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Targeted alterations in dietary n-3 and n-6 fatty acids improve life functioning and reduce psychological distress among patients with chronic headache: a secondary analysis of a randomized trial

Ramsden, Christopher E.a,b,*; Faurot, Keturah R.b; Zamora, Daisyb; Palsson, Olafur S.c; MacIntosh, Beth A.b,d; Gaylord, Susanb; Taha, Ameer Y.e; Rapoport, Stanley I.e; Hibbeln, Joseph R.a; Davis, John M.f; Mann, J. Douglasg

doi: 10.1097/01.j.pain.0000460348.84965.47
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Omega-3 and omega-6 fatty acids are precursors of bioactive lipid mediators posited to modulate both physical pain and psychological distress. In a randomized trial of 67 subjects with severe headaches, we recently demonstrated that targeted dietary manipulation—increasing omega-3 fatty acids with concurrent reduction in omega-6 linoleic acid (the H3-L6 intervention)—produced major reductions in headache compared with an omega-6 lowering (L6) intervention. Because chronic pain is often accompanied by psychological distress and impaired health-related quality of life (HRQOL), we used data from this trial to examine whether the H3-L6 intervention favorably impacted these domains. Additionally, we examined the effect of the interventions on the number of cases with substantial physical or mental impairments as defined by cutoff values in the Brief Symptom Inventory (BSI-18), Medical Outcomes Study Short Forms 12 (SF-12), Headache Impact Test (HIT-6), and the number of headache days per month. In the intention-to-treat analysis, participants in the H3-L6 group experienced statistically significant reductions in psychological distress (BSI-18 mean difference: −6.56; 95% confidence interval [CI]: −11.43 to −1.69) and improvements in SF-12 mental (mean difference: 6.01; 95% CI: 0.57 to 11.45) and physical (mean difference: 6.65; 95% CI: 2.14 to 11.16) health summary scores. At 12 weeks, the proportion of subjects experiencing substantial impairment according to cutoff values in the BSI-18, SF-12 physical, HIT-6, and headache days per month was significantly lower in the H3-L6 group. Dietary manipulation of n-3 and n-6 fatty acids, previously shown to produce major improvements in headache, was found to also reduce psychological distress and improve HRQOL and function.

Supplemental Digital Content is Available in the Text.Dietary manipulation of n-3 and n-6 fatty acids reduced psychological distress and improved quality of life and function in a population with chronic headaches.

aSection on Nutritional Neurosciences, Laboratory of Membrane Biochemistry and Biophysics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA

bDepartment of Physical Medicine and Rehabilitation, Program on Integrative Medicine, University of North Carolina, Chapel Hill, NC, USA

cDivision of Gastroenterology and Hepatology, Center for Functional GI and Motility Disorders, University of North Carolina, Chapel Hill, NC, USA

dNutrition Research and Metabolism Core, North Carolina Translational Clinical Sciences Institute, University of North Carolina, Chapel Hill, NC, USA

eBrain Physiology and Metabolism Section, Laboratory of Neurosciences, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA

fDepartment of Psychiatry, University of North Carolina, Chapel Hill, NC, USA

gDepartment of Neurology, University of North Carolina, Chapel Hill, NC, USA

Corresponding author. Address: Section on Nutritional Neurosciences, Laboratory of Membrane Biochemistry and Biophysics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 31 Center Drive, Room 1B54, Bethesda, MD, 20892. Tel.: +1-301-435-6591; fax: +1-301-594-0035. E-mail address: chris.ramsden@nih.gov (C. E. Ramsden).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.painjournalonline.com).

Received December 10, 2014

Accepted December 16, 2014

© 2015 International Association for the Study of Pain
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