A systematic review and meta-analysis of nutrition interventions for chronic noncancer pain

BACKGROUND

This systematic review aimed to evaluate the impact of nutrition interventions on participant reported pain severity and intensity in populations with chronic pain.

METHODS

Eight databases were systematically searched for studies that included adult populations with a chronic pain condition, a nutrition intervention and a measure of pain. Where possible, data were pooled using meta-analysis. Seventy-one studies were included, with 23 being eligible for meta-analysis.

RESULTS

Studies were categorised into four groups: (i) altered overall diet with 12 of 16 studies finding a significant reduction in participant reported pain; (ii) altered specific nutrients with two of five studies reporting a significant reduction in participant reported pain; (iii) supplement-based interventions with 11 of 46 studies showing a significant reduction in pain; and (iv) fasting therapy with one of four studies reporting a significant reduction in pain. The meta-analysis found that, overall, nutrition interventions had a significant effect on pain reduction with studies testing an altered overall diet or just one nutrient having the greatest effect.

CONCLUSIONS

This review highlights the importance and effectiveness of nutrition interventions for people who experience chronic pain.

Dissipation and leaching of acephate, chlorpyrifos, and their main metabolites in field soils of Malaysia

Preventive treatment with insecticides at high dosing rates before planting of a new crop- soil drenching- is a common practice in some tropical intensive cropping systems, which may increase the risk of leaching, soil functioning, and pesticide uptake in the next crop. The degradation rates and migration of acephate and chlorpyrifos and their primary metabolites, methamidophos and 3,5,6-trichloropyridinol (TCP), have been studied in clayey red yellow podzolic (Typic Paleudults), alluvial (Typic Udorthents), and red yellow podzolic soils (Typic Kandiudults) of Malaysia under field conditions. The initial concentrations of acephate and chlorpyrifos in topsoils were found to strongly depend on solar radiation. Both pesticides and their metabolites were detected in subsoils at the deepest sampling depth monitored (50 cm) and with maximum concentrations up to 2.3 mg kg(-1) at soil depths of 10 to 20 cm. Extraordinary high dissipation rates for weakly sorbed acephate was in part attributed to preferential flow which was activated due to the high moisture content of the soils, high precipitation and the presence of conducting macropores running from below the A horizons to at least 1 m, as seen from a dye tracer experiment. Transport of chlorpyrifos and TCP which both sorb strongly to soil organic matter was attributed to macropore transport with soil particles. The half-lives for acephate in topsoils were 0.4 to 2.6 d while substantially longer half-lives of between 12.6 and 19.8 d were observed for chlorpyrifos. The transport through preferential flow of strongly sorbed pesticides is of concern in the tropics.

Vaginal misoprostol for term labor induction

Misoprostol is an effective agent for cervical ripening and induction of labor. The use of oxytocin was significantly decreased in patients treated with misoprostol versus dinoprostone. It has been used to induce over 1000 women in reported studies and has demonstrated a safety profile comparable with that of endocervical and vaginal dinoprostone. Uterine hyperstimulation was a concern in earlier trials, but at a reduced dose of 25 micrograms, the incidence has decreased to a level that is comparable with the values reported for dinoprostone. Misoprostol tablets are stable at room temperature and are considerably less expensive than the dinoprostone alternatives. Two additional factors pertaining to misoprostol administration must be taken into account before the drug is selected for vaginal use. First, Cytotec tablets are currently available in two strengths, 100 and 200 micrograms. This can lead to confusion or error if the clinician orders a quarter or half tablet. The order should always identify the strength in micrograms (25 or 50 micrograms). Second, the 100-microgram tablet is not scored; therefore, the proper dose should be carefully prepared by a pharmacist using a pill cutter. Key members of the hospital staff must be trained about the proper use of misoprostol for labor induction before initiating therapy. One alternative to directly inserting the tablet is to pulverize it and mix with a gel such as hydroxyethylcellulose gel. However, such compounding introduces the same problems with stability and uniformity of dose as experienced with dinoprostone gels. Despite the success of misoprostol in clinical trials, it is not approved for this indication, and the manufacturer of Cytotec does not plan to pursue approval. Therefore, independent, large-scale studies are warranted to more accurately assess the efficacy and overall safety of using intravaginal alprostadil for cervical ripening and labor induction. Additional clinical experience should also help to determine the best regimen and method of administration. From the data currently available, it appears that either a 25- or 50-microgram dose (one-fourth or one-half of a 100-microgram tablet) inserted into the posterior vaginal fornix and repeated at 4-5-hour intervals if needed, is a clinically effective regimen, and is associated with the least amount of adverse effects and complications. As with all labor inductions, uterine contractions and fetal heart rate should be monitored carefully throughout the procedure.