in the disease process of rheumatoid arthritis. This study on 42 rheumatoid arthritis patients showed that after eight weeks of receiving either 1g per day of Nigella sativa oil or placebo, the Nigella sativa group had increased levels of anti-inflammatory markers and decreases in pro-inflammatory chemical markers, compared to the placebo group. Researchers concluded that Nigella sativa could reduce inflammation and oxidative stress in patients with rheumatoid arthritis, and may be a beneficial adjunctive therapy in the management or rheumatoid arthritis.
Thymoquinone is a major constituent of the essential oil of Nigella sativa seeds. Studies show this compound is anti-inflammatory in experimental models of rheumatoid arthritis. This study looks at the effect of thymoquinone on the immune system. It shows that thymoquinone may be protective against rheumatoid arthritis, as shown by reduced markers of pro-inflammatory mediators and reduced bone turnover. Research suggest thymoquinone may be clinically valuable for the prevention of articular diseases, including rheumatoid arthritis.
Another study also found thymoquinone inhibits pro-inflammatory pathways of the immune system and therefore may help to regulate tissue destruction in rheumatoid arthritis.
Fish oil and rheumatoid arthritis
Certain species of fish are a good source of anti-inflammatory omega-3 fatty acids. These healthy oils are also available as dietary supplements and often used by patients with rheumatoid arthritis.
A meta-analysis of 17 trials showed that fish oil provides modest benefits for pain reduction, morning stiffness, and number of joints affected. Importantly it also allowed people to reduce their intake of non-steroidal anti-inflammatory drugs.
It appears that it is the long-chain omega-3 fatty acids rather than the shorter chain omega-3 fats found in plant based foods such as flaxseed, that are beneficial for rheumatoid arthritis. A small trial, lasting three months found that 30g per day of flaxseed oil provided no special benefits for rheumatoid arthritis patients.
This was the second in a series of posts about a research review into complementary therapies and chronic pain. The review claims that data for the benefits of these complementary therapies for chronic pain is inconclusive. Yet, at least for rheumatoid arthritis there appears to be at least modest benefit for many of the therapies. The review itself suggests that for some complementary therapies the benefits are at least comparable with conventional drug treatments for rheumatoid arthritis.
The next post in this series about the potential benefits of complementary therapies for chronic pain focuses on remedies for chronic lower back pain, as reported in the British Medical Journal article. You can read the article here: