Study Finds Mindfulness Reduces Pain and Despair

By Pat Anson, PNN Editor

“Mindfulness” may as well be a four-letter word to chronic pain patients. Many have tried mindfulness meditation – a form of cognitive behavioral therapy (CBT) – and found it does not relieve their pain.

“The quackery continues,” one reader told us. “This is a modern-day lobotomy experiment.”

“I have tried CBT and mindfulness. They made me feel much worse emotionally, paradoxically enough, and made me more acutely aware of the pain,” another patient said.

“We have ALL been through almost every other treatment you can think of including psychological therapy, mindfulness, yoga, etc. before given opiates. We still use these to help cope, but they do not really help much when all you want is to die to stop the pain you are in,” another patient wrote.

A new study at the University of Utah provides some intriguing evidence that mindfulness can enhance the quality of life, while also reducing pain and the need for opioids.

The study, published in the journal Science Advances, looked at data from four experiments involving 135 adults who took opioids daily for chronic pain.

Participants were randomly assigned to two groups that participated in eight weeks of support group therapy or eight weeks of a meditation program called Mindfulness-Oriented Recovery Enhancement (MORE), which was primarily designed to treat addiction. Patients in the MORE group were asked to focus on rewarding experiences, such as watching a beautiful nature scene.

At the beginning and end of the study, researchers collected electroencephalogram (EEG) data from the participants, using electrodes on the face and scalp to track their eye movements, smiles, frowns, changes in heart rate, and brain function.

Researchers say patients in the MORE group had fewer cravings for opioids and became more responsive to pleasant images by using mindfulness. They also reported significantly less pain, more positive emotions, enhanced joy and more meaning in life compared to patients in the therapy group.

IMAGE COURTESY UNIVERSITY OF UTAH

"Previous research shows that prolonged use of opioids makes our brains more sensitive to pain and less receptive to the joy one might normally experience from natural rewards, like spending time with loved ones or appreciating a beautiful sunset," said lead author Eric Garland, PhD, an associate dean for research at the University of Utah College of Social Work.

“This blunted ability to experience natural positive feelings leads people to take higher and higher doses of opioids just to feel okay, and ultimately propels a downward spiral of opioid dependence and misuse. Because of this downward spiral, scholars are increasingly referring to chronic pain and opioid misuse as 'diseases of despair.'"

Garland developed MORE as a mindfulness therapy to promote positive psychological health while simultaneously addressing addiction, pain and stress. MORE teaches mental training techniques to help people find meaning in the face of adversity, while simultaneously alleviating physical and emotional pain by cultivating positive feelings and experiences.

"MORE teaches people to better notice, appreciate and amplify the good things in life, while also deriving meaning and value from difficult situations," said Garland.

Previous studies on mindfulness using MRI imaging found that changes in the brain do occur during meditation, making people less sensitive to pain. Meditation activated brain regions associated with the self-control of pain, while deactivating regions that process sensory information.

You can take a free 20-minute guided meditation at Meditainment.com. The online mindfulness program takes you into a “secret garden” of your own imagination, designed to help your pain seem less important.

Low Dose Naltrexone a ‘Game Changer’

By Alex Smith, Kaiser Health News

Lori Pinkley, a 50-year-old from Kansas City, Mo., has struggled with puzzling chronic pain since she was 15.

She has had countless disappointing visits with doctors. Some said they couldn’t help her. Others diagnosed her with everything from fibromyalgia to lipedema to the rare Ehlers-Danlos syndrome.

Pinkley has taken opioids a few times after surgeries, but they never helped her underlying pain. Recently she joined a growing group of patients using an outside-the-box remedy: naltrexone. It is typically used to treat addiction to opioids or alcohol, in pill form or as a monthly shot.

As the medical establishment attempts a huge U-turn after two disastrous decades of pushing long-term opioid use for chronic pain, scientists have been struggling to develop safe, effective alternatives.

When naltrexone is used to treat addiction in pill form, it’s prescribed at 50 milligrams. But chronic pain patients say it helps their pain at doses of less than a tenth of that.

Low-dose naltrexone (LDN) has lurked for years on the fringes of medicine, and its zealous advocates worry it may be stuck there. Naltrexone, which can be produced generically, is not even manufactured at the low doses that seem best for pain patients.

