Antioxidants for pain relief in chronic pancreatitis

Long-term pain relief with optimized medical treatment including antioxidants and step-up interventional therapy in patients with chronic pancreatitis

BACKGROUND AND AIM

Abdominal pain is difficult to treat in patients with chronic pancreatitis (CP). Medical therapy including antioxidants has been shown to relieve pain of CP in the short-term. Our aim was to study the long-term results of optimized medical and interventional therapy for pain relief in patients with CP with a step-up approach.

METHODS

All consecutive patients with CP were included prospectively in the study. They were treated medically with a well-balanced diet, pancreatic enzymes, and antioxidants (9000 IU beta-carotene, 0.54 g vitamin C, 270 IU vitamin E, 600 µg organic selenium, and 2 g methionine). Endoscopic therapy and/or surgery were offered if medical therapy failed. Pain relief was the primary outcome measure.

RESULTS

A total of 313 patients (mean age 26.16 ± 12.17; 244 males) with CP were included; 288 (92%) patients had abdominal pain. The etiology of CP was idiopathic in 224 (71.6%) and alcohol in 82 (26.2%). At 1-year follow-up, significant pain relief was achieved in 84.7% of patients: 52.1% with medical therapy, 16.7% with endoscopic therapy, 7.6% with surgery, and 8.3% spontaneously. The mean pain score decreased from 6.36 ± 1.92 to 1.62 ± 2.10 (P < 0.001). Of the 288 patients, 261, 218, 112, and 51 patients were followed up for 3, 5, 10, and 15 years, respectively; 54.0%, 57.3%, 60.7%, and 68.8% of them became pain free at those follow-up periods.

CONCLUSION

Significant pain relief is achieved in the majority of patients with optimized medical and interventional treatment.

The Analgesic Effect of the Mitochondria-Targeted Antioxidant SkQ1 in Pancreatic Inflammation

Background. Chronic pancreatitis is one of the main risk factors for pancreatic cancer. In acute and chronic pancreatitis, oxidative stress is thought to play a key role. In this respect, the recently described mitochondria-targeted antioxidant SkQ1 effectively scavenges reactive oxygen species at nanomolar concentrations. Therefore, we aimed to characterize the influence of SkQ1 on tissue injury and pain in acute and chronic pancreatitis. Methods. Both acute and chronic pancreatitis were induced in C57BL/6 mice by intraperitoneal cerulein injections and treatment with SkQ1 was carried out by peroral applications. Hyperalgesia was assessed by behavioral observation and measurement of abdominal mechanical sensitivity. Blood serum and pancreatic tissue were harvested for analysis of lipase and histology. Results. SkQ1 did not influence pain, serological, or histological parameters of tissue injury in acute pancreatitis. In chronic pancreatitis, a highly significant reduction of pain-related behavior (p < 0.0001) was evident, but histological grading revealed increased tissue injury in SkQ1-treated animals (p = 0.03). Conclusion. After SkQ1 treatment, tissue injury is not ameliorated in acute pancreatitis and increased in chronic pancreatitis. However, we show an analgesic effect in chronic pancreatitis. Further studies will need to elucidate the risks and benefits of mitochondria-targeted antioxidants as an analgesic.

Therapeutic implications of oxidative stress in acute and chronic pancreatitis

PURPOSE OF REVIEW

This review presents new evidence on the role of oxidative stress and antioxidant status in acute and chronic pancreatitis published in the last year.

RECENT FINDINGS

In-vitro studies showed that protein phosphatases may play an important role in the interaction between reactive oxygen species and proinflammatory cytokines in acute pancreatitis. In-vivo studies found that several natural compounds ameliorate oxidative stress and, therefore, have therapeutic potential. In the domain of clinical studies, the major development is the first double-blind placebo-controlled randomized trial that showed effectiveness of oral antioxidant supplementation (organic selenium, ascorbic acid, alpha-tocopherol, beta-carotene, and methionine) in relieving pain in patients with chronic pancreatitis. The developments in clinical studies on acute pancreatitis are less spectacular and mainly limited to evaluation of different markers of oxidative stress and antioxidant status in the course of disease.

SUMMARY

A significant advance has been made in the arena of research in chronic, but not acute, pancreatitis. There is now solid evidence to justify the use of oral antioxidants in the treatment of patients with chronic pancreatitis. The progress in clinical research on antioxidants in acute pancreatitis is hampered by several factors, including suboptimal classification of acute pancreatitis and route of administration used in previous studies.