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reference
Ko GD, Nowacki NB, Arseneau L, et al. Omega-3 fatty acids for neuropathic pain.Clin J Pain2010;26:168-172.
design
Uncontrolled case studies
Participant
5 patients with chronic pain due to burns, spinal stenosis, carpal tunnel syndrome, fibromyalgia or herniated disc
Study medications and dosage
Combinations of EPA and DHA with a total dose of 2,400-7,200 mg/day depending on pain severity
Primary outcome measures
McGill Pain Questionnaire, DN4 Neuropathic Pain Scales, the Pain Detect Questionnaire, Grip Strength and Tender Point Algometry
Key findings
A significant reduction in pain was reported in all cases.
Case 1 involved a patient with a C6/C7 disc herniation compressing the right root of the C7 nerve, accompanied by spinal stenosis. A combined EPA+DHA dose of 4,800 mg/day for 8 months resulted in a 42% increase in grip strength, 92% increase in triceps extension strength, and complete resolution of pain. The improvement began after 2.5 weeks.
Case 2 involved a patient with thoracic outlet syndrome and fibromyalgia. A combined EPA+DHA dose of 2,400 mg/day for 7 months resulted in a 43% reduction in pain as measured by the McGill Pain Questionnaire and a 60% increase in grip strength on the affected side. A 13-month follow-up of the Pain Detect Questionnaire showed a 70 percent reduction in pain from baseline and an 80 percent reduction in DN4 pain scores.
Case 3 was a patient who suffered from an accident-related C6/C7 disc bulge. X-rays also revealed evidence of moderate to severe stenosis of the cervical spine. A combined EPA+DHA dose of 4,800 mg/day, later increased to 7,200 mg/day, for a total of 17 months resulted in a 90% reduction in Pain Detect Questionnaire score, a 65% reduction in pain as measured by the McGill Pain Questionnaire, and an 8% increase in grip strength on the subject Page.
Case 4 involved a patient with pain due to carpal tunnel syndrome. A combined EPA+DHA dose of 3,000 mg per day for 8 months resulted in a 41% reduction in global symptom score. The patient improved sufficiently and returned to a full-time work schedule without requiring surgery.
Case 5 involved a patient with first and second degree burns covering 30% of the total body surface area. A combination of EPA+DHA (1,200 mg per 23 kg body weight) resulted in a 25-53% reduction in pain scores and an unspecified reduction in morphine dosage.
Effects on practice
This is the first published report examining the effects of omega-3 fatty acids on neuropathic pain. Various possible mechanisms have been proposed to explain how EPA and DHA might relieve such pain (e.g. blocking voltage-gated sodium channels), but to date these mechanistic explanations remain hypothetical.
In this column, we generally avoid reporting the results of case studies. A small number of subjects coupled with a lack of placebo control or randomization or observer blinding and a lack of statistical analysis do not provide sufficient scientific support.
However, the results of case studies may prompt further research and, as in this case, even immediate experimentation by medical professionals.
However, the results of case studies may prompt further research and, as in this case, even immediate experimentation by medical professionals.
Treating patients with the chronic pain described in this case series can be difficult. The significant reductions in chronic pain reported here far exceed what would be expected from the placebo effect alone and suggest that if other therapies do not produce sufficient clinical results, some readers of this column may consider therapeutic trials with high-dose EPA+DHA. More evidence is needed before omega-3 fatty acids can be proven to provide pain relief in cases such as those described here.