THURSDAY, Feb. 21 (HealthDay News) -- People who take more than one nonsteroidal anti-inflammatory drug (NSAID) may have poorer health-related quality of life, a U.S. study suggests.

NSAIDs, which are available in both prescription and over-the-counter (OTC) forms, are commonly used to treat arthritis.

These drugs are widely available, and patients may take both prescription and OTC NSAIDs at the same time, either because they need more pain relief or because they don't realize the products belong to the same class of drugs, said the study authors, who added that doctors may not know their patients are taking more than one NSAID.

This study, led by Stacey H. Kovac of Durham VA Medical Center and Duke University in North Carolina, included 138 patients enrolled in a large regional managed-care organization. All of the patients had filled at least one NSAID prescription between February and August 2002.

The researchers found that 26 percent of the patients reported taking at least two NSAIDs (prescription, OTC or both) during the previous month. These dual users scored lower than others on the physical component of a questionnaire designed to evaluate physical and mental health.

Keeping a complete list of a patient's medications would help doctors identify patients who are taking more than one NSAID, the study authors said.

"The increased awareness may lead to better communication between the patient and provider about the appropriate use of NSAIDs," they wrote.

Patients who take more than one NSAID may do so because of inadequate clinical pain management or because they have higher levels of pain than other patients, said the researchers. Future research should examine factors that may lead to dual NSAID use and methods of identifying patients taking two or more NSAIDs and may be at higher risk of adverse side effects from the drugs.

"Adequate pain management may have the potential to reduce dual use, improve patient symptoms, including physical functioning, and reduce patient safety problems," the researches concluded.

The study was published in the February issue of Arthritis Care & Research.

More information

The U.S. Centers for Disease Control and Prevention has more about arthritis.

WEDNESDAY, Feb. 20 (HealthDay News) -- The largest study of its kind concludes that surgery is better than nonsurgical treatments for spinal stenosis, a painful narrowing of the spine that stems from the normal deterioration that accompanies aging.

People who underwent an operation showed more improvement in pain, function, satisfaction and self-rated progress than those who received the typical, nonsurgical care.

But the procedure should not be overused, warned the authors of the study, which is published in the Feb. 21 issue of the New England Journal of Medicine.

"We don't want people to surmise that because this works, all spine surgery is good," said study author Dr. James Weinstein, chairman of the department of orthopedics at Dartmouth Medical School, in Lebanon, N.H. "These people all had very specific physical findings and diagnostic criteria. In these specific cases, this is a good operation. This is not a back pain operation."

Although surgery to correct the condition is common, particularly among those over the age of 65, Weinstein noted there was little objective evidence on the effectiveness of such a procedure.

"Studies have not been done in a way that might be generalizable or usable for the rest of country," Weinstein said.

The study involved two groups of patients: 289 who were randomized to receive surgery or usual nonsurgical care (physical therapy, education or counseling with home exercise instruction, and non-steroidal anti-inflammatory drugs if indicated), and 365 who did not want to be randomized and so were assigned to an "observational" group. In all, 13 clinics in 11 states were involved.

All participants had had at least 12 weeks of symptoms of spinal stenosis, without spondyloisthesis (when a vertebra in the lower part of the spine slips), as confirmed by imaging.

After two years, two-thirds of patients who had been randomly assigned to surgery had actually undergone surgery, while 43 percent of those in the nonsurgical group had also undergone surgery.

Surgery was twice as effective as nonsurgical treatment in addressing symptoms and improving actual function. Some improvements were seen as early as six weeks post-surgery, reaching their peak at six months and continuing for two years.

"I was hoping as a spine surgeon that it really worked, and we found that it did," Weinstein said. "It looks like from our results that surgery is better than non-surgery."

"People who received nonsurgical care did a little better, but not a lot. They pretty much stayed the same," Weinstein said. "Operative patients get a lot better, comparatively."

But there's an argument for both approaches. "One thing I learned is there's still a choice," Weinstein said. "Nobody got worse with or without surgery."

