How to Use Fish Oil for Pain Relief

Using fish oil for pain relief is well documented, and, unlike drugs, fish oil increases in effectiveness with consistent use. However, it might surprise you to learn that pain relief requires at least six times the dose that most people would take!

Since prehistoric times and until very recently, people ate large amounts of seafood to stay healthy.

fish oil for pain relief

Today, to relieve pain, it’s necessary to get seafood in concentrated form: fish oil or other marine oils (including a vegetarian option from algae), or, even more practical, concentrated omega-3 fatty acids from marine oils.

We’ll show you the how-to and the documentation in this article.

But first, just a little bit about healthy fat.



Fat is Essential to Life

Fat is absolutely essential to life, to the normal functioning of the body, and to becoming and staying pain-free.

Scientists estimate that your body is composed of 37 trillion individual cells. Each cell is like a little bag of salt water. The cell contents are in the salt water; the bag itself, known as the cell membrane, is made out of fat.

More special than plastic, the membrane must be permeable to allow substances in and out of the cell, be solid enough to hold together the 37 trillion cells into one body, and be fluid enough to allow for movement.

Remember  that we are what we eat. The cell membranes are a prime example. Capable cell membranes—that keep us out of pain–come only from eating high-quality healthy fats.

We’re starving for healthy fats

Our standard diet—with its white bread, hamburger buns, frozen pizzas, french fries, pastries, candy bars—is chock full of unhealthy, substandard fats. It’s low in healthy fats, and almost completely lacking in the fats that are the basis for healthy cell membranes.

When we crave junk food, it’s our body’s desperate attempt to locate healthy fats. We Americans are starving for healthy fats!

The famous omega-3 fats

One group of healthy fats missing from our diet are the famous omega-3 fatty acids. The most prominent of them are known by their initials: DHA, EPA, and ALA.

The body’s favorite of the omega-3 fats, by far, is DHA (which stands for “docosahexaenoic acid”). DHA is in all of our cell membranes, and at an especially high level in the brain, nervous system, and retina. All human cell membranes, when analyzed, have five to ten times more DHA than EPA, and only traces of ALA.

The body prefers to get DHA from food, but can, in a pinch, create it from EPA or ALA, which it does with difficulty.

And we’re starving for omega-3 fats

Omega-3 fats aren’t in our bakery, desserts or junk food, and not even in our meat, grains, or vegetables. Most (not all) omega-3 sources come from the sea: fish, other seafood, and algae.

The World Health Organization recommends a minimum of half a gram of omega-3 fat per day. We can visualize half a gram as about 1/8th teaspoon.

But the average American diet contains only one-tenth of a gram of omega-3 fat per day, just 20% of the minimum. That’s less than 1/32nd teaspoon!

And as we’ll see, pain relief requires far more omega-3 fat than WHO’s minimum.



DHA, EPA, and Fish Oil for Pain

Fish oil and other marine oils contain varying amounts of the omega-3 fatty acids DHA and EPA.

Fish oil, in particular, has been the subject of a large amount of medical research. This research shows that fish oil (that is, its omega-3 fatty acids DHA and EPA) controls chronic pain.

Unlike pain-relieving drugs, DHA and EPA will resolve both inflammatory pain—the standard pain when something is swollen—and neuropathic pain—the pain that originates from the nerves themselves.

Pain relief in rheumatoid arthritis

Much clinical research about fish oil has focused on advanced rheumatoid arthritis.

Fish oil has been tested in patients with rheumatoid arthritis using randomized controlled trials. That’s the same protocol used in drug testing.

A 2003 review article in the medical journal Drugs1 described 13 of these trials. Reduced morning stiffness and fewer painful joints were consistent results.

A few studies asked whether patients were able to reduce medication. An article in the medical journal American Journal of Clinical Nutrition summarized in 20002, “Several investigators have reported that rheumatoid arthritis patients consuming [omega-3] dietary supplements were able to lower or discontinue their background doses of nonsteroidal antiinflammatory drugs or disease-modifying antirheumatic drugs.”

Pain relief in other conditions

Does it work on pain other than rheumatoid arthritis? Yes.

In 2010, The Clinical Journal of Pain3 published a case series: five patients with other types of pain. The diagnoses included cervical radiculopathy, thoracic outlet syndrome, fibromyalgia, carpal tunnel syndrome, and burn injury. The doctors reported significant improvement—not just on the patients’ pain scales and reports, but on objective measures such as grip strength and EMG nerve conduction studies.

How long does it take to work?

The article in Drugs4 emphasizes that fish oil takes two to three months to work. It points out that is similar to the length of time that the “disease-modifying anti-inflammatory drugs” now used in rheumatoid arthritis take to work. And that it is in contrast to the short-acting painkillers.