Instead, patients go to compounding pharmacies or resort to DIY methods — YouTube videos and online support groups show people how to turn 50 mg pills into a low-dose liquid.

Some doctors prescribe it off label even though it’s not FDA-approved for pain.

University of Kansas pain specialist Dr. Andrea Nicol recently started prescribing LDN to her patients, including Pinkley. Nicol explained that for addiction patients it works by blocking opioid receptors — some of the brain’s most important feel-good regions. So it prevents patients from feeling high and can help patients resist cravings.

At low doses of about 4.5 mg, however, naltrexone seems to work differently.

“What it’s felt to do is not shut down the system, but restore some balance to the opioid system,” Nicol said.

Some of the hype over low-dose naltrexone has included some pretty extreme claims with limited research to back them, like using it to treat multiple sclerosis and neuropathic pain or even using it as a weight-loss drug.

In the past two years, however, there’s been a significant increase in new studies published on low-dose naltrexone, many strengthening claims of its effectiveness as a treatment for chronic pain, though most of these were small pilot studies.

Dr. Bruce Vrooman, an associate professor at Dartmouth’s Geisel School of Medicine, authored a recent review of low-dose naltrexone research.

Vrooman said that, when it comes to treating some patients with complex chronic pain, low-dose naltrexone appears to be more effective and well-tolerated than the big-name opioids that dominated pain management for decades.

“Those patients may report that this is indeed a game changer. It may truly help them with their activities, help them feel better.”

— Dr. Bruce Vrooman

“Those patients may report that this is indeed a game changer,” Vrooman said. “It may truly help them with their activities, help them feel better.”

So how does it work? Scientists think that for many chronic pain patients the central nervous system gets overworked and agitated. Pain signals fire in an out-of-control feedback loop that drowns out the body’s natural pain-relieving systems.

They suspect that low doses of naltrexone dampen that inflammation and kick-start the body’s production of pain-killing endorphins — all with relatively minor side effects.

Drug Companies Not Promoting LDN

Despite the promise of naltrexone, its advocates say, few doctors know about it. The low-dose version is generally not covered by insurance, so patients typically have to pay out-of-pocket to have it specially made at compounding pharmacies.

Advocates worry that the treatment is doomed to be stuck on the periphery of medicine because, as a 50-year-old drug, naltrexone can be made generically.

Patricia Danzon, a professor of health care management at the Wharton School at the University of Pennsylvania, explains that drug companies don’t have much interest in producing a new drug unless they can be the only maker of it.

“Bringing a new drug to market requires getting FDA approval, and that requires doing clinical trials,” Danzon said. “That’s a significant investment, and companies — unsurprisingly — are not willing to do that unless they can get a patent and be the sole supplier of that drug for at least some period of time.”

And without a drug company’s backing, a treatment like low-dose naltrexone is unlikely to get the promotional push out to doctors and TV advertisements that has made household names of drugs like Humira and Chantix.

 “It’s absolutely true that once a product becomes generic, you don’t see promotion happening, because it never pays a generic company to promote something if there are multiple versions of it available, and they can’t be sure that they’ll capture the reward on that promotion,” Danzon said.

The drugmaker Alkermes has had huge success with its exclusive rights to the extended-release version of naltrexone, called Vivitrol. In a statement for this story, the company said it hasn’t seen enough evidence to support the use of low-dose naltrexone to treat chronic pain and therefore is remaining focused on opioid addiction treatment.

Lori Pinkley said it’s frustrating that there are so many missing pieces in the puzzle of understanding and treating chronic pain, but she, too, has become a believer in naltrexone.

She’s been taking it for about a year now, at first paying $50 a month out-of-pocket to have the prescription filled at a compounding pharmacy. In July, her insurance started covering it.

“I can go from having days that I really don’t want to get out of bed because I hurt so bad,” she said, “to within a half-hour of taking it, I’m up and running, moving around, on the computer, able to do stuff.”

A recent review by British researchers found that LDN is safe to use and more clinical studies are needed on its potential uses. PNN readers have shared their positive experiences using LDN to treat Interstitial Cystitis and fibromyalgia.

The LDN Research Trust includes a list of LDN-friendly doctors and pharmacies on its website.

This story is part of a partnership that includes KCUR, NPR and Kaiser Health News, a nonprofit news service covering health issues. KHN is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.

