Pain

Reference: Omega-3 Fatty Acids (Fish Oil) as an Anti-inflammatory: An Alternative to Nonsteroidal Anti-inflammatory Drugs for Discogcnic Pain by Joseph Charles Maroon, M.D., Jeffrey W. Bost, P.A.C. (These authors are from the Department of Neurological Surgery, University of Pittsburgh Medical Center) Surgical Neurology April 2006, pp. 326-331 (This paper won first prize in the poster competition at the American Association of Neurological Surgeons Annual Meeting, New Orleans, April 2005) KEY POINTS FROM DAN MURPHY l)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 arc written each year, and 30 billion over-the-coun- ter 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 os-teoarthritis, 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 (Prostaglan-din 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. ARACHIDONIC ACID 20 Carbon Long Omega-6 Fat I I COX LOX Enzymes Enzymes SERIES 2 SERIES 4 Prostaglandins Leukotrienes PRO-INFLAMMATORY EICOSAPENTAENOIC ACID 20 Carbon Long Omega-3 Fat COX Enzymes LOX Enzymes SERIES 3 Prostaglandins SERIES 5 Leukotrienes ANTI-INFLAMMATORY Figure 1 Linoleic Acid 18:2n-6 Corn, Cottonseed , Sunflower, Safflower, Peanut, Soy, Canola 1 DiHomoGammaLinolenic Acid r\\ 1 GLA rot1^m -------LJn 20;3n-6 Activated Bv Insulin I Inhibited By EPA D5D Arachidonic Acid AA 20:4n-6 Cox 1 Cox 2 Increase SNS ^Production of Cox 3 / CAs Prostaglandin E E2j Fibrosis*------------ PGE2 \—*-#2 cause of INFLAMMATION 1 Free Radicals / | \ V<i\r\ DJD Vascular Immune Disease System Dysfunction Increased IgE Reduced IgG Figure 2 17) The delta-5 dcsaturase 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 offish 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, polychlo-rinated 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.). [I use those from Nutri-West along with their necessary double bond protective co-factors (Nutri-West: 800-443-3333).| A 1978 graduate of Western Slates Chiropractic Col­lege, Dr. Dan Murphv is on the faculty of Life Chiropractic College West, and is the Vice President of the Internation­al Chiropractic Association. For more information, visit www.duiunurphvdc.com. UU9 Alpha-Linolenic Acid ALA 18:3n-3 Flax, Hemp, Walnut Eicosapentaenoic Acid -------------EPA-------------- 'PGE3 20:5n-3 Cold Water Fatty Fish Powerfully Anti-Inflammatory Docosahexaenoic Acid DHA 22:6n-3 Cold Water Fatty Fish Algae Oil Source Builds Brain Synapses Increases Production of Serotonin, Dopamine Figure 3