Joseph C. Maroon, MD, FACS feature Omega-3 EFAs A better choice for pain relief F or the first 15 years of my neurosurgical practice, most of my patients with spine complaints routinely left the office either scheduled for surgery or with a pre- scription for conservative treatments. These treatments included physiotherapy, traction, injections, and a host of other treatments too numerous to list. But in addition to active therapies, all patients received prescriptions for both a pain medication and a non-steroidal anti-inflammatory (NSAID) capsule. Conservatively, I wrote more than 5,000 of these prescriptions without any thought other than providing relief for my patient’s pain complaints. However, two events occurred in 2004 that forever changed the way I treat my pa- tients’ non-surgical pain, and what I prescribe for them to take. The first event was very personal. As a triathlete, having participated in more than 70 triathlons, including seven Ironman triathlons, I was accustomed to enduring pain. But I began to have severe left knee pain and took COX-1 NSAIDs, like ibuprofen, for this pain. Over approximately a two-month period, I felt much better but began to have stomach pains, which I found out later was gastritis and early gastric erosion. I became concerned about experiencing this common side effect myself, but also worried about the tens of thousands of patients I had placed on these medications. (I had recently begun to switch many of my patients to the newest COX-2 NSAIDs, but still heard occasional reports about stomach upset.) I considered switching to a different drug, myself, but the next event that sealed how I was going to change my practice, was about to break. On September 30, 2004, the FDA acknowledged the voluntary withdrawal of Vioxx® (rofecoxib), a COX-2 selective NSAID manufactured by Merck & Co. Vioxx and its other COX-2 inhibitor cousins were actually believed to be safer than Dr. Joseph Maroon, a board certi- fied neurosurgeon at the University of Pittsburgh and team physician to the Pittsburgh Steelers, has become one of the leading advocates of fish oil in the United States. He has recently authored two books, Fish Oil: The Natural Anti-inflammatory and The Longevity Factor: How Resveratrol and Red Wine Activate Genes for a Longer and Healthier Life.Dr.Maroon currently serves as medical advisor for Nordic Naturals. For more information, see www. inflammationsolutions.com. the COX-1. Because these drugs had gleaned fewer reports of gastrointestinal (GI) side effects, and since there had been no hint of the serious heart and coagulation complica- tions that were now being reported, Vioxx had reached more than nine billion dollars in annual sales in the United States alone! The Vioxx storm started when an increased occurrence of serious cardiovascular events, including myocardial infarction (MI) and strokes, were reported during a clinical trial to determine whether the drug could reduce the risk of colon cancer. It became apparent that besides inhibiting COX-2, these agents selectively interfered with prostacyclin synthesis, a prostaglandin essential in reducing intravascular coagulation, and thus the increased incidence of MI and stroke. Because of persistent significant gastric, and now cardiovascular, side effects, the safety of these pharmaceutical choices was now being called into question. With the removal of Vioxx from the market, many practitioners now treat NSAIDs with increased caution when prescribing. In 2006, The American Medical Association recommended the following considerations with their use: • Limit the duration and dosage of the prescribed NSAID and ask about and advise patients on combination NSAID therapy. • Treat patients with H pylori infection prior to beginning NSAID therapy so as not to increase the risk of complicated ulcers. • Institute “gastroprotection” for patients at high risk of gastrointestinal complications. OMEGA-3 FISH OILS – A BETTER CHOICE Following my own negative experience with NSAIDs and my heightened concern result- ing from the Vioxx scare, I was determined to seek out a better choice for providing a reduction in inflammation-induced pain, and also reducing the side effects from medi- cations consumed for months at a time. I began seeking out alternative treatments, and quickly found several hundred peer-reviewed journal articles in mainstream medical 18 • CANADIAN CHIROPRACTOR | MAY 2010 www.canadianchiropractor.ca
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