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Acute Pain | Chronic Pain | General

Pancreatic enzyme supplementation for pain in chronic pancreatitis

Clinical bottom line:

Pancreatic enzyme supplementation is not effective in alleviating pain caused by chronic pancreatitis. Treatments ranging from two weeks to eight months had a relative benefit of 1.2 (0.8 to 1.8). More suitable methods of pain relief should be used.


Chronic pancreatitis is relatively uncommon, but is estimated to account for approximately 122,000 outpatient visits and 56,000 hospitalisations per year in the US. Alcoholism is by far the most common cause. Chronic pancreatitis is associated with severe abdominal pain and steatorrhoea, and the treatment of choice advocated by well-known textbooks is pancreatic enzyme supplementation.

Systematic review

Brown A, Hughes M, Tenner S, Banks PA. Does pancreatic enzyme supplementation reduce pain in patients with chronic pancreatitis: a meta-analysis. American Journal of Gastroenterology. 1997; 92: 2032-2035.

Inclusion criteria were randomised, prospective, double-blind, placebo-controlled trials of pancreatic enzyme supplements for pain; no use of enzymes at time of enrolment.

Using the main pain outcome, reviewers calculated the percentage of patients expressing a preference for enzymes over placebo. This derived from the number of patients obtaining greater pain relief from pancreatic enzymes than from placebo. This percentage was then used to calculate the log odds and a pooled estimate with 95% confidence intervals. We have also calculated a relative benefit for each trial and a pooled relative benefit (all with 95% confidence intervals).

Findings

All six trials were crossover design, and of two weeks to eight months duration. Six different pancreatic enzyme supplements were used.

Only one of six trials showed a statistical improvement over placebo as judged by patient preference. This trial had a two week outcome. Overall the relative benefit was 1.2 (0.8 to 1.8).

NB. Authors could have devised a more comprehensive search strategy.

Adverse effects

The review did not report on adverse effects.

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