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Alissa J. Cruz
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Bethesda, MD (Jan. 1, 2009) — Antioxidant supplementation was found
to be effective in relieving pain and reducing levels of oxidative
stress in patients with chronic pancreatitis (CP), reports a new study
in Gastroenterology. CP is a progressive inflammatory disease
of the pancreas in which patients experience abdominal pain (in early
stage) and diabetes and maldigestion (in late stage). Pain is the major
problem in 90 percent of patients with CP and currently, there is no
effective medical therapy for pain relief. Gastroenterology is the official journal of the American Gastroenterological Association (AGA) Institute.
In
this placebo-controlled, double blind trial, 127 patients, ages
30.5+/-10.5, were assigned to placebo or antioxidant groups. After six
months, the reduction in the number of painful days/month was
significantly higher in the antioxidant group, compared with the
placebo group (7.4±6.8 versus 3.2±4, respectively). The reduction in
the number of analgesic tablets/month was also higher in the
antioxidant group (10.5±11.8 versus 4.4±5.8, respectively).
Furthermore, 32 percent and 13 percent of patients became pain free in
the antioxidant and placebo groups, respectively; the beneficial effect
of antioxidants on pain relief was noted early at three months.
"Abdominal
pain, the predominant symptom in patients with CP, is difficult to
treat. The main reason for a largely ineffective medical treatment is
that the mechanism of pain in CP is not well understood," said Pramod
Kumar Garg, MD, DM, of the All India Institute of Medical Sciences, New
Delhi and lead author of the study. "We are encouraged by our findings,
as significant improvement was noted with antioxidants in respect to
all the parameters of pain in this study. In addition, reduction in
pain resulted in fewer man-days lost, thus providing functional
employment gain to the patients. The findings should spur further
research in this exciting area."
There are two important
implications of this study — the fact that measures of oxidative stress
were increased initially and decreased subsequently after
supplementation with antioxidants suggests that there is a state of
heightened free radical mediated injury in CP, and that injury is
reversible. Second, with regard to pain management, this trial showed
that antioxidant therapy is effective for pain relief in patients with
CP. This assumes significance since no effective medical therapy exists
for pain relief for such patients.
Pancreatitis is
inflammation of the pancreas that usually begins as a sudden attack and
is often caused by gallstones, alcohol abuse or genetic mutations.
Symptoms of pancreatitis start with a gradual or sudden severe pain in
the center part of the upper abdomen going through to the back.
Treatment often focuses on the nutritional and metabolic needs of the
patient and on relieving pain. Most people with chronic pancreatitis
have a good prognosis if they follow their treatment regimen. "Aside
from medication, abstaining from alcohol and smoking are most important
and key to halt the progression of CP," added Dr. Garg.
Source: American Gastroenterological Association
Original article: Payal Bhardwaj, Pramod Kumar Garg, Subir Kumar Maulik, Anoop Saraya, Rakesh Kumar Tandon, Subrat Kumar Acharya. A Randomized Controlled Trial of Antioxidant Supplementation for Pain Relief in Patients With Chronic Pancreatitis. Gastroenterology, 136(1): 149-159 (January 2009).
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