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Antioxidant therapy for pain relief in patients with chronic pancreatitis: systematic review and meta-analysis.

Abstract

BACKGROUND

Currently, there is no specific therapy for chronic pancreatitis (CP). The treatment of micronutrient antioxidant therapy for painful CP has been sporadically used for more than 30 years, however, its efficacy are still poorly understood.

OBJECTIVE

The purpose of this meta-analysis is to investigate the safety and efficacy of antioxidant therapy for pain relief in patients with CP.

SETTING

University Hospital in China

STUDY DESIGN

Systematic review and meta-analysis

METHODS

Two authors independently reviewed the search results and extracted data and disagreements were resolved by discussion. Effects were summarized using standardized mean differences (SMDs), weighted mean differences, or odds ratio (OR) according to the suitable effect model. MEDLINE, PsycINFO, Scopus, EMBASE, and the Cochrane Central Register of Controlled Trials  were searched from 1980 through December 2012. Randomized controlled trials (RCTs) that studied antioxidant supplementation for pain relief in patients with CP were analyzed.

RESULTS

Nine randomized controlled trials (RCTs) involving 390 patients were included. Overall, there was no association of antioxidant therapy with pain reduction in CP patients (SMD, -0.55; 95% CI, -1.22 to 0.12; P = 0.67). However, antioxidant therapy significantly increased blood levels of antioxidants in CP patients versus the placebo group (SMD, 1.08; 95% CI, 0.74 to 1.43; P < 0.00001). Interestingly, combined antioxidant (selenium, β-carotene, vitamin C, vitamin E, methionine) therapy was found to be associated with pain relief (SMD, -0.93; 95% CI, -1.72 to -0.14; P = 0.02), while the trials in which a single antioxidant was used revealed no significant pain relief (SMD, -0.12; 95% CI, -1.23 to 0.99; P = 0.83) in CP patients. Strong evidence was obtained that the antioxidants increased adverse effects (OR, 6.09; 95% CI, 2.29 to 16.17, P < 0.01); nevertheless, none was serious.

LIMITATIONS

Because of the small sample, a consolidated conclusion cannot be reached based on current RCTs. Large-sample RCTs are needed to clarify the analgesic effect of antioxidants in CP patients.

CONCLUSIONS

Combined antioxidant therapy seems to be a safe and effective therapy for pain relief in CP patients. Measures of total antioxidant status may not help to monitor the efficacy of antioxidant therapy for patients with CP.

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  • Authors+Show Affiliations

    ,

    Fourth Military Medical University, Xi'an, Shaan'xii Province, China.

    , , , , , , , ,

    Source

    Pain physician 16:6 pg 521-32

    MeSH

    Antioxidants
    Humans
    Pain
    Pain Management
    Pancreatitis, Chronic
    Randomized Controlled Trials as Topic

    Pub Type(s)

    Journal Article
    Meta-Analysis
    Research Support, Non-U.S. Gov't
    Review
    Systematic Review

    Language

    eng

    PubMed ID

    24284838

    Citation

    Cai, Guo-Hong, et al. "Antioxidant Therapy for Pain Relief in Patients With Chronic Pancreatitis: Systematic Review and Meta-analysis." Pain Physician, vol. 16, no. 6, 2013, pp. 521-32.
    Cai GH, Huang J, Zhao Y, et al. Antioxidant therapy for pain relief in patients with chronic pancreatitis: systematic review and meta-analysis. Pain Physician. 2013;16(6):521-32.
    Cai, G. H., Huang, J., Zhao, Y., Chen, J., Wu, H. H., Dong, Y. L., ... Wu, S. X. (2013). Antioxidant therapy for pain relief in patients with chronic pancreatitis: systematic review and meta-analysis. Pain Physician, 16(6), pp. 521-32.
    Cai GH, et al. Antioxidant Therapy for Pain Relief in Patients With Chronic Pancreatitis: Systematic Review and Meta-analysis. Pain Physician. 2013;16(6):521-32. PubMed PMID: 24284838.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Antioxidant therapy for pain relief in patients with chronic pancreatitis: systematic review and meta-analysis. AU - Cai,Guo-Hong, AU - Huang,Jing, AU - Zhao,Yan, AU - Chen,Jing, AU - Wu,Huang-Hui, AU - Dong,Yu-Lin, AU - Smith,Howard S, AU - Li,Yun-Qing, AU - Wang,Wen, AU - Wu,Sheng-Xi, PY - 2013/11/29/entrez PY - 2013/11/29/pubmed PY - 2014/8/7/medline SP - 521 EP - 32 JF - Pain physician JO - Pain Physician VL - 16 IS - 6 N2 - BACKGROUND: Currently, there is no specific therapy for chronic pancreatitis (CP). The treatment of micronutrient antioxidant therapy for painful CP has been sporadically used for more than 30 years, however, its efficacy are still poorly understood. OBJECTIVE: The purpose of this meta-analysis is to investigate the safety and efficacy of antioxidant therapy for pain relief in patients with CP. SETTING: University Hospital in China STUDY DESIGN: Systematic review and meta-analysis METHODS: Two authors independently reviewed the search results and extracted data and disagreements were resolved by discussion. Effects were summarized using standardized mean differences (SMDs), weighted mean differences, or odds ratio (OR) according to the suitable effect model. MEDLINE, PsycINFO, Scopus, EMBASE, and the Cochrane Central Register of Controlled Trials  were searched from 1980 through December 2012. Randomized controlled trials (RCTs) that studied antioxidant supplementation for pain relief in patients with CP were analyzed. RESULTS: Nine randomized controlled trials (RCTs) involving 390 patients were included. Overall, there was no association of antioxidant therapy with pain reduction in CP patients (SMD, -0.55; 95% CI, -1.22 to 0.12; P = 0.67). However, antioxidant therapy significantly increased blood levels of antioxidants in CP patients versus the placebo group (SMD, 1.08; 95% CI, 0.74 to 1.43; P < 0.00001). Interestingly, combined antioxidant (selenium, β-carotene, vitamin C, vitamin E, methionine) therapy was found to be associated with pain relief (SMD, -0.93; 95% CI, -1.72 to -0.14; P = 0.02), while the trials in which a single antioxidant was used revealed no significant pain relief (SMD, -0.12; 95% CI, -1.23 to 0.99; P = 0.83) in CP patients. Strong evidence was obtained that the antioxidants increased adverse effects (OR, 6.09; 95% CI, 2.29 to 16.17, P < 0.01); nevertheless, none was serious. LIMITATIONS: Because of the small sample, a consolidated conclusion cannot be reached based on current RCTs. Large-sample RCTs are needed to clarify the analgesic effect of antioxidants in CP patients. CONCLUSIONS: Combined antioxidant therapy seems to be a safe and effective therapy for pain relief in CP patients. Measures of total antioxidant status may not help to monitor the efficacy of antioxidant therapy for patients with CP. SN - 2150-1149 UR - https://www.unboundmedicine.com/medline/citation/24284838/full_citation L2 - http://www.painphysicianjournal.com/linkout?issn=1533-3159&amp;vol=16&amp;page=521 DB - PRIME DP - Unbound Medicine ER -