title: Oral choline supplementation for postoperative pain.
abstract: BACKGROUND
  Activation of nicotinic receptors with nicotine has been shown to reduce post-surgical pain in clinical and preclinical studies. Choline is a selective agonist at α7-type nicotinic receptors that does not have addictive or sympathetic activating properties. It is anti-nociceptive in animal studies. We conducted a double-blind randomized trial of oral choline supplementation with lecithin to aid in the treatment of pain after gynaecological surgery.
  
  
  METHODS
  Sixty women having open gynaecological surgery were randomly assigned to receive 20 g of lecithin before surgery or placebo. Plasma choline concentration and tumour necrosis factor (TNF) were measured. Pain report was the primary outcome measure.
  
  
  RESULTS
  We achieved a small but statistically significant increase in choline after surgery with oral supplementation. Plasma TNF was not decreased and pain report was not different between groups at rest or with movement. There were no adverse effects of treatment.
  
  
  CONCLUSIONS
  Oral supplementation with lecithin during the perioperative period resulted in very slow absorption and thus only a small increase in plasma choline was achieved. This concentration was inadequate to reduce TNF as has been shown in other studies. The absence of an anti-inflammatory effect was likely related to our failure to demonstrate efficacy in pain reduction.
authors.affiliation: University of California, San Francisco, San Francisco, CA, USA.
authors.forename: N
authors.initials: N
authors.lastname: Sidhu
authors.forename: S
authors.initials: S
authors.lastname: Davies
authors.forename: A
authors.initials: A
authors.lastname: Nadarajah
authors.forename: J
authors.initials: J
authors.lastname: Rivera
authors.forename: R
authors.initials: R
authors.lastname: Whittington
authors.forename: R J
authors.initials: RJ
authors.lastname: Mercier
authors.forename: L
authors.initials: L
authors.lastname: Virag
authors.forename: S
authors.initials: S
authors.lastname: Wang
authors.forename: P
authors.initials: P
authors.lastname: Flood
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D002794:Choline / Q000097:blood / Q000627:therapeutic use*; D019587:Dietary Supplements; D004311:Double-Blind Method; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D054709:Lecithins / Q000008:administration & dosage; D008082:Lipotropic Agents / Q000097:blood / Q000627:therapeutic use*; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000188:drug therapy*; D010865:Pilot Projects; D014409:Tumor Necrosis Factor-alpha / Q000097:blood / Q000187:drug effects; D055815:Young Adult
chemical_list: D054709:Lecithins; D008082:Lipotropic Agents; D014409:Tumor Necrosis Factor-alpha; D002794:Choline
keywords: analgesia; anti-inflammatory agents; nutritional requirements; pain; pain measurement