Omega-3: Promise for Treatment of Neuropathic Pain
By Richard H. Adler
July 20, 2011
Treatment of neuropathic pain, regardless of the source, can be challenging for the practitioner and frustrating to the patient. Use of prescription medication can provide relief but carries with it risks of side effects and dependency. A new study suggests that omega-3s may be an effective supplement for neuropathic pain, in addition to the other benefits of this fatty acid.
Omega-3 fatty acids are long-chain polyunsaturated fatty acids that have been found to be effective for the prevention and treatment of a wide variety of health conditions including inflammatory joint pain, chronic spinal pain, autoimmune disease, cardiovascular disease, depression and, potentially, fibromyalgia.1 A 2010 study suggests that it is also effective for pain reduction in patients with neuropathic pain.
Ko, MD, et al,2 reported on a case series of patients with neuropathic pain treated with high dose (2400 – 7200 mg/day) omega-3 supplementation. Five patients were assessed, treated with high dose omega-3 and reassessed after several months. All five had subjective pain and functional improvement.
Patient 1: C7 radiculopathy. EMG revealed decreased recruitment in the right C7 innervated triceps. Lafayette manual muscle test right 29.5 kg. Grip strength right 12.7 kg. McGill pain questionnaire (SF-MPQ) 30/45. Functionally unable to work out or play hockey as he had pre-injury. Treated with 4800 mg of omega-3. Eight months later, SF-MPQ was 0/45. Lafayette was 56.7 kg and Jamar was 18.1 on the right. Patient was back to working out and playing full equipment hockey.
Patient 2: Right TOS and left lateral epicondylalgia. 14/18 positive fibromyalgia tender points. SF-MPQ 7/45. Pain up to 8/10. Treated with 2400 mg omega-3. After 7 months, grip strength improved, tender points reduced to 9/18. Overall pain was 2/10, 4/10 at worst.
Patient 3: Right C7 radiculopathy. Right arm weakness subjectively and electrodiagnostically. Average pain 6/10, up to 9/10 at worst. Significant limitation of ADLs. Treated with 4800 mg omega-3, later increased to 7200 mg. After 17 months, patient reported no pain with activity. Improved grip strength, SF-MPQ reduced from 17/45 to 6/45.
Patient 4: Carpal tunnel syndrome. Right median nerve distal latency and right median sensory latencies on electrodiagnostic studies. Jamar 8.2kg on the right and global symptom score 22/50. Treated with 3000 mg omega-3 for nine months. Objective improvement on EMG, Jamar 11.6 kg and global symptom score 13/50. Improved to the point where surgery was unnecessary.
Patient 5: 30% total body second and third degree burns. Multiple medications including morphine. NRS pain score 8/10 and Neuropathy Pain Scale 85/100. After four months, there was objective improvement of shoulder and neck range of motion, NRS pain score was 4.5/10 and Neuropathy Pain Scale improved to 32/100.
Interestingly, no adverse effects were noted by any of the patients studied. However, before recommending high dose omega-3 or any other nutraceutical, the authors recommend a full medical work up. Full knowledge of the patient’s prescription and over-the-counter medications should be obtained, particularly the use of anticoagulants as the blood thinning effects of omega-3 may effect coagulation. Omega-3 will increase caloric intake and diabetic patients should adjust diet and insulin accordingly.
The authors also recommend laboratory monitoring with high dose use of omega-3. Excess omega-3 intake which results in a high level of arachidonic acid has been associated with increased risk for hemorrhagic stroke. Patients should be advised to obtain high quality brands that have been tested for impurities and have good potency. A recommended conservative dose is 2700mg EPA/DHA.
Omega-3 or any nutraceutical supplementation is part of an integrative approach to treatment of patients with chronic pain. Supplementation can be a valuable part of the treatment regimen and many practitioners are beginning to recommend this as part of an anti-inflammatory protocol. Patients who have suffered traumatic injury and/or struggling with the aftermath of chronic pain due to the negligence of another should seek consultation with legal counsel versed in the variety of approaches to management of traumatic injury. If you or your patient require consultation regarding a traumatic injury, the attorneys of Adler Giersch are available to assist you.
1 Ozgocmen S, Catal SA, Ardicoglu O, et al. Effect of omega-3 fatty acids in the management of fibromyalgia syndrome. Int J Clin Pharmacol Ther. 2000;38:362-363.
2 Ko GD, Nowaki NB, Arseneau L, Eitel M, Hum A. Omega-3 Fatty Acids for Neuropathic Pain: Case Series. Clin J Pain. 2010;26:168-172.