Clinical Health Updates

Omega-3 fatty acids have small analgesic effect

Clinical Question:
Can long-term dosing of omega-3 fatty acids decrease inflammatory joint pain?

Bottom Line:
In patients with joint pain due to rheumatoid arthritis, inflammatory bowel disease, or dysmenorrhea, continuous therapy with fish oil or other sources of omega-3 fatty acids produced statistically significant decreases in pain. The onset of action is approximately 3 months. Even though the benefit may be small, the lack of significant side effects and the beneficial effect on cardiovascular disease (Circulation 2002;106:2747-2757) make fish oil and other sources a useful option in patients with pain due to inflammation.

Reference:
Goldberg RJ, Katz J. A meta-analysis of the analgesic effects of omega-3 polyunsaturated fatty acid supplementation for inflammatory joint pain. Pain 2007;129;210-223.

Study Design:
Meta-analysis (randomized controlled trials)

Synopsis:
Between 40% and 60% of Americans use complementary and alternative medicine to manage medical conditions, prevent disease, and promote health and well-being. Omega-3 polyunsaturated fatty acids (omega-3 PUFAs) have been used to treat joint pain associated with several inflammatory conditions. The investigators conducted a meta-analysis of 17 randomized, controlled trials assessing the pain relieving effects of omega-3 PUFAs in patients with rheumatoid arthritis or joint pain secondary to inflammatory bowel disease and dysmenorrhea. Meta-analysis was conducted with Cochrane Review Manager 4.2.8. for six separate outcomes using standardized mean differences (SMDs) as a measure of effect size:
(1) patient assessed pain
(2) physician assessed pain
(3) duration of morning stiffness
(4) number of painful and/or tender joints
(5) Ritchie articular index
(6) nonselective nonsteroidal anti-inflammatory drug consumption.
Supplementation with omega-3 PUFAs for 3-4 months reduces patient reported joint pain intensity (SMD: -0.26; 95% CI: -0.49 to -0.03, p=0.03), minutes of morning stiffness (SMD: -0.43; 95% CI: -0.72 to -0.15, p=0.003), number of painful and/or tender joints (SMD: -0.29; 95% CI: -0.48 to -0.10, p=0.003), and NSAID consumption (SMD: -0.40; 95% CI: -0.72 to -0.08, p=0.01). Significant effects were not detected for physician assessed pain (SMD: -0.14; 95% CI: -0.49 to 0.22, p=0.45) or Ritchie articular index (SMD: 0.15; 95% CI: -0.19 to 0.49, p=0.40) at 3-4 months.