How Awareness Can Help Calm Your Pain

By Dr. David Hanscom, PNN Columnist

Anxiety and anger are major aspects of the chronic pain experience. In this state, your mind is full of racing thoughts and vivid imagery, and it’s hard to focus on anything but you and your pain.

They block your awareness of other’s needs. It becomes a challenge for friends, family, and coworkers – anyone – to connect with you. If you’re touchy and constantly on edge, it’s exhausting for others to be in your presence.

Having a good support system is an important part of your recovery from chronic pain because positive relationships have a calming effect. But now you are driving people away.

Awareness is a powerful and necessary tool in breaking through this barrier. What you are not aware of can and will control you.

I have found it helpful to look at awareness from four different perspectives: environmental, emotional, judgement and ingrained thought patterns.

Environmental awareness is placing your attention on a single sensation – taste, touch, sound, temperature, etc. What you are doing is switching sensory input from racing thoughts to another sensation. This is the basis of mindfulness – fully experiencing what you are doing in the moment.

I use an abbreviated version that I call “active meditation,” which is placing my attention on a specific sensory input for 5 to 10 seconds. It is simple and can be done multiple times per day.  

Emotional awareness is more challenging. It often works for a while, but then it doesn’t. When you are suppressing feelings of anxiety, your body’s chemistry is still off and full of stress hormones. This translates into physical symptoms.

Allowing yourself to feel all of your emotions is the first step in healing because you can’t change what you can’t feel. Everyone that is alive has anxiety. It is how we survive.

Judgment is a major contributor to creating mental chaos in our lives. Dr. David Burns in his book “Feeling Good” outlines 10 cognitive distortions that are a core part of our upbringing. Some of them include:

• Labeling yourself or others

• “Should” thinking – the essence of perfectionism

• Focusing on the negative

• Minimizing the positive

• Catastrophizing

• Emotional reasoning

Becoming aware of these errors in thinking allows you to substitute more rational thought patterns.

Ingrained thought patterns are the most problematic to be aware of. Recent neuroscience research has revealed that thoughts, concepts and ideals become embedded in our brains and are just as real to you as the chair you are sitting in.

That is why people engage in aggressive behavior when their belief systems are challenged. We are all programmed by our past. Your thoughts and beliefs are your version of reality.

Becoming Aware of Your ‘Unawareness’

The first step in becoming aware is realizing that you are unaware. This never ends because there will always be areas of our thinking and behavior that are not consistent with the needs of the situation. 

When I look back on my life’s journey, one of the most disturbing aspects of it is realizing the extent of my unawareness. For instance, when I was in my full-blown obsessive mode, I didn’t have a clue. I recall one time when a friend referred to my “obsessive nature.”  I didn’t know what the word really meant and was certain it didn’t apply to me.

How can you tap into your unawareness? One way is to look for cues in certain behaviors and attitudes, which may mean we’re out of touch with how we’re feeling.  Some examples: 

• Having a rigid opinion about almost anything: religion, politics, someone’s character, etc.

• Being told you are stubborn or “not listening”

• Interrupting someone to offer an opinion before you’ve heard theirs

• Insisting on being right.

• Thinking about something besides what you are doing.

• Judging yourself or others negatively or positively.

• Feeling anxious or angry

• Giving advice when not asked for it

• Thinking you are wiser than your children

• Acting on impulse.

This list is infinite. If one or more resonates with you, it’s probably time to take a step back so that you can respond appropriately to a given person or situation. This is the essence of awareness.

Another clue of unawareness -- not listening -- is one that I discovered with others’ help. My weakness in this area became readily apparent when I attended a parents’ meeting at my daughter’s school.

I will preface this story by saying that I had always considered myself a good listener. It was one of my major personal identities. My wife has not always agreed with that viewpoint. Of course, I did not listen to her.

At the parents’ meeting, we did an exercise where we had to write down on a piece of paper a characteristic that another parent could “work on.”  We could write to two parents anonymously.

Most parents received one or two slips of paper. I received twelve (out of 18) that all said the same thing: “David, you don’t know how to listen.”  

That was a very difficult moment for me. I found it extremely hard to not become defensive. But how could I disagree with 12 people?  I came to accept that they were right, especially in retrospect. It was a trait that I truly could not see. I simply had to trust a group of people who I knew did not have an agenda and had my best interests at heart. 

After that meeting, I came to realize how not listening had interfered with my general awareness. It’s one of the central tenets of awareness: You cannot be aware if you cannot listen.