Because it is a food that restores normal function, fish oil and its DHA / EPA may take many months to give you the full benefit.

Dosage: How much to take

Many people take fish oil—yet the typical amount they take is one or two capsules a day. Many people eat fish once or twice a week. But it turns out that is nowhere near enough for pain relief.

The studies about fish oil found that the effective amount is based on the amount of DHA and EPA contained within the fish oil. On average, 30% of fish oil is DHA and EPA, but different oils may contain different amounts.

When you get a bottle of fish oil or marine oil concentrate, read the label to find the amount of DHA and EPA contained in that particular product.

An 2006 article in Arthritis Research and Therapy, “Fish Oil: What the Prescriber Needs to Know”5 summarizes the amounts shown to be successful in studies.

  • The minimum amount for pain relief is 2.7 g. (grams) of the omega-3 fatty acids DHA / EPA per day. (That is, 2.7 grams of DHA and EPA, not 2.7 grams of fish oil.)
  • No additional benefit has been shown from taking more than 6 g. of DHA / EPA per day.

The amount to take every day for pain relief is between 2.7 grams and 6 grams of DHA / EPA.


The same article in Arthritis Research and Therapy6 says, “A dose of 3 g. / day EPA plus DHA has been assessed as safe for general consumption.”

Further, the European Food Safety Authority published in EFSA Journal in 20127: “Supplemental intakes of EPA and DHA combined at doses up to 5 g/day, and supplemental intakes of EPA alone up to 1.8 g/day, do not raise safety concerns for adults.”

These and other articles state that there was once concern that fish oil interacts with blood-thinning medications to thin the blood too much, but that research has shown these effects are unlikely.

Nevertheless, you must check with your doctor and pharmacist for possible interactions with your medications.

How much DHA and how much EPA?

The clinical research did not entirely distinguish between DHA and EPA, as patients were nearly always given a mixture.

Parris M. Kidd, PhD, has argued convincingly that it is important to take far more DHA than EPA:

  • Cell membranes contain vastly more DHA than EPA
  • When DHA and EPA levels are measured in patients, low DHA “predicts functional problems,” while EPA levels do not.
  • Taking EPA alone decreases DHA in cell membranes, while taking DHA increases both DHA and EPA in cell membranes.



Action Steps: Fish Oil for Pain Relief

Print out the medical journal article (linked here:) Fish Oil: What the Prescriber Needs to Know to show to your doctor and for more information for yourself.

The first half of the article is technical, but you can find practical recommendations for patients in its second half. The article also may help your doctor answer the question whether fish oil, DHA, or EPA would interact with your medications.

Check with your doctor for his or her approval.

Look for one of the products below in a health food store, natural food store, or online. The brands listed below are easy to find.

Slowly build up the amount you take, starting with one softgel or less than a  teaspoon.

Consider taking a fat-digesting enzyme along with each dose.


Do not stop taking medications.

Check with your doctor and pharmacist for any interactions with your medications.

Sources recommend that amounts over two grams per day be under a doctor’s supervision.

Pain-Relieving Amount

  • Fish body oil containing 2.7 grams to 6 grams DHA / EPA, per day


  • 2.7 grams to 6 grams DHA / EPA per day, from fish, squid, or algae


500 mg. (milligrams) = 1/2 g. (grams)
1000 mg. = 1 g.
3000 mg. = 3 g.​

Getting used to fat

If you aren’t used to eating a lot of fat, your body will need to get used to it. Build up slowly.

To help digestibility:

  • Take in divided doses (several doses throughout the day), if possible.
  • Take it immediately before a meal, if possible.

Consider taking a capsule of the fat-digesting enzyme lipase with each dose of fish oil or DHA. You can find this online or at the same stores that carry fish oil and DHA supplements.

(If you have had your gallbladder removed: you have a great deal of difficulty digesting fat without a gallbladder, and the fat-digesting enzyme will be a necessity.)

Example Fat-Digesting Enzyme Product

Enzymedica Lypo
One capsule contains the digestive enzymes amylase, lipase, protease, and lactase
Formulated to optimize fat digestion

According to “Fish Oil: What the Prescriber Needs to Know,”8 about 15% of people just can’t tolerate fish oil.​


The literature also shows that the other fats in your diet may affect how well DHA / EPA works.


  • More omega-3 fats and other healthy fats
  • Less trans fat
  • Less corn oil (omega-6 vegetable oil)
  • Less soybean oil (omega-6 vegetable oil)



Fish Body Oil

Although I would generally suggest taking a concentrated DHA marine oil product (in the next section) rather than fish oil, I want to include information about fish oil.

“Fish oil” here is not cod liver oil, but is what is known as “fish body oil.”

Unfortunately, you can’t cook with it, so you need to take it separately.

Reliable brands use a purification process that removes environmental toxins from the oil.