Another expert applauded the research.

"This study confirms what surgeons have felt all along," said Dr. Mark D. Rahm, assistant professor of surgery at Texas A&M Health Science Center College of Medicine. "It points out that people who are symptomatic enough to want to do surgery can feel good about the fact that it will likely improve their overall condition."

More information

The American Academy of Orthopaedic Surgeons has more on spinal stenosis  .

MONDAY, Feb. 18 (HealthDay News) -- Glucosamine sulfate, a popular dietary supplement purported to ease the pain and inflammation of arthritis, does not seem to help people with arthritis in their hips.

That's the conclusion of a study that compared the use of glucosamine to a placebo for the treatment of mild to moderate hip arthritis.

"For these patients with hip osteoarthritis, glucosamine sulfate does not seem to be an effective treatment on the basis of our results," said study author Rianne Rozendaal, a researcher at Erasmus Medical Center in Rotterdam, The Netherlands.

Not everyone is so certain that glucosamine isn't useful though.

"This study is not definitive. This is the first one specific on hip osteoarthritis, and only subgroups of patients improved. So, no confirmation, but no refuting either," said Dr. Johannes W.J. Bijlsma, the author of an accompanying editorial and chair of the department of rheumatology and clinical immunology at the University Medical Center Utrecht, in The Netherlands.

Results of the study appear in the Feb. 19 issue of the Annals of Internal Medicine.

As many as one in five Americans has been diagnosed with arthritis, according to the U.S. Centers for Disease Control and Prevention, and arthritis is the leading cause of disability in the United States.

While lifestyle interventions, such as exercising, can help prevent some of the disability associated with arthritis, few effective medical interventions are available. That may explain why people with arthritis turn to unproven remedies in the hope that these products might ease the pain in their aching joints.

Glucosamine sulfate is one such product, but clinical trials of the supplement have had mixed results. For every study that finds a benefit, it seems there's another that finds none. However, no studies had been done looking specifically at glucosamine's usefulness for arthritis of the hip, according to Rozendaal.

This double-blind randomized study included 222 people who had mild to moderate osteoarthritis of the hip. For two years, half the group took 1,500 milligrams of glucosamine daily and the other half took a placebo.

Pain and function levels were measured at the start of the study, and again every three months for two years. X-rays of the affected joint were taken at the start and end of the study to see if there was any improvement.

At the end of the study, the researchers found no evidence that glucosamine had any effect on pain or function, and they saw no improvement in the X-rays for people taking glucosamine. The researchers also conducted a small subgroup analysis on people with more severe arthritis, and found no benefit for this group either.

But an industry expert said the study contained what he called a "glaring error:" many of the patients had very low levels of daily pain.

"In other words, they don't have much room for improvement," said Dr. Jason Theodosakis, a consultant for the supplements industry and an assistant professor at the University of Arizona College of Medicine, Tucson.

"Patients with arthritis who have small amounts of pain -- not significant enough to inhibit sleeping, daily activities or work -- do fine without treatment. This is exemplified by the fact that only 19 percent of those in the placebo group were using daily medications," Theodosakis added. "I don't think conclusions should be drawn from the study."

Bijlsma agreed that the verdict is still out on glucosamine's effectiveness. Some studies have found that glucosamine is effective for knee arthritis, he noted, and because there are no good treatment options available for people with arthritis, Bijlsma said that taking glucosamine should remain an option for patients.

"I advise them to use it for three months; if they experience improvement, I advise them to continue. If there is no improvement, I advise them to stop. I'm aware that a lot of the osteoarthritis problems for patients are indeed symptoms [pain, stiffness] that are subjective, but patients can decide for themselves. In practice, between 60 and 70 percent of the patients continue this treatment for a more prolonged period of time," Bijlsma said.

More information

To learn more about osteoarthritis and available treatments, visit the U.S. National Institute of Arthritis and Musculoskeletal Diseases.