Practicing Awareness

Understanding and practicing awareness is the first step in reprogramming your brain. It’s the easiest technique to explain and the most difficult to consistently use. Environmental awareness is the foundational first step and spending as much time as possible doing “active meditation.” Regardless of where you are in your journey, being fully aware of stimuli coming into your brain will help calm you down.

When you are ready for the second level of emotional awareness, simply watch your emotions pass by and then pull yourself back into seeing, hearing and feeling, as quickly as possible. It is a little challenging, as emotions often evoke powerful reactions. Training yourself to be with these feelings instead of fighting them is a learned skill and may require some support from a professional.

The third level – judgement -- is a lifetime journey. The key is to be persistent in not judging yourself or others. A good starting point is understanding than whenever you place a positive or negative judgment on someone else, you have simply projected your view of yourself onto the other person. As you become aware of these cognitive distortions, you will be able to regain control of your life.

Remember that in the fourth level of ingrained patterns, it is impossible to see yourself through your own eyes. This is where resources such as psychologists, good friends, spouses, children, and seminars have to be utilized. The key is being willing to listen.

Becoming aware of everyone and everything around you is much more interesting and enjoyable than merely expressing and reinforcing your own views on life day in and day out.  

Dr. David Hanscom is a spinal surgeon who has helped hundreds of back pain sufferers by teaching them how to calm their central nervous systems without the use of drugs or surgery.

In his book Back in Control, Hanscom shares the latest developments in neuroscience research and his own personal history with pain.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

Study: Virtual Reality Can Relieve Severe Chronic Pain

By Pat Anson, PNN Editor

Therapeutic virtual reality (VR) may finally be on the verge of going mainstream. For the first time, research has shown that VR can help relieve a variety of pain conditions and is most effective for severe chronic pain.

 "I believe that one day soon VR will be part of every doctor's tool kit for pain management," says Brennan Spiegel, MD, director of Health Service Research at Cedars-Sinai Medical Center in Los Angeles.

Spiegel is lead author of a new study published in PLOS ONE, which looked at the effectiveness of VR in 120 hospitalized adult patients suffering from neurological, orthopedic, gastrointestinal or cancer pain. All of the patients were being treated with opioid medication and had a pain score of at least three on a 1 to 10 pain scale.

“There’s been decades of research testing VR in highly controlled environments — university laboratories, the psychology department and so on,” Brennan told MobiHealthNews. “This study is really letting VR free and seeing what happens. What I mean by that is it’s a pragmatic study where we didn’t want to control every single element of the study, but literally just see [what would happen] if we were to give it to a broad range of people in the hospital with pain; how would it do compared to a control condition already available in the hospital?”

Half of the patients were given VR goggles with a variety of relaxing and meditative experiences to choose from. They were advised to use the headsets three times a day for 10 minutes — and as needed for breakthrough pain – for three days.

The other participants were instructed to tune their hospital room TVs to a health and wellness channel that offered programs on guided-relaxation, yoga and meditation.

Several times a day, nurses asked all the patients to rate their pain on the pain scale.

The study found that on-demand use of VR resulted in a small but statistically significant improvement in pain scores compared to the TV group, with patients in the VR group averaging 1.7 points lower on the pain scale. VR patients with the most severe baseline pain of 7 or more reduced their pain scores three points lower than the TV group.

"This is our largest and most ambitious VR study to date," Spiegel said. "Our results support previous research that VR can meaningfully reduce pain using a nonaddictive, drug-free treatment for people experience a range of different pain conditions."

In the previous study, patients who watched a 15-minute nature video had a 13% drop in their pain scores, while patients who played an animated game had a 24% decline.

Spiegel says the current study showed that VR can do more than just distract the mind from pain, but may even block pain signals from reaching the brain by overwhelming the brain with visual and audio stimulation.  

Several patients found VR so helpful in managing their pain that they now use it regularly at home. One of them is 70-year old Joseph Norris, a retired Air Force lieutenant colonel, who suffers from chronic pain in his spine, back and hips. Norris started using VR six months ago, and today uses his VR headset once a week to help relax and distract. 

"VR is a tool I use to successfully divert attention away from my pain, and it helps me reinforce my breathing pattern," he said.

There remains a great deal of skepticism about VR, particularly among older patients. Spiegel and his colleagues evaluated nearly 600 patients for the study, but many chose not to participate.

