Chronic pancreatitis is characterized by a slow inflammatory destruction of pancreatic tissue and subsequent fibrosis. Patients present with abdominal pain or signs of pancreatic endocrine or exocrine insufficiency. The mechanism underlying the pain in this disorder is still poorly understood and treatment has largely depended on the use of narcotics or endoscopic or surgical decompression in the event of an obstructed pancreatic duct. Oxidative stress has been implicated in the pathogenesis of pancreatic inflammation and pancreatitis pain. Previously small studies suggested potential therapeutic benefit from antioxidant supplementation. Now Bhardwaj and colleagues (2009) have reported on a large multicenter, placebo-controlled trial of antioxidant supplementation in chronic pancreatitis. A total of 147 patients were randomized to treatment with placebo or antioxidant supplements for 6 months. The antioxidant supplementation consisted of daily doses of (1) 600 µg organic selenium, (2) 0.54 g ascorbic acid, (3) 9000 IU β-carotene, (4) 270 IU α-tocopherol, and (6) 2 g methionine. The assessment of pain was done in terms of the number of painful days per month, the requirement of oral or parenteral analgesics, and the need for hospitalization.
These investigators found that antioxidant supplementation led to a significantly lower number of painful days per month, a high reduction in the need for oral analgesics and a lower need for hospitalization. The beneficial effect of these antioxidants on pain relief was already significant at 3 months. Serum levels of superoxide dismutase and thiobarbituric acid (markers of oxidative stress) were elevated initially and decreased significantly during antioxidant therapy.
This controlled trial has shown that antioxidant supplementation significantly reduced abdominal pain in patients with chronic pancreatitis. The data suggest that free radical mediated injury is involved in the causation of pain in chronic pancreatitis and that this process may be reversible with antioxidant supplementation. Whether antioxidants will remain effective beyond 6 months of therapy remains to be determined.
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Cite this: Chronic Pancreatitis: The Use of Antioxidants to Reduce Chronic Pain - Medscape - Jan 19, 2009.
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