A randomised controlled trial of long-chain omega-3 polyunsaturated fatty acids in the management of rotator cuff related shoulder pain

Abstract

Study designMulticentre, double-blind, placebo-controlled randomised clinical trial.ObjectivesTo compare the effectiveness of long chain omega-3 polyunsaturated fatty acids (PUFAs) as part of the management for people diagnosed with rotator cuff related shoulder pain (RCRSP).Summary of backgroundAlthough there is no robust evidence to support their use, omega-3 PUFAs have been recommended for those with tendinopathy due to their potential to moderate inflammation.MethodsParticipants with RCRSP (n=73) were randomised to take either nine MaxEPA capsules providing 1.53 g eicosapentaenoic acid, 1.04 g docosahexaenoic acid or nine matching placebo capsules containing oleic acid per day for 8 weeks. In addition, participants attended an exercise/education programme for 8 weeks. Participants were assessed at prerandomisation, 8 weeks (primary outcome point), 3 months, 6 months and 12 months (secondary outcome point). Primary outcome was the Oxford Shoulder Score (OSS). Secondary outcomes included the Shoulder Pain and Disability Index (SPADI), Patient Specific Functional Score, Euro Qol 5D-3L, Short Form 36, global rating of change and impairment measurements. Analysis was by intention to treat.ResultsDifference in the change in the OSS between the two groups at 2 months was –0.1 (95% CI −2.6 to 2.5, p=0.95). The change in SPADI scores was −8.3 (95% CI −15.6 to −0.94, p=0.03, analysed by analysis of covariance adjusted for baseline) at 3 months.Conclusion Omega-3 PUFA supplementation may have a modest effect on disability and pain outcomes in RCRSP.

Endogenous conversion of n-6 to n-3 polyunsaturated fatty acids facilitates the repair of cardiotoxin-induced skeletal muscle injury in fat-1 mice

“…Moreover, n-3 PUFA supplementation showed beneficial effects by preventing soft-tissue injuries caused by exercise as well as improving their healing times [ 23 , 44 ]. A randomized controlled trial showed that n-3 PUFA supplementation decreased disability and pain in individuals suffering from rotator cuff-related shoulder pain [ 45 ].…”

The Physiological Effect of n-3 Polyunsaturated Fatty Acids (n-3 PUFAs) Intake and Exercise on Hemorheology, Microvascular Function, and Physical Performance in Health and Cardiovascular Diseases; Is There an Interaction of Exercise and Dietary n-3 PUFA Intake?

“…Several examples confirm that speculation. Patients with rotator cuff-related shoulder pain taking 1.53 g EPA and 1.04 g DHA for 8 weeks exhibited improvements in disability and pain after 3 months (Sandford et al, 2018). The double-blind study of Lewis and Sandford has shown significant pain reduction after 32 days of n-3 PUFA supplementation and administration of antioxidant pills in recreational athletes with tendinopathies (Lewis and Sandford, 2009).…”

Inflammatory mechanisms linking obesity and tendinopathy

“…Besides, patients with full thickness degenerative rotator cuff tears had a significantly lower Omega-3 Index than controls without rotator cuff tendinopathy in a cross-sectional study [ 75 ]. In addition, the supplementation with long-chain ω3 polyunsaturated FFAs (eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)) for 8 weeks reduced shoulder pain [ 76 ]. On the contrary, supplementation with ω3 FFA and vitamins (A, B6, C, E, selenium and zinc) for 8 weeks has no effects on pain level and maximal grip force compared to the placebo group after 6 months in patients with epicondylitis [ 77 ].…”