Omega-3 Fatty acids (fish oil) as an anti-inflammatory: an alternative to nonsteroidal anti-inflammatory drugs for discogenic pain
Maroon JC and Bost JW, Surgical Neurology, 65 : 326-311 (2006).
Department of Neurological Surgery, University of Pittsburgh Medical Centre, Pittsburgh, PA
The authors evaluated the effect of supplementation with fish oil containing DHA/EPA omega-3 fatty acids in 250 patients who had been seen by a neurosurgeon and found to have nonsurgical neck or back pain. Pain symptoms including joint pain was assessed by questionnaire. The majority of the patients had degenerative disease and were already taking NSAIDs (non-steroid anti-inflammatory drugs) which are discogenic spine pain (with 75 percent of the subjects on COX 2 inhibitors). The patients were asked to take omega-3 fatty acids (pharmaceutical-grade fish oil containing DHA plus EPA) at a dose of 2.4 g (DHA/EPA combined) for two weeks and then 1.2 g thereafter. After the initial two week period, they were instructed to taper off on their NSAIDs over 1-2 weeks. The average duration of time on DHA/EPA supplementation was 75 days. Supplementation with DHA/EPA omega-3 fatty acid was found to yield the following findings: 1) most patients (59%) stopped their NSAIDs and pain medicines after a 2 month period on fish oil. 2) the majority (60%) had less pain symptoms. 3) joint pain improved in 60% of the respondents. 4) 80% indicated satisfaction with fish oil supplementation containing DHA/EPA. The authors concluded that ‘… fish oil supplements appear to be a safer alternative to NSAIDs for treatment of nonsurgical neck or back pain in this select group'.
Dr. Holub's Comments:
This open trial which strongly supports the possible alternative use of appropriate levels of DHA/EPA omega-3 as an alternative to nonsteroidal anti-inflammatory drugs for discogenic pain is certainly deserving of follow up clinical trials. Future randomized controlled trials (placebo-controlled) in the target population (patients having nonsurgical neck or back pain) are warranted. The levels of DHA/EPA consumed daily in providing the apparent pain relief ranged from 1200 mg-2400 mg; these intake levels are below the optimal safe intake indicated by the Food and Drug Administration (3000 mg DHA/EPA combined per day from all sources).
It should be pointed out, that Dr. J. I. Ausman (MD, PhD and Editor of Surgical Neurology) concluded in an editorial (Surgical Neurology, 65:325 (2006)) entitled ‘Why Omega-3 Fatty Acids are Important to Neurosurgeons' gave the following statement: “The importance of this work to neurosurgeons is that now there is an analgesic agent that can take the place of the COX-2 inhibitors and be used with no side effects.”