Alternative Medicine and Enthesopathy

Introduction

When patients with advanced cancer take alternative medicines there is no obvious improvement. Nobody with a heart attack takes alternative remedies but seek life saving clot busting drugs.

As also explained in this website, a large burden of musculoskeletal pain and inflammation relates to disorders of the enthesis. This page deals specifically with the consumption of non-medically approved or endorsed medications for enthesis related pain.

When patients with joint pain take alternative medicine they often appear to get better. Indeed there is a massive industry supplying remedies for joint pains.

Why do Alternative medicines appear to work for enthesopathy?

As explained in this website the natural powers of rejuvenation of the enthesis are considerable.

As a consequence of high levels of mechanical stressing, the enthesis is subject to micro damage and needs to repair itself. Insertions are therefore in a constant state of repair.

Repair often starts with inflammation. This may be a painful process and even more so at insertions which are well endowed with nerve endings. Pain enforces rest, or a decrease in physical activity, which is key to natural repair and recovery. However, during the phase of maximal painfulness the consumption of non-medically proven remedies may be falsely associated with an apparent cure.

Chronic pain emanating from the enthesis and Alternative Medicine

Whilst acute painful conditions of the enthesis are likely to spontaneously get better what about chronic pain emanating from the enthesis?

Chronic low back pain is at least in part mediated by pain originating from the annulus fibrosis or capsule of the intervertebral disc enthesis. Pain in this setting may at least in part relate to blood vessels carrying nerves into the damaged tissue which ordinarily lacks a nerve supply. Compression of these nerves when subjects are standing may be associated with pain. It is hard to see how Alternative Medications or even conventional medications make much difference to this type of pain. More research is needed in this area.

Indeed conventional or traditional medicines including steroid injections are not proven to alter the long term outlook for chronic mechanically related enthesopathies.

Implications

Understanding the enthesis and mechanisms of pain emanating from enthesis related disease does not currently support Alternative Medicine strategies beyond addressing abnormal joint mechanics, weight reduction and physical therapy for mechanically related enthesopathy.

In the case of inflammatory enthesopathy termed enthesitis certain classes of medically approved drugs have a proven track record.

In trials of inflammatory poly-enthesitis conditions including Ankylosing Spondylitis and Psoriatic Arthritis the improvement in the non-therapy groups is typically in the order of 30%. So even when enthesitis appears to be related to chronic inflammation there is a high placebo response that could in part reflect spontaneous repair of the enthesis.

Summary

Mechanical disorders of the enthesis are capable of self repair and alternative medicines products may be falsely endorsed for pain relief in this setting.

Resources

An article on the Placebo effect

Spondylitis Association of America alternative treatments