Are there effective remedies for bursitis/tendonitis? I began losing use of my shoulder joints over two years ago. A little while later I developed an aching sensation on the inside of my elbow joints. I am physically active by nature. I have had all my amalgam fillings removed and have been through a detoxifying programme. In addition I am having regular sessions with an acupuncturist and am taking blue green algae. My joints still ache like mad. Can I speed up treatment in any way? JP, Hove........
The traditional view is that both conditions are caused by wear and tear. However, more recent evidence suggests that inflammation and chronic pain (even after an injury has healed) may be linked to an immune system response.
According to work presented by Dr Joyce DeLeo, a neuropharmacologist at Dartmouth Medical School, at the annual meeting of the American Association for the Advancement of Science in Philadelphia (February 16, 1998) there is a large biological overlap between the immune system and the central nervous system. Dr DeLeo's paper suggested that some forms of chronic pain persist and become even more intense after healing is apparently complete. This could be because a persistent barrage of nerve signals from a site of nerve or tissue damage may sensitise the nervous system and may even alter the way it functions.
Dr DeLeo and her colleagues believe the immune system is intimately involved in the initiation and maintenance of pain through the production of proteins called cytokines. Their studies have identified at least three proteins interleukin-1, interleukin-6 and tumour necrosis factor alpha which were produced by cells in the spinal cord as a result of nerve injury. One of these, interleukin-6, was shown to generate pain even in the absence of injury. Cytokines were first described in relation to their activities in the immune system. Their actions are known to be complex and affected by the presence of hormones and inflammation. Dr DeLeo now suggests they also have an essential role in the development and survival of the nervous system.
The immune system theory dovetails neatly with more well founded ideas such as inflammation being caused by allergy (which also involves an immune system response). Anyone suffering from bursitis or tendonitis should certainly rule out both food and chemical sensitivities before considering aggressive conventional treatments such as prednisolone, ibuprofen or the more radical "solution" of surgery.
Nutritional therapy has a great deal to offer bursitis sufferers. In one study of 40 patients with bursitis (mostly sub deltoid type), 1000 mcg daily of B12 for seven to 10 days, tapering off to three times weekly for two to three weeks, then one to two times weekly for two to three weeks (depending on rate of progress), all but three patients improved. They experienced rapid relief of pain and subjective symptoms, sometimes within a few hours. Follow up x-rays of cases of calcific bursitis showed considerable reabsorption of calcium deposits (Indust Med Surg, 1957; 26: 20-2). A combination of vitamin C with bioflavonoids, 200 mg three times a day, may ease subpatellar bursitis. In one case, symptoms were all but gone within 72 hours (AM J Digest Dis, 1955; 22: 41-45). Vitamin E also protects against inflammation (J Vitaminol, 1972: 18: 204-9). In addition, low zinc levels may result in the accumulation of free radicals which can cause inflammatory disease. Supplementation may help (Agents Actions, 1986; 18: 103-6).
The omega-3 fatty acids can reduce inflammation by altering the balance of pain producing prostaglandins and leukotrienes (Wein Klin Wochenschr, 1986; 98: 104-6, N Eng J Med, 1985; 312: 1217-23). Omega-6 fatty acids in the form of either borage oil or blackcurrant oil may also help reduce inflammation (Am J Clin Nutri, 1992; 55: 39-45).
WDDTY panellist Harald Gaier has found that Urarthone (available from the Nutri Centre, Tel: 0171-436 5122) is quick and effective in alleviating joint problems. It's a mixture of some 18 different natural ingredients, which should be taken in water twice a day.
Another of our panellists, osteopath Dr. David Charlaff, cautions: "Bursitis usually involves a number of different tissues and other elements around the pain site, and not simply the fluid filled sac between muscles, muscles and tendons, and tendons and bones, called the bursa."
He suggests first trying local and distal acupuncture particularly effective with electro stimulation. Secondly, if the pain is bilateral (on both sides), it could have a spinal cause, which osteopathy could deal with effectively. To reduce inflammation, he suggests homoeopathy initially using remedies such as Arnica, Ruta grav and Rhus tox in 6th or 30th potencies, depending on the indication. If they don't work, he would then use herbal medicine.
There is good research to show the efficacy of herbal preparations in cases of bursitis. There are, for instance, hundreds of papers on the applications of bromelain in cases of inflammation due to arthritis, sports injury or trauma (J Ethnopharmacol, 1988; 22: 191-203). Bromelain has been shown to stimulate the production of anti inflammatory prostaglandin E1 (Med Hypoth, 1980; 6: 99-104) and may inhibit the synthesis of pro inflammatory prostaglandin E2 (Arzneim Forsch, 1986; 36: 110-12).
Curcumin, the pigment and active component of turmeric (Curcuma longa), has long been used in Ayurvedic medicine, locally and internally, for sprains and inflammation. The recommended dose is 400 to 600 mg three times daily (Agents Actions, 1989; 28: 298-303).
Feverfew may also be effective in reducing the synthesis of prostaglandin E2 and the formation of leukotrienes and thromboxane, all of which are involved in the inflammatory and pain process (Lancet, 1985; i: 1071-4). Feverfew's efficacy is dependent on the level of parthenolide in the preparation used. Most clinical trials have a parthenolide content of 0.4-0.66 per cent.
David Charlaff also recommends remedial exercise, such as simple yoga or the Pilates method. A recent review shows that gentle stretching exercises, combined with nutritional supplements, may be the best way of keeping joints in good shape (Townsend Letter for Docs and Patients, April 1998). Be aware that it can take up to 18 months for pain to disappear completely. If the pain lasts longer, you may need to have further analysis, such as ultrasound, to determine the cause. However, Charlaff acknowledges that there is a certain amount of trial and error in whatever method one uses. Although removing your amalgam fillings was probably a good first step, detoxification can take some time particularly if you had many fillings in your mouth for a long period of time.
Finally, you may want to reconsider your use of blue green algae, also known as AFA (Aphanizommenon flosaquae). Recent reports are that some algae products, particularly those harvested from the Klamath Lake region of Oregon in the US have produced undesirable side effects such as nausea, vomiting chills and malaise symptoms usually associated with the presence of toxins (Proof!, 1998, 2: 20), causing or exacerbating chronic pain.