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8 Articles in Volume 8, Issue #7
Class IV Therapy Lasers Maximize Primary Biostimulative Effects
Functional Restoration and Complex Regional Pain Syndrome
Hamular Process Bursitis
Longitudinal Study of Long-term Opioid Patients
Omega-3 Fatty Acids and Neuropathic Pain
Osteopathic Manipulative Medicine (OMM) for Lower Back Pain
Pain Care for a Global Community: Part 2
Practical Application of Neuropostural Evaluations

Omega-3 Fatty Acids and Neuropathic Pain

Case studies demonstrate that oral intake of omega-3 polyunsaturated fatty acids from pharmaceutical-grade fish oil supplements results in pain reduction and functional improvement in patients with neuropathic pain.
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Because of the “blood-thinning” effects of omega-3, we usually advise patients to stop such supplements, as well as herbal products such as ginkgo, curcumin, ginger, two weeks prior to any surgery, dental work, and invasive procedures such as a colonoscopy.

Lab work should be done to follow patients on high dose omega-3. This includes markers of “silent inflammation” and include the Arachidonic acid to Eicosapentaenoic acid ratio (AA:EPA ratio). The average North American ratio is 12:1. An optimal ratio for cardiovascular health is 1.5-3:1. Excess intake of omega-3 with a ratio of 0.5:1 is associated with an increased risk for hemorrhagic stroke. Unfortunately, such lab testing is expensive (about $130 ) and most of our patients did not undergo such testing unless they were taking extremely high doses—7.5 gm EPA/DHA or more per day. Testing is available at a lab such as Nutrasource Diagnostics, Inc., Ontario, Canada. This lab measures the serum phospholipid levels which is more accurate, and more studied, than red blood cell (RBC) levels. Other useful lab tests to detect silent inflammation include the HS-CRP (optimal levels are <1.0), fasting insulin (optimal is <10 uIU/ml) and TG:HDL ratio (optimal is <2). The references and research for this are summarized nicely in chapters 4 and 7 in the “Anti-inflammation Zone” book by Barry Sears, PhD.25

It is important to recommend a high quality brand of omega-3. Patients are taught to read labels and ensure that products have good potency—one gets more for the money in a capsule or teaspoon that has a higher concentration of EPA/DHA—and has been tested for impurities. Websites such as the www.ifosprogram.com will list omega-3 products that have been independently lab tested for contaminants such as heavy metals—including mercury—PCBs, and dioxin. The standards set by IFOS for ultra-refined EPA/DHA concentrate are very rigorous with upper limits set as follows: mercury <10 parts per billion (ppb), pcbs <45 ppb, dioxins <1 part per trillion, total oxidation <13 meq/L.

Our preferred products, based on purity and patient compliance (taste), are the SuperEFA liquid (Seroyal Inc) and the See Yourself Well capsules (Nutratec). A recommended conservative dose is 2700mg of EPA + DHA, based on the Goldberg meta-analysis. However, a more aggressive approach for more severe pain can be up to 7500mg EPA+DHA. The latter approach will require serum lab tests to monitor the AA:EPA ratio.

For patients who experience stomach difficulties or nausea from the use of omega-3, we usually advise them to try freezing the capsules. A better response occurs with enteric coated capsules for which we recommend the Metagenics’ EPA-DHA extra strength product. Digestion is better when omega-3 are taken with food. It is also useful to split the dosage through several meals instead of all at once.

Instruct patients clearly to take only omega-3 and not omega-3-6-9. As noted earlier, the omega-6’s are pro-inflammatory and the use of such products will not help in ameliorating pain. Omega 6’s are essential but, in the typical North American diet, an excess of this is already ingested.

Remember that omega-3 FA are just one component of an overall integrative medical approach in treating pain and optimizing wellness. Patients must learn to improve their diets and reduce arachidonic acid sources such as too much red meat and fried foods. Diets that are deficient in vitamin B6, magnesium, zinc and have excessive trans-fatty acids, caffeine will have impaired delta-6 desaturase activity (needed to convert alpha-linolenic acid in the pathway towards EPA). We often combine omega-3 FA and other nutraceuticals with judicious courses of anti-inflammatory drugs (celecoxib)26 for post-surgical and post-musculoskeletal trauma. For severe neuropathic pain (NRS pain >6/10), we combine omega-3 FA with pregabalin. For opioid-resistant neuropathic pain, pharmaceutical cannabinoids are also helpful (nabilone, sativex spray).

Long-lasting lifestyle changes need to be adopted to ensure long-term relief of pain. This includes appropriate exercise, both cardio and core strengthening, weight-loss, stress reduction (prayer, meditation, humor), and good sleep hygiene. Efforts to detoxify the body of unhealthy “toxic” substances, such as trans-fats, and unhealthy “talk-sick” attitudes and behaviour are all important.

Conclusion

Case studies using omega-3 FA supplementation for neuropathic pain—in a variety of patient presentations—has demonstrated the efficacy of this modality. While pain questionnaires were utilized in documenting outcome measures, further research in the way of randomized double-blind controlled trials would be needed to validate the use of omega-3 fatty acids for neuropathic pain. We hope this article will stimulate such research and lead to greater pain-free wellness in our patients. n

Last updated on: December 20, 2011
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