For the fibromyalgia sufferer, pain is an everyday part of living – chronic, often with few pain-free intervals, and increased sensitivity. Fibromyalgia also interferes with function, largely to a greater extent than other musculoskeletal conditions.
Diagnosis of fibromyalgia is often difficult, and the condition itself is far from simple in its definition. Whilst malfunctions in pain processing include the over sensitisation of nerves responsible for pain-transmitting, and a dysfunction in the pathways involved in inhibiting pain, fibromyalgia also includes changes in our neuroendocrine responses to stress. The neuroendocrine system, or the ‘HPA-axis’, is a highly complex system that is triggered in stressful situations, and primes the body to cope with whatever situation is raised.
While the stresses of our ancestors were relatively simple to define in initiating the ‘flight or fight’ response when faced with immediate danger, modern day stressors may be less obvious, with work stress or money worries being classic examples. Interestingly, however, whatever the stress source is, the mechanism by which the body reacts is just the same.
Furthermore, because there are so many influential variables within the HPA-axis (the interactions of stress response include neurotransmitters, hormones, the immune system and the nervous system), multiple abnormalities can affect the normal functioning of both the immune and the nervous systems. In response, the body releases several types of chemical messengers that can then trigger both inflammation and pain. The detection of specific products called cytokines within the blood provides information on both the degree and severity of this process.
Indeed, increased levels of inflammatory cytokines are common to many conditions including chronic pain conditions such as fibromyalgia (FMS), complex regional pain syndrome (CRPS) and also in neuropathic conditions (such as nerve damage associated with diabetes). A recent study has found that elevated omega-6 long chain fatty acids, as well as trans fatty acid levels, are directly correlated with pain-related disability and anxiety levels in individuals with CRPS. Because the same fatty acid profile is not seen in pain-free control subjects, this indicates that these fats play a direct role in CRPS development, and therefore in pain processing pathways (Ramsden et al, 2010).
So what is it exactly about omega-6 that relates to pain in such conditions? Omega-6 fats are a family of polyunsaturated fatty acids, generally over-consumed in Western diets. These fats are found in common vegetable oils and non-organic red meat (cattle are often fed on grains rich in omega-6 and so these tend accumulate in their flesh). The relevance of this is that specific fats have specific functions, and one particular type of omega-6 called arachidonic acid (AA) accumulates in our cell membranes and, upon its release, is converted into inflammatory products.
Diets that are particularly rich in this type of fatty acid will therefore result in the over-production of inflammatory products in the body. We can also convert the omega-6 found in vegetable oils to AA, further adding to its accumulation in the body. Given that different types of fat give rise to different end products, it is possible to manipulate the production of inflammatory or anti-inflammatory products simply by our dietary intake of fat.
Firstly, we need to limit our intake of omega-6 and increase our intake of another family of fats called omega-3, which have anti-inflammatory properties and are also associated with many health benefits. For example:
- Swap common vegetable oils rich in omega-6 for other oils such as olive or coconut oil (which is an excellent choice for frying, for example).
- Avoid or reduce non-organic meat and processed meat (such as sausages, burgers, and cold meats such as salami).
- Use oils such as flaxseed oil in dressings, and consume two portions of oily fish a week. Whilst flaxseed oil contains omega-3, the body first has to modify it into ‘long-chain’ fatty acids in order to provide significant health benefits. Fish, on the other hand, contains the preformed long-chain omega-3 eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), which have direct health benefits. EPA is particularly significant because not only does it give rise to its own family of anti-inflammatory products, but it directly competes with AA, not only for space in cell membranes, but also for the enzymes needed to turn AA into inflammatory products. Simply put, this means that consuming EPA lowers the ability of AA to induce inflammation. With some inflammatory conditions, however, the amount of EPA needed for this to occur far is difficult to obtain simply by consuming the average diet. Using highly purified and concentrated EPA oils overcomes this problem, as these can simply be added to a normal daily diet.
Given the benefits of omega-3 for pain modulating pathways, and for their known benefits on reducing inflammation, it is not surprising that the use of omega-3 is the focus of many clinical studies where pain is a key influential factor. For example, omega-3 fish oil has been shown to help diabetic neuropathy (Ko et al, 2010), back pain (Maroon & Bost 2006), arthritis (Das et al, 2009) and FMS (Ozgocmen et al, 2000) – to name but a few conditions.
Adding quality supplements to the diet has a myriad of health benefits, not only for relieving pain but also for reducing the need for over-the-counter and prescription pain relief medicines. Many of us who often resort to common pain-relieving products, such as ibuprofen or paracetamol, will be pleased to know that long-term supplementation with high strength EPA fish oil may even have a protective role in the prevention of pain.
Das Gupta AB, Hossain AK, Islam MH, Dey SR, Khan AL. Role of omega-3 fatty acid supplementation with indomethacin in suppression of disease activity in rheumatoid arthritis. Bangladesh Med Res Counc Bull. 2009 Aug;35(2):63-8.
Ko GD, Nowacki NB, Arseneau L, Eitel M, Hum A. Omega-3 fatty acids for neuropathic pain: case series. Clin J Pain. 2010 Feb;26(2):168-72.
Maroon JC, Bost JW. Omega-3 fatty acids (fish oil) as an anti-inflammatory: an alternative to nonsteroidal anti-inflammatory drugs for discogenic pain. Surg Neurol. 2006 65:326-31.
Okuda Y, Mizutani M, Ogawa M, Sone H, Asano M, Asakura Y, Isaka M, Suzuki S, Kawakami Y, Field JB, Yamashita K. Long-term effects of eicosapentaenoic acid on diabetic peripheral neuropathy and serum lipids in patients with type II diabetes mellitus. J Diabetes Complications. 1996 10:280-7.
Ozgocmen S, Catal SA, Ardicoglu O, Kamanli A. Effect of omega-3 fatty acids in the management of fibromyalgia syndrome. Int J Clin Pharmacol Ther. 2000 Jul;38(7):362-3.
Ramsden C, Gagnon C, Graciosa J, Faurot K, David R, Bralley JA, Harden RN. Do Omega-6 and Trans Fatty Acids Play a Role in Complex Regional Pain Syndrome? A Pilot Study. Pain Med. 2010 Jun 8. [Epub ahead of print]