Sunday, April 06, 2008
Research
By Jeff Minerd, Contributing Writer, MedPage Today
Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine.
May 24, 2007
WASHINGTON, May 24 -- Vitamins C and E and other antioxidants may be an option for managing abdominal pain in patients suffering from chronic pancreatitis, according to a study presented here.
One-third (33%) of patients with chronic pancreatitis reported no pain after six months of antioxidant therapy, compared with only 13% of patients in a placebo group (P=0.009), reported Payal Bhardwaj, M.D., of the All India Institute of Medical Sciences, New Delhi, at the Digestive Disease Week conference.
Dr. Bhardwaj and colleagues hypothesized that the inflammation produced by oxidative stress may be causing the pain suffered by up to 90% of patients, and that antioxidant therapy might relieve that pain.
Previous studies exploring this hypothesis used only small numbers of patients and were not randomized, blinded, placebo-controlled trials, she said. In addition, she noted, the longest ran only six weeks.
The current study involved 127 chronic pancreatitis patients, mostly males, with an average age of 30. Of these, the condition was caused by alcohol consumption in 35 patients and was idiopathic in the others.
The patients were randomized to receive either placebo (n=56) or a daily combination of five antioxidants: 600 micrograms of selenium, 0.54 grams of vitamin C, 9000 international units of beta-carotene, 2,701 international units of vitamin E, and 2 grams of methionine (n=71).
At six-month follow up, the number of painful days per month averaged 3.4 for the placebo group and 1.7 for the treatment group (P=0.012). The placebo group took an average of 10.5 oral analgesics per month to help manage their pain, while the treatment group needed an average of only 4.4 (P=0.001).
Markers of oxidative stress, assessed by blood tests and spectrographic methods, were also significantly improved in the treatment group. For example, the amount of thiobarbituric acid reactive substances averaged 5.4 nmoles/ml in the placebo group versus 3.6 nmoles/ml in the treatment group (P=0.001). Furthermore, the level of serum superoxide dismutase was 27.3 U/mg/Hb in the placebo group and 51.1 U/mg/Hb in the treatment group (P<0.001).
"Antioxidant supplementation was effective in relieving pain in chronic pancreatitis, with a decrease in oxidative stress and an increase in antioxidant status," the investigators concluded.
There is little in the way of satisfactory treatments for pain associated with chronic pancreatitis, Dr. Bhardwaj said. For example, surgical treatments such as removing part of the pancreas are highly invasive and not always successful, she said.
The current study is also important because another option, narcotic pain relievers, are risky, becoming less effective over time and carrying the risk of addiction, commented Ananya Das, M.D., of the Mayo Clinic in Scottsdale, Arizona.
"Antioxidants are a simple, non-invasive, well-tolerated treatment," Dr. Bhardwaj said. If further studies bear out these results, "antioxidants could be immensely useful to these patients," she said.
Further research should investigate whether antioxidants could relieve pain in other diseases in which inflammation and oxidative stress play a role, she suggested, including various types of cancer and heart disease.
The study was not funded by any outside sources. Dr. Bhardwaj did not disclose any financial conflicts.
Primary source: Digestive Disease Week 2007
Source reference:
Bhardwaj P et al. "Antioxidant Supplementation for pain relief in chronic pancreatitis: a randomized, placebo controlled double blind trial." Abstrat number 271. Presented at Digestive Disease Week 2007, Washington, D.C., May 19-21.
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