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Author(s)

Laurie Barclay, MD

Laurie Barclay, MD is a freelance reviewer and writer for Medscape.

From Medscape Medical News

Laurie Barclay, MD
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January 8, 2009 — Antioxidant supplementation effectively relieves pain and oxidative stress in patients with chronic
pancreatitis (CP), according to the results of a placebo-controlled, double-blind trial reported in the January issue of
Gastroenterology.

"Oxidative stress has been implicated in the pathophysiology of...CP," write Payal Bhardwaj, from the All India Institute of
Medical Sciences in New Delhi, and colleagues. "We evaluated the effects of antioxidant supplementation on pain relief,
oxidative stress, and antioxidant status in patients with CP."

Consecutive patients with CP were randomly assigned to receive placebo or antioxidant supplementation for 6 months, with
the main endpoint of the study being pain relief. Secondary endpoints were a need for analgesics and hospitalization.
Oxidative stress markers measured were thiobarbituric acid–reactive substances and antioxidant status (ferric-reducing ability
of plasma).

Mean age of the patients was 30.5 ± 10.5 years, 86 were men, 35 had alcoholic CP, and 92 had idiopathic CP. Of 127
patients randomly assigned, 56 were in the placebo group and 71 in the antioxidant group. Compared with the placebo group,
the antioxidant group had a significantly greater decrease after 6 months in the number of painful days per month (7.4 ± 6.8 vs
3.2 ± 4 days, respectively; P < .001; 95% confidence interval [CI], 2.07 - 6.23).

The antioxidant group also had a greater reduction in the number of analgesic tablets taken per month (10.5 ± 11.8 vs 4.4 ±
5.8 tablets, respectively; P < .001; 95% CI, 2.65 - 9.65). The proportion of patients that became pain-free was 32% in the
antioxidant group and 13% in the placebo group (P = .009).

Compared with the placebo group, the antioxidant group had a significantly greater reduction in the level of thiobarbituric
acid–reactive substances and an increase in the ferric-reducing ability of plasma (thiobarbituric acid–reactive substances:
placebo, 1.2 ± 2.7 nmol/mL vs antioxidant, 3.5 ± 3.4 nmol/mL; P = .001; 95% CI, 0.96 - 3.55; ferric-reducing ability of plasma:
placebo, –5.6 ± 154.9 µMFe+2 liberated vs antioxidant 97.8 ± 134.9 µMFe+2 liberated; P = .001; 95% CI, 44.98 - 161.7).

"Antioxidant supplementation was effective in relieving pain and reducing levels of oxidative stress in patients with CP," the
study authors write. "Reduction in pain also resulted in fewer man-days lost, thus providing functional employment gain to the
patients. The beneficial effect of antioxidants on pain relief was noted early — at 3 months."

Limitations of the study include evaluation of pain subject to bias, reduction of pain in the placebo group, loss to follow-up, and
lack of data concerning for how long the effect of antioxidants will last and for how long the antioxidant supplementation should
be continued.

"We did not observe any significant adverse drug reactions due to antioxidants in our study," the study authors conclude. "This
could be due to the fact that the patients were antioxidant deficient. We believe that antioxidant therapy can be prescribed in an
appropriate clinical setting of CP."

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Antioxidants Reduce Pain, Oxidative Stress in Chronic Pancreatitis (printe... http://www.medscape.com/viewarticle/586502_print

This study was supported by Indian Council of Medical Research. Osper Pharmanautics provided the drug and placebo
without charge.

Gastroenterology. 2009;136:149-159.

Medscape Medical News © 2009

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