Nonsteroidal anti-inflammatory drugs (NSAIDs) have been used for many years after the discovery that aspirin-like drugs could inhibit the synthesis of prostaglandins (and their related substances: thromboxanes). Prostaglandins (PgLs) are made in tissues throughout the body from unsaturated fatty acids, primarily arachidonic acid, when the tissue is subjected to trauma, stress, or disease in both chronic and acute conditions. Diets high in meat and animal produce tend to contain a lot more pro-inflammatory arachidonic acid than plant-based diets.
Unfortunately there are numerous side-effects associated with NSAIDs (including bleeding, kidney damage, and increased dementia risk), leading many to look for an alternative. Fish oils have been extensively researched in recent years to evaluate their effectiveness at lowering PgL production and subsequently reducing the inflammation associated with neck pain.
How do Fish Oils Work?
Fish oils are naturally rich in long-chain omega 3 polyunsaturated fatty acids such as eicosapentonic acid (EPA) and docosahexanoic acid (DHA). EPA is actually more efficient at reducing inflammation by inhibiting PgL production because it acts on both major enzymes in the process of synthesis (the COX and LOX enzymes). Inhibition of these enzymes reduced the production of prostaglandin E2 and Leukotriene B4, which both instigate the inflammatory cascade resulting in pain. Fish oils inhibit the production of interleukin-1 Beta and tumour necrosis factor alpha, two more key components in the process of inflammation (Calder, 2006).
The Available Evidence
Maroon (2004) conducted a study with 250 patients who were not candidates for surgery and were using fish oil for neck pain and back pain. The majority (78%) took 1200mg/day, and the rest (22%) took 2400mg/day. After 75 days on the fish oil 59% of patients has discontinued their use of NSAIDs, 60% reported reduced pain, and 88% said they would continue taking the fish oil as a method of pain management and relief. Importantly, there were no side-effects reported with the fish oil, making it an appealing alternative to NSAIDs.
As well as competing with arachidonic acid and thereby reducing inflammation, omega 3 can also produce novel lipids in the body such as protectins and resolvin which also have an anti-inflammatory effect (Hudert, 2006).
Which Fish Oil is Best?
Excellent sources of EPA and DHA are the cold-water fatty fish like sardines, anchovies, salmon and herring. A quality fish oil supplement will clearly show the source of the oil and should have information available on their screening processes and quality control testing. Unfortunately fish can concentrate heavy metals, such as mercury and lead, from polluted waters, so paying for quality products is paramount for safety’s sake when using fish oil.
Some people may consider fish oil capsules superior as they are usually made with gelatin but the evidence supporting the use of gelatin (and collagen) for connective tissue disease and joint pain is somewhat lacking. Even if gelatin was effective for neck pain from arthritis or other joint pain the amount in the capsule shell is insignificant.
Storing Fish Oil
The oil should be kept away from heat and light so as to reduce the chances of oxidation and the same is true for fish oil capsules as they may stick together if they become warm, and can also oxidize if exposed to heat and/or light. Once opened it is a good idea to keep fish oil liquid, and capsules, in the fridge to preserve its nutritional value and slow down rancidity. A good fish oil supplement will contain a small amount of vitamin E which acts as an antioxidant to prevent the oil becoming rancid. Some liquid fish oils may contain flavouring in an attempt to make it more palatable, check the labels, however as sometimes this involves adding sugar which is clearly not beneficial for health. There are many quality supplements around which are naturally flavoured however.
Major Benefits of Fish Oil
As well as reducing inflammation, fish oils also have a blood-thinning effect, with concomitant reductions in the risk of heart attacks, strokes, and thrombosis. The EPA and DHA have also been found to benefit brain function, mood, depression, and cognitive performance by some researchers. They are essential for proper brain development, making them candidates for supplementation in childhood and adolescence. Athletes also use fish oil to reduce post-workout stresses and strains, improve their circulation, possibly prevent muscle breakdown, aid fat loss, and improve immune function.
Fish oils do reduce blood stickiness which can be beneficial. However, a patient who is due to have neck surgery or who is on medications that also thin the blood, such as Warfarin/Coumadin, Aspirin, ginkgo biloba, and garlic may need to consider the potential for poor blood clotting ability in these cases. Clearly, another consideration is ensuring a supplement is of good quality so as to avoid the possibility of heavy metal, and toxin, contamination. If ethics, taste, or allergies are an issue then taking a good quality algal oil, or combination of flax and algal oil can be highly beneficial. Look for one which contains stearidonic acid (SDA) and DHA, as the SDA converts very readily into EPA and can directly compete with arachidonic acid, thereby lowering inflammation.
- Glucosamine, and Chondroitin
- Methylsulphonylmethane (MSM)
- NutraVege from NutraSea
Keeping inflammation at bay by taking fish oil for neck pain can be very effective. It may also help to break the inflammation cascade cycle, giving the body a chance to begin healing, and perhaps reduce inflammation and pain longer-term without the need for medication. Dosages will vary depending on individual circumstances and should be discussed with a healthcare practitioner. Unfortunately, as the intervertebral discs have poor circulation it can take time for nutrients to reach them. Where neck pain is due to systemic inflammation, however, in conditions such as fibromyalgia or rheumatoid arthritis, the impact of fish oil for neck pain can be much quicker.
Maroon, J.C., Bost, J.W., (2006), Omega-3 fatty acids (fish oil) as an anti-inflammatory: an alternative to nonsteroidal anti-inflammatory drugs for discogenic pain, Surg. Neurol., Vol 65., No.4, pp.326-31. PMID: 16531187
Hudert, C.A., Weylandt, Y., Lu, J., Wang, S., Hong, Dignass, A., (2006), Transgenic mice rich in endogenous omega-3 fatty acids are protected from colitis, Proc Natl Acad Sci USA, Vol.103, pp.11276–11281
Calder, P.C., (2006), n-3 polyunsaturated fatty acids, inflammation, and inflammatory diseases, Am J Clin Nutr, Vol.83, pp.1505S–1519S.