Alternatives to NSAID’s in the Treatment of Spinal Pain

The treatment of pain with non-steroidal anti-inflammatory drugs (NSAID’s) is big business in America, which leads to a substantial number of deaths and extraordinary costs to treat NSAID-complications. Consider the following facts about NSAID use:

• More than 70 million NSAID prescriptions each year in US
• More than 30 billion OTC NSAID’s sold each year in US
• 5-10% of US adult population routinely takes NSAID’s for pain control
• 14% of elderly US population routinely takes NSAID’s for pain control
• NSAID-associated dyspepsia occurs in 50% of users
• Almost all patients who take NSAID’s long term will demonstrate sub-epithelial gastric hemorrhage
• About 8-20% of long term users will develop frank gut ulceration
• About 3% will develop serious side-effects, which lead to 100,000 hospitalizations and an estimated 16,500 deaths
• Annual cost to treat NSAID complications exceeds $1.5 billion annually

Natural biochemical treatments may be a way to curtail the damage caused by NSAID’s. A recent article published in Surgical Neurology examined the use of fish oil supplements in the treatment of patients with discogenic pain.1 One of the authors is a neurosurgeon who evaluated some 250 patients, none of which turned out to be a surgical case; all were suffering from degenerative disc disease with facet arthropathy in the cervical and/or lumbar spine.

All patients were taking NSAID’s and 75% were on COX2 inhibitors. They were asked to take EPA/DHA from fish oil, at a dose of 2.4 grams for 2 weeks, and 1.2 grams thereafter. Questionnaires were sent to all patients and 125 were returned at an average of 75 days on fish oil supplements. Seventy-eight percent of patients were taking 1.2 grams, while 22% decided to continue with 2.4 grams/day.

A total of 59% of patients were able to discontinue the use of any NSAID’s; 60% reported their overall pain was less; 60% stated their joint pain was improved; 80% stated they were satisfied with their improvements; and, 88% stated they would continue taking fish oil. Only 2 patients reported side effects of any significance: loose bowel movements on 1.2 grams/day.

These positive results should not be surprising, as pharmacology texts tell us that EPA/DHA supplements approximate the potency of NSAID’s.2

The authors of this article mention additional natural anti-inflammatory agents, including turmeric, boswellia, bromelain, white willow bark, and green tea. Ginger is also a popular herb that is known to have anti-inflammatory properties.

Keep your nutritional approach simple and straightforward. For pain and inflammation, have you patients eat an anti-inflammatory diet as described in my previous articles in The American Chiropractor, and have them take a multi, plus magnesium, EPA/DHA, coenzyme Q10, ginger/turmeric and, if they have joint pain, glucosamine as well. This approach is not typically contraindicated, save for those on anti-coagulants, such as Coumadin. Maroon and Bost indicated that patients taking aspirin are not at risk, if they take fish oil.1


1. Maroon JC, Bost JW. n-3 fatty acids (fish oil) as an anti-inflammatory: an alternative to nonsteroidal anti-inflammatory drugs for discogenic pain. Surg Neurol 2006; 65:326-331

2. Katzung BG. Basic & Clinical Pharmacology. 8th ed. New York: Lange Medical Books/McGraw Hill; 2001: p.615

Dr. Seaman is the Clinical Chiropractic Consultant for Anabolic Laboratories, one of the first supplement manufacturers to service the chiropractic profession. He is on the postgraduate faculties of several chiropractic colleges, providing nutrition seminars that focus on the needs of the chiropractic patient. He is also a faculty member at Palmer College of Chiropractic Florida, where he teaches nutrition and subluxation theories. He can be reached by e-mail at [email protected].

Leave a Reply