A few reliable brands are: Carlson Labs; Nordic Naturals; Barleans.​ There are others.

The label will state how much DHA and EPA are in the fish oil.

Examples of Fish Oil Products

Carlson Labs The Very Finest Fish Oil – liquid version
One teaspoon contains 800 mg. EPA and 500 mg. DHA

Carlson Labs The Very Finest Fish Oil – softgel version
One softgel contains 160 mg. EPA and 100 mg. DHA

Carlson Labs Super Omega 3 Gems fish oil concentrate softgels
One softgel contains 300 mg. EPA and 200 mg. DHA


500 mg. (milligrams) = 1/2 g. (grams)
1000 mg. = 1 g.
3000 mg. = 3 g.​

Drinking Liquid Fish Oil

“Fish Oil: What the Prescriber Needs to Know”9 describes a method of taking liquid fish oil: pour two small glasses of juice. Add the fish oil to one of the glasses—don’t stir. Drink that glass quickly, and immediately and quickly follow it with the other glass.



DHA From Marine Oils

To take the pain-relieving amounts, concentrated DHA is more practical. There is even a vegetarian alternative.

Examples of DHA Products

DHA From Fish Oil

Nordic Naturals DHA Xtra
One softgel contains 450 mg. DHA and 180 mg. EPA

DHA From Squid Oil

Doctor’s Best Best DHA 500 From Calamari
One softgel contains 500 mg. DHA and 50 mg. EPA

DHA from Algae – Vegetarian

Nordic Naturals Algae Omega
One softgel contains 190 mg. DHA and 97.5 mg. EPA

I don’t recommend DHA from algae unless you are a committed vegan. Other oils and ingredients are included; the amount of DHA per capsule is low.


500 mg. (milligrams) = 1/2 g. (grams)
1000 mg. = 1 g.
3000 mg. = 3 g.​




Unfortunately, it isn’t practical to eat fish for pain relief. A large amount of wild (not farmed) fish would be required; it would need to be eaten every single day; and there could be a high toxic load from eating that much fish.

Wild fish have significant amounts of omega-3 fats. Farmed fish have little omega-3 when they are fed grain, and farmed fish are more frequently highly contaminated with toxins.​

Unfortunately, fish concentrate many poisonous substances, such as mercury and PCBs; when you eat fish, you eat these toxins. In contrast, reputable manufacturers of fish oil purify the oil to remove these contaminants.


Wild Alaska salmon
4 oz. broiled wild Coho: 1.32 g. omega-3, including 750 mg. DHA

​Note: All Sockeye salmon is wild

3.2 oz. canned Atlantic sardines: 1.46 g. omega-3, including 460 mg. DHA

Pacific mackerel
3 oz.: 1.5 g. omega-3

Atlantic mackerel
3 oz.: 1 g. omega-3​




Medical Journal Articles

Every link leads to free full text, except as noted. In some cases, to get to the full text, you’ll need to find and click an additional PDF or full text link .

PMID is the ID number in the free PubMed medical literature index. PMCID is the ID number in the free PubMed Central full-text archive.

n-3 Fatty Acid Supplements in Rheumatoid Arthritis
Joel M. Kremer
American Journal of Clinical Nutrition 2000;71(suppl):349S-51S
PMID: 10617995

Effects of Altering Dietary Essential Fatty Acids on Requirements for Non-Steroidal anti-Inflammatory Drugs in Patients with With Rheumatoid Arthritis: a Double Blind Placebo Controlled Study
J.J.F. Belch, D. Answell, R. Madhok, A. O’Dowd, and R.D. Sturrock
Annals of the Rheumatic Diseases 1988; 47, 96-104
PMID: 2833184

Fish Oil: What the Prescriber Needs to Know
Leslie G. Cleland, Michael J. James, and Susanna M. Proudman
Arthritis Research and Therapy 2006, 8:202
PMID: 16542466

Unsaturated Fatty Acids and Pain
Shogo Tokuyama and Kazuo Nakamoto
Biological and Pharmaceutical Bulletin 34(8) 1174-1178 (2011)
PMID: 21804202

Omega-3 Fatty Acids for Neuropathic Pain: Case Series
G.D. Ko, N.B. Nowacki, L. Arseneau, M. Eitel, A. Hum
Clinical Journal of Pain 2010 Feb; 26(2):168-72
PMID: 20090445
(Abstract only is free.)

The Role of Fish Oils in the Treatment of Rheumatoid Arthritis
Leslie C. Cleland, Michael J. James, and Susanna M. Proudman
Drugs 2003; 63(9): 845-853
PMID: 1267871

Scientific Opinion on the Tolerable Upper Intake Level of eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA) and docosapentaenoic acid (DPA)
European Food Safety Authority
EFSA Journal 2012; 10(7):2815