The Effects of Fish Oil on Patients With Chronic Nonspecific Low Back Pain

Overview

Objectives: To investigate the efficacy of omega-3 polyunsaturated fatty acids (PUFA) on patients with chronic nonspecific low back pain (NLBP). Methods and Materials: Twenty-nine patients with chronic NLBP were randomly divided into experimental and control groups. For 8 weeks, participants in the experimental group received omega-3 PUFA at 3000 mg/day plus physical therapy, while those in the control group received placebo plus physical therapy. The visual analog pain scale, pressure algometer, Biering-Sorenson test, Roland-Morris Low Back Pain and Disability Questionnaire (RMQ), and occupational burnout inventory (OBI) were used in assessments at baseline (T0) and after 4 (T1) and 8 weeks (T2). Serum erythrocyte sedimentation rate (ESR) and hypersensitive C-reactive protein (hs-CRP) were checked at baseline and T2.

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Treatment
    • Masking: Double (Participant, Outcomes Assessor)
  • Study Primary Completion Date: November 2017

Detailed Description

Low back pain is a common symptom in modern society. However, nearly 85% of those who seek medical care for low back pain have no specific history and no specific finding in image study, and therefore do not receive a specific diagnosis. This type of low back pain is termed "nonspecific low back pain." Fish oil contains omega-3 polyunsaturated fatty acid, including eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). EPA and DHA can reduce the synthesis of prostaglandin E2. They are also the precursors of the E-resolvin and D-resolvin that suppress inflammatory cytokine production and act to resolve inflammation. Several previous studies showed that fish oil has the effect of anti-inflammation and pain reduction without side effect that affecting stomach and renal function. Therefore, fish oil is considered a new type of NSAID, and many studies are investigating its effect of anti-inflammation and pain reduction on different diseases. The purpose of this study is to investigate the effects of fish oil on patients with chronic nonspecific low back pain.

Interventions

  • Dietary Supplement: Fish oil
    • Five 1000mg fish oil soft capsules per day (each capsule containing 350mg EPA and 250mg DHA) for 8 weeks
  • Dietary Supplement: Placebo
    • Five 1000mg sunflower oil soft capsules per day for 8 weeks
  • Procedure: Hotpacking
    • Hotpacking 15min on low back, three times a week for 8 weeks
  • Procedure: Transcutaneous electrical nerve stimulation (TENS)
    • Transcutaneous electrical nerve stimulation (TENS) 15min on low back, three times a week for 8 weeks

Arms, Groups and Cohorts

  • Experimental: Experimental group
    • Participants in the experimental group will take fish oil (five 1000mg fish oil soft capsules per day, each capsule containing 350mg EPA and 250mg DHA) and receive physical modality treatment (hotpacking 15min and transcutaneous electrical nerve stimulation (TENS) 15min, three times a week) for 8 weeks
  • Placebo Comparator: Control group
    • Participants in the control group will take placebo (five 1000mg sunflower oil soft capsules per day) and receive physical modality treatment (hotpacking 15min and transcutaneous electrical nerve stimulation (TENS) 15min, three times a week) for 8 weeks

Clinical Trial Outcome Measures

Primary Measures

  • 100mm Visual Analogue Scale (VAS)
    • Time Frame: Week 8 (T2)
    • Assess low back pain intensity (current, least and worst in the past one week)

Secondary Measures

  • Pressure pain threshold
    • Time Frame: Baseline (T0), Week 4 (T1), Week 8 (T2)
    • Assess pressure pain threshold with pressure algometer at quadratus lumborum and sacroiliac joint
  • Roland Morris Low Back Pain and Disability Questionnaire (RMQ)
    • Time Frame: Baseline (T0), Week 4 (T1), Week 8 (T2)
    • Assess the impact of low back pain on daily life with Taiwan version of Roland Morris Low Back Pain and Disability Questionnaire
  • Biering-Sorenson test
    • Time Frame: Baseline (T0), Week 4 (T1), Week 8 (T2)
    • Assess back extensor endurance
  • Occupational burnout inventory
    • Time Frame: Baseline (T0), Week 4 (T1), Week 8 (T2)
    • Assess objective occupational burnout feeling
  • 100mm Visual Analogue Scale (VAS)
    • Time Frame: Baseline (T0), Week 4 (T1)
    • Assess low back pain intensity (current, least and worst in the past one week)
  • Blood test: ESR
    • Time Frame: Baseline (T0) and Week 8 (T2)
    • Draw 10ml blood for checking the level of ESR
  • Blood test: hs-CRP
    • Time Frame: Baseline (T0) and Week 8 (T2)
    • Draw 10ml blood for checking the level of hs-CRP

Participating in This Clinical Trial

Inclusion Criteria

  • Male and female aged 20-50 – Low back pain duration over 3 months and pain intensity over 40mm when assessed with 100mm VAS Exclusion Criteria:

  • History of major trauma or surgery at back – Obvious spinal pathology on plain film (e.g. scoliosis, spondylosis, spondylolisthesis) – Not suitable for taking fish oil or receiving physical modality treatment – Having other inflammatory disease (e.g. rheumatic arthritis, endometriosis, ankylosing spondylitis, infection) – Pregnancy – Regularly taking fish oil or fatty fish more than 2 times per week – Having coagulopathy or currently taking anti-coagulation agent – Receiving oral or topical NSAID in the past one week – Taking oral corticosteroid in the past 6 weeks – Receiving local injection of corticosteroid or prolotherapy in the past 3 months

Gender Eligibility: All

Minimum Age: 20 Years

Maximum Age: 50 Years

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Chang Gung Memorial Hospital
  • Provider of Information About this Clinical Study
    • Sponsor
  • Overall Official(s)
    • Tsung-Hsun Yang, MD, Principal Investigator, Kaohsiung Chang Cung Memorial Hospital

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