Surgical Neurology 2006 (Apr); 65 (4): 326–331
Maroon JC, Bost JW
Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. firstname.lastname@example.org
Editorial Commentary: Chiropractors are the leading profession in the successful treatment of “Nonspecific” neck or Back Pain. Nonspecific pain usually refers to pain caused by a tissues like a muscle or a ligament. This article is remarkable in that neurosurgeons looked for a conservative approach to treating pain. It is well known that NSAIDS are dangerous, killing more than 16,500 individuals per year. It is delightful to see medical doctors looking to reduce that risk of iatrogenic complications by utilizing omega-3 fatty acids as a safe alternative for pain treatment!
BACKGROUND: The use of NSAID medications is a well-established effective therapy for both acute and chronic nonspecific neck and back pain. Extreme complications, including gastric ulcers, bleeding, myocardial infarction, and even deaths, are associated with their use. An alternative treatment with fewer side effects that also reduces the inflammatory response and thereby reduces pain is believed to be omega-3 EFAs found in fish oil. We report our experience in a neurosurgical practice using fish oil supplements for pain relief.
METHODS: From March to June 2004, 250 patients who had been seen by a neurosurgeon and were found to have nonsurgical neck or back pain were asked to take a total of 1200 mg per day of omega-3 EFAs (eicosapentaenoic acid and decosahexaenoic acid) found in fish oil supplements. A questionnaire was sent approximately 1 month after starting the supplement.
RESULTS: Of the 250 patients, 125 returned the questionnaire at an average of 75 days on fish oil. Seventy-eight percent were taking 1200 mg and 22% were taking 2400 mg of EFAs. Fifty-nine percent discontinued to take their prescription NSAID medications for pain. Sixty percent stated that their overall pain was improved, and 60% stated that their joint pain had improved. Eighty percent stated they were satisfied with their improvement, and 88% stated they would continue to take the fish oil. There were no significant side effects reported.
CONCLUSIONS: Our results mirror other controlled studies that compared ibuprofen and omega-3 EFAs demonstrating equivalent effect in reducing arthritic pain. Omega-3 EFA fish oil supplements appear to be a safer alternative to NSAIDs for treatment of nonsurgical neck or back pain in this selective group.
KEY POINTS from Dan Murphy, D.C.
1) The use of NSAID’s is associated with extreme complications, including gastric ulcers, bleeding, myocardial infarction, stroke, and even death.
2) In this study, after seventy-five days on fish oil, 59% of patients who were taking NSAID’s for chronic spinal pain and who had degenerative spine disease were able to discontinue their prescription NSAID’s, and 88% stated they were satisfied with their improvement and that they would continue to take the fish oil.
3) In this study, fish oil supplementation was not associated with any significant side effects.
4) “Omega-3 EFA fish oil supplements appear to be a safer alternative to NSAID’s for treatment of nonsurgical neck or back pain.”
5) “More than 70 million NSAID prescriptions are written each year, and 30 billion over-the-counter NSAID tablets are sold annually.” [Notice: 30 BILLION over-the-counter NSAID tablets are sold annually.]
6) “5% to 10% of the adult US population and approximately 14% of the elderly routinely use NSAID’s for pain control.”
7) Selling NSAID’s is a 9 billion dollar per year US industry.
8) Prescription NSAID’s for rheumatoid and osteoarthritis, alone, conservatively cause 16,500 deaths per year.
9) “NSAID’s are the most common cause of drug-related morbidity and mortality reported to the FDA and other regulatory agencies around the world.”
10) “The agent best documented by hundreds of references in the literature for its anti-inflammatory effects is omega-3 EFA’s found in fish and in pharmaceutical-grade fish oil supplements.”
11) The beneficial anti-inflammatory effects of high-dose fish oil include the reduction of joint pain from rheumatoid and osteoarthritis, improvement in dry eyes and macular degeneration, reduced plaque formation, reduced arrhythmias, and reduced infarction from coronary arthrosclerosis.
12) Both natural and synthetic corticosteroids decreased healing capabilities, decreased the normal immune response, and have significant bone and gastric side effects.
13) COX-2 inhibitors significantly increase gastric and cardiovascular side effects.
14) Omega-3 DHA and EPA are used to make the anti-inflammatory eicosanoids (Prostaglandin E3: PG3), whereas excess omega-6 EFA’s form inflammatory arachidonic acid based eicosanoids (Prostaglandin E2: PG2).
15) “Animal proteins, especially red meat, also contain an abundant amount of arachidonic acid.”
16) A deficiency in omega-3 fatty acids, especially EPA and DHA, will result in a deficiency of anti-inflammatory prostaglandins.
17) The delta-5 desaturase enzyme is the gatekeeper to inflammation and is increased from elevated levels of insulin [from being diabetic, consuming refined carbohydrates, or consuming any high fructose corn syrup].
18) “To encourage the production of anti-inflammatory PG’s and to discourage the production of inflammatory PG’s, saturated fats, trans-fatty acids, and arachidonic acid should be reduced in the diet; blood glucose should be controlled; and appropriate amounts of omega-3 fatty acids found in fish oils should be consumed.”
19) Omega-3 supplementation is safe and effective for many inflammation-related conditions and has a low incidence of side effects.
20) NSAID’s inhibit the effectiveness of fish oil in producing anti-inflammatory prostaglandins.
21) “The US Department of Agriculture has limited fish consumption to one fish serving per week in adults and even less in children and pregnant women because of the concern of toxic contaminants, such as mercury, polychlorinated biphenyls, and dioxin in our fish population.”
22) These authors did not recommend the fish oil for those on anticoagulants or fish-related allergies, but noted “aspirin use was not a contraindication.” The ratios of the various omega-3 essential fatty acids is important (ALA/EPA/DHA plus GLA, etc.).
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