“Patients expressed varying degrees of skepticism, fear, sense of vulnerability, concern regarding psychological consequences, or simply not wanting to be bothered by using the equipment. We believe it is important for the digital health community to recognize that despite the great promise of health technology, clinical realities can undermine expectations,” he wrote.    

Spiegel and his research team are currently involved in a study following patients using VR in their homes for 60 days.

Medicare to Cover Acupuncture in Pilot Program

By Pat Anson, PNN Editor

A week after a federal report documented a significant decline in opioid prescriptions among Medicare beneficiaries, the Centers for Medicare & Medicaid Services (CMS) has taken a tentative step to cover acupuncture as an alternative treatment for chronic low back pain.

Under a CMS proposal, patients enrolled in clinical trials of acupuncture sponsored by the National Institutes of Health (NIH) or in studies approved by CMS would be covered under Medicare’s Part D program. CMS has been collaborating with the NIH in studying acupuncture as a treatment of chronic low back pain in adults 65 years of age and older.

In a statement, CMS acknowledged that while “questions remain” about acupuncture’s effectiveness, interest in the therapy had grown in recent years as a non-drug alternative to opioids.  

Acupuncture is an ancient Chinese form of treatment that involves the insertion of fine needles into various points on the body to alleviate pain and other symptoms.

“Chronic low back pain impacts many Medicare patients and is a leading reason for opioid prescribing,” said CMS Principal Deputy Administrator of Operations and Policy Kimberly Brandt. “Today’s proposed decision would provide Medicare patients who suffer from chronic low back pain with access to a nonpharmacologic treatment option and could help reduce reliance on prescription opioids.”

Currently, acupuncture is not covered by Medicare. CMS is inviting public comment on the proposal to gather evidence and help determine if acupuncture is appropriate for low back pain. Comments will be accepted through August 14.

“Defeating our country’s epidemic of opioid addiction requires identifying all possible ways to treat the very real problem of chronic pain, and this proposal would provide patients with new options while expanding our scientific understanding of alternative approaches to pain.” said Health and Human Services Secretary Alex Azar.

Spending on Opioids Peaked in 2015

Medicare Part D spending on opioid prescriptions has been falling for years. It peaked in 2015 at $4.2 billion and now stands at its lowest level since 2012, according to a report released last week by the HHS Office of Inspector General.

The decline in opioid prescriptions appears to be accelerating. Last year, 13.4 million Medicare beneficiaries received an opioid prescription, down from 14.1 million in 2017.

SOURCE: HHS OFFICE OF INSPECTOR GENERAL

The Inspector General identified over 350,000 Medicare patients as receiving high amounts of opioids, with an average daily dose great than 120 MME (morphine milligram equivalent) for at least three months. The CDC opioid guideline recommends that daily doses not exceed 90 MME.  

The report highlighted the case of an unnamed Pennsylvania woman who received 10,728 oxycodone tablets and 570 fentanyl patches in 2018. Her average daily dose was 2,900 MME. She received all of her opioid prescriptions from a single physician.

The report said there were 198 prescribers who “warrant further scrutiny” because they ordered high doses of opioids for multiple patients.

“Although these opioids may be necessary for some patients, prescribing to an unusually high number of beneficiaries at serious risk raises concerns. It may indicate that beneficiaries are receiving poorly coordinated care and could be in danger of overdose or dependence,” the report found.  “Prescribing to an unusually high number of beneficiaries at serious risk could also indicate that the prescriber is ordering medically unnecessary drugs, which could be diverted for resale or recreational use.”

Under a new federal law, CMS is required to identify and warn “outlier prescribers of opioids” on an annual basis about their prescribing patterns. Medicare insurers could also require high-risk patients to use selected pharmacies or prescribers for their opioid prescriptions.

FDA Clears Ear Device for IBS Pain

By Pat Anson, PNN Editor

The U.S. Food and Drug Administration has cleared for marketing the first medical device to treat abdominal pain in patients 11-18 years of age with irritable bowel syndrome (IBS).

The IB-Stim device is made by Innovative Health Solutions and is only available by prescription. It uses neuromodulation to stimulate cranial nerves around the ear to provide relief from IBS, a condition affecting the large intestines that causes abdominal pain and discomfort during bowel movements.

