There has been increasing interest in and use of alternative or complementary medicines in recent times, which is somewhat paradoxical given the scientific advances in understanding and treating disease made during this period.

Many surveys show patients with musculoskeletal diseases frequently use complementary therapies and this is not restricted to any particular disease category or type of patient. Interest in complementary medicine probably relates to factors such as dissatisfaction with conventional therapy and/or medical attitudes, a need for more sense of control and a belief that complementary therapies are natural and therefore at worst harmless.

Adjustment to chronic illness is ultimately personal. It incorporates an individual’s background, personality and philosophy as well as access to care and information, social support etc. It can be difficult to integrate all these individual factors into a modern medical encounter, and this may cause frustration for the patient (it can be frustrating for the doctor too!).

However, illnesses are defined events with causes, mediators and outcomes, each of which can eventually be understood in rational terms, leading to prevention or treatment. Sometimes progress is frustratingly slow, but scientific inquiry is the best long-term approach because it allows generalisations to be made in a way that will help most, or even all people with a particular condition. In the past, conventional medicine grew out of empirical observations, some of which have stood the test of time. Conventional medicine has sometimes adopted some spectacularly misguided ideas, and at others has certainly been guilty of unscientific practice (as well as irrationally dismissing unorthodox views!).

Lessons have been learned and progress has been made. Modern scientific inquiry demands objective proof and places less weight on opinion and anecdote � this is the essence of the double blinded (neither patient nor doctor know which treatment is being used), randomised (allocation to treatment group is random) clinical trial, which conventional medicine now relies on.

Some areas of complementary medicine are now subjecting their treatments to the same standard of proof. This is very important because studies consistently show major ‘placebo effects’ (of the order of 20 � 30%) in treatment trials for patients with musculoskeletal diseases.

Another major problem with some complementary medicines is chemical composition and purity. Whilst this can be tied up with the appeal of using something perceived as ‘natural’, an administered agent which has effects on the body is by definition a drug and can therefore have unintended side effects. Because these agents are not marketed as drugs, they are not subject to the same controls over manufacturing, testing of absorption and availability within the body etc. This may in fact make it more difficult to demonstrate any positive effects from a complementary medicine, because the active ingredient(s) may vary enormously between preparations.

What follows are references to recent assessments of some commonly used complementary therapies for musculoskeletal disorders, using the above philosophical framework:

  • Glucosamine (a so called ‘neutraceutical’) seems to be modestly effective (equivalent to some commonly used NSAIDs) for relieving symptoms of and perhaps reducing the rate of cartilage loss in osteoarthritis. (Glucosamine therapy for treating osteoarthritis. Cochrane Database Syst Rev 2001;1:CD002946)
  • Vitamin E is ineffective for symptomatic relief of osteoarthritis of the knee: a six month double blind randomised placebo controlled study. (In press Annals of Rheumatic Diseases)
  • Fish oils containing N3 polyunsaturated fatty acids are anti-inflammatory and reduce symptoms of RA. (Dietary n-3 fatty acids and therapy for rheumatoid arthritis. Semin Arthritis Rheum. 1997 Oct;27(2):85-97).
  • Tetracycline antibiotics (minocycline and tetracycline) have modest effects in rheumatoid arthritis