Are you having back pain with any of the following?

  • Severe pain, weakness or tingling in your leg(s).
  • Difficulty stopping urination or loss of control of bladder or bowels.
  • Unexplained fever, nausea or vomiting.
  • A history of cancer or unexplained weight loss.

We understand that you are experiencing one or more of the health issues that might be impacting your back pain.

We recommend that you discuss these health issues with your doctor before proceeding with this program.

Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.

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Complementary and Alternative Medicine (CAM)

Some people prefer treatment options that complement traditional medicine such as acupuncture or herbal supplements that can help you stay healthy, feel better, and manage medical problems safely. To ensure the best possible treatment, please talk to us about your options.


Glucosamine sulfate and chondroitin are supplements that were thought to be helpful for joints, but newer research shows that chondroitin does not relieve joint pain. It is also unclear if glucosamine helps osteoarthritis knee pain or pain in other joints.  

Both substances are found naturally in the body's tendons, ligaments, cartilage, and other tissues.

Glucosamine in supplements often comes from shellfish (crab, lobster, and shrimp). Chondroitin is usually from bovine (cow) sources. They can also be manufactured.

Side Effects

Side effects from both glucosamine and chondroitin are rare, but you may experience:

  • Nausea
  • Indigestion
  • Heartburn
  • Diarrhea
  • Constipation
  • Drowsiness
  • Headache

Depending on whether you're using glucosamine or chondroitin, you may experience some additional side effects.


After taking glucosamine, some people have reported skin rashes, in addition to the general side effects.

Some studies found that you might have more trouble controlling your blood sugar when taking glucosamine.

Also, glucosamine is sometimes made from shellfish products. If you are allergic to shellfish, you may have an allergic reaction to the glucosamine supplements as well.


While chondroitin is generally well tolerated, it may cause these additional side effects:

  • Abdominal pain
  • Eyelid edema
  • Lower limb edema (swelling)
  • Hair loss
  • Blood thinning

If you have prostate cancer or an increased risk for prostate cancer, we may recommend avoiding the use of chondroitin. It may increase the spread or the return of the disease.

In addition, according to the Natural Medicine Database, glucosamine and chondroitin can both interact strongly with Warfarin, so ask your doctor before use. 

Note how these supplements affect your pain by keeping a pain diary. If you have side effects, write them down and share this information with us.

Safety and Quality Issues

Many people think that because an herb is natural, it must be safe. However, anything that is strong enough to affect your health is also strong enough to have side effects. In fact, some herbs can cause sickness and even death.

It's important to know the facts about all of your medications, including natural products. We  work with the Natural Medicines Comprehensive Database to provide you with recent information so you can better understand dietary supplements, including:

  • Herbal remedies
  • Vitamins
  • Minerals
  • Other natural products

Before beginning any herbal treatment, talk to your doctor or other medical professional. They will be able to tell you if your treatment helps or interferes with other medications or with your treatment plan.

Our pharmacies carry only herbs and supplements known to be effective in treating certain medical conditions.

Regulation of Herbs and Supplements

In the United States, herbs are not regulated by the Food and Drug Administration (FDA). This means that they are not tested for safety or purity by manufacturers. The amount of any herb in a product can range from 0 to 150 percent of the amount shown on the label. The herb in the bottle may even be different from the herb on the label.

You should be aware of these risks with herbal supplements:

  • Toxicity. Certain herbs can make you sick.
  • Contamination. The herb (or a pesticide used on the herb) may make you sick.
  • Impurity. Herbs imported from other countries may have prescription drugs added to them.
  • Incorrect dosage. You may be getting less – or more – of an ingredient than the label shows, even if it uses the word “standardized” or “certified.” 

However, if a product has the U.S. Pharmacopeial stamp (USP), this means the dietary supplement has passed rigorous testing and contains the ingredients listed on the label, and in the stated strength and amounts. It also does not contain harmful levels of ingredients and is made according to FDA and USP Good Manufacturing Practices by using sanitary and well-controlled processes.  

To manage your health, you need to be informed. We strongly recommend that you talk to your doctor before taking herbs or supplements.

Before You Use Herbs and Supplements

We recommend that you talk to us before taking any herbs or supplements. You can talk to us in person, by email, or by visiting your nearest Health Education Department. 

Before using herbs or supplements, you should think about these risks:

  • Some herbal supplements can interact with prescription and over-the-counter medicines.
  • Pregnant or nursing women should be especially careful when using herbal supplements. This also applies if giving them to children.

The Natural Medicines Comprehensive Database provides information about when to get medical care and when it's safe to self-treat. You can access this website on your physicians’ home page on My Doctor Online.

Keep in mind that information about the safety and effectiveness of herbal supplements can change. To check for recent updates, please visit the Herbs at a Glance series online at

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If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder. This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.

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