Over 100 million Americans have chronic pain. Common treatments for pain include medications and procedures that can have significant side effects and risks. Lifestyle, activity and dietary modifications represent a relatively safe and potentially effective means of reducing painful symptoms. Specifically, dietary modifications including consumption of fish or fish oil supplements with omega-3 long chain fatty acids DHA (docosahexaenoic acid) and EPA (eicosapentaenoic acid) have the potential to reduce pain from inflammation.
DHA and EPA are fats naturally found in fish that can increase the anti-inflammatory chemicals within your body. The typical American diet is high in omega-6 fatty acids and these fats can actually increase inflammation. Increasing the consumption of foods high in omega-3 long chain fatty acids can displace those foods high in omega-6 fatty acids. Additionally, supplementation with fish oil containing DHA and EPA can compete with these potentially inflammatory fatty acids to reduce the overall inflammatory state of our bodies. Several studies have demonstrated daily use of the long chain omega-3 fatty acids: EPA and DHA, resulted in decreased pain complaints in patients with osteoarthritis and rheumatoid arthritis.
Mackerel, salmon, anchovies, lake trout, herring, sardines, and canned light tuna are examples of fish high in DHA and EPA. Fish oil supplements are an alternative source of these fatty acids. Over the counter supplements can contain a wide range of concentration of DHA and EPA depending on the preparation. Such supplements typically come in a liquid or capsule form and both forms can contain high concentrations of DHA and EPA. There is no clear evidence to support the health benefit of any form over the other. The majority of studies utilized a combination of DHA and EPA totaling 1-12 grams per day. These studies averaged daily doses between 2-4 grams total of DHA, EPA or a combination of the two. The best ratio and concentration of DHA and EPA for treatment of pain has not been established.
Fish oil supplements high in DHA and EPA have demonstrated relative safety. They are commonly prescribed by physicians for their association with reducing heart disease. Mercury toxicity has been raised as a potential concern when consuming fish or fish oil on a daily basis. Frequent consumption of shark, swordfish, tilefish and king mackerel should be avoided for this reason. Bleeding is another rare but serious side effect associated with the consumption of high doses of fish oil. Caution should be used if you are on blood thinning medication or have a bleeding disorder. Your doctor should be consulted prior to beginning supplementation with fish oil.
There is a growing body of research supporting the use of the omega-3 long chain fatty acids, EPA and DHA. The Unites States Department of Agriculture is currently enrolling patients in a study comparing the absorption of emulsified verses capsular forms of fish oil supplements. More research is needed to identify the most effective form and dose of fish oil supplements for the treatment of pain.
Written by Marshall Emig, M.D.