The battery powered device is placed behind the patient’s ear — much like a hearing aid — and emits low-frequency electrical pulses that disrupt pain signals. It is intended for use up to three consecutive weeks.  

“This device offers a safe option for treatment of adolescents experiencing pain from IBS through the use of mild nerve stimulation,” said Carlos Peña, PhD, director of the FDA’[s Office of Neurological and Physical Medicine Devices.

The FDA reviewed data from a placebo controlled study published in The Lancet that included 50 adolescent patients with IBS. During the study, patients were allowed to continue using medication to treat their abdominal pain. Most had failed to improve through the use of drugs.

IB-Stim treatment resulted in at least a 30% decrease in pain after three weeks in 52% of the treated patients, compared to 30% of patients who received the placebo. Six patients reported mild ear discomfort and three had an allergic reaction caused by an adhesive at the site of application.

IMAGE COURTESY OF INNOVATIVE HEALTH SOLUTIONS

Innovative Health Solutions is not disclosing any details about the potential cost of an IB-Stim or where it will be available.

“We are still working to finalize our pricing structure,” Ryan Kuhlman, National Director of Innovative Health Solutions, said in an email. “There are many factors that go into the final contract price with a hospital and will likely vary from hospital to hospital. We do want to make this treatment available and affordable as we work towards favorable insurance coverage.”  

The FDA reviewed the IB-Stim through a regulatory pathway for low- to moderate-risk medical devices. Clearance of the device creates a new regulatory classification, which means that similar devices for IBS may be cleared if they are substantially equivalent to an approved device. Similar ear devices have been cleared by the FDA to treat symptoms of opioid withdrawal and for use in acupuncture.

IBS is a group of symptoms that include chronic pain in the abdomen and changes in bowel movements, which may include diarrhea, constipation or both. A 2018 study found that hypnosis relieves pain in about a third of IBS patients.

The Hidden Benefits of Glucosamine

By Pat Anson, PNN Editor

Do you take glucosamine supplements to reduce joint pain and stiffness? You’re not alone if you do. According to a 2007 survey, nearly 20 percent of U.S. adults take glucosamine to prevent or treat pain from osteoarthritis, back pain and other conditions.

The evidence to support the use of glucosamine for joint pain is thin, but a large new study in The BMJ suggests regular use of the supplement can reduce the risk of cardiovascular disease.

Researchers at Tulane University analyzed 7 years of extensive health data for almost half a million adults aged 40 to 69 enrolled in the UK Biobank study. Those who regularly took glucosamine were about 15% less likely to develop heart disease or have a stroke.

Glucosamine occurs naturally in the fluid around joints and plays an importantly role in building cartilage. Glucosamine is extracted from shellfish and is often combined in supplements with chondroitin, a similar substance that is also found in joints.

People who took glucosamine in the BMJ study were more likely to be women, older, more physically active, have healthier diets and take other supplements.

Over the course of seven years, 2.2% of those who did not use glucosamine had a heart attack or stroke, compared to 2.0% of people who did use glucosamine. People who used glucosamine were also less likely to die from a heart attack or stroke, 0.5% vs. 0.7% of those who didn’t use the supplement.

The difference doesn’t appear to be significant, but when adjusted for risk and other factors, it means that glucosamine users had a 22% lower risk of dying from a heart attack or stroke.

For smokers, the benefits of regular glucosamine use were even greater. They had 37% less risk of having coronary heart disease compared to smokers who didn’t use the supplements.

Researchers didn’t establish the reason why glucosamine lowers the risk of cardiovascular disease (CVD), but they believe the supplements help reduce inflammation – one of the main factors involved in the development of heart disease, as well as chronic pain.

“Several potential mechanisms could explain the observed protective relation between glucosamine use and CVD diseases. In the National Health and Nutrition Examination Survey (NHANES) study, regular use of glucosamine was associated with a statistically significant reduction in C reactive protein concentrations, which is a marker for systemic inflammation,” researchers reported. “Other mechanisms might also be involved, and future investigations are needed to explore the functional roles of glucosamine in cardiovascular health.”

The UK’s National Health Service (NHS) downplayed the study findings, pointing out the cardiovascular benefits of glucosamine are “quite small.”

“If you want to reduce your risk of having a heart attack or stroke, it would be much better to concentrate on living a healthy lifestyle, rather than paying for glucosamine supplements,” the NHS said.