Tolerance and efficacy of a polyamine-deficient diet for the treatment of perioperative pain.
BACKGROUND
Polyamines have been identified as pain agonists and interact with N-methyl-D-aspartate receptors. A prospective, randomized, multicenter, and blinded phase II clinical trial was conducted to evaluate a polyamine-deficient diet for the treatment of perioperative pain in patients during spinal surgery.


METHODS
All analyses followed the intention-to-treat principle. The trial was designed to evaluate the dose-ranging effect of a low polyamine diet with respect to a total (group 1) or partial (group 2) polyamine diet on perioperative pain (7 d before and 5 d after surgery). Pain (numerical scale at rest and motion), quality of life questionnaires (Brief Pain Inventory, EIFEL questionnaire, and Short Form-12 acute questionnaire), and tolerance of and compliance with the nutritional program were measured.


RESULTS
Compliance (preoperatively: 100% in group 1 and 83% in group 2; postoperatively: 83% in group 1 and 71% in group 2) and tolerance were good. After 7 d following the diet before surgery, decreased pain was observed in group 1 whereas no effect was observed in group 2 (P = 0.144). This analgesic effect became significant in group 1 in the subgroup of patients with initial high levels of pain (NS ≥ 4) at rest (P = 0.03) and during motion (P = 0.011). Quality of life was significantly improved in group 1 (P = 0.0465). In the postoperative period, pain was significantly decreased in group 1 compared to group 2 at rest (P = 0.022) and during motion (P = 0.029). The effect was significantly better on patients with higher initial pain both at rest (P = 0.013) and during motion (P = 0.005) in group 1 compared to group 2.


CONCLUSIONS
Suppression of polyamines from the diet offers a nutrition-based treatment option for perioperative pain reduction independent of and complementary to typical analgesic approaches.
Department of Anesthesiology, University Hospital of Rennes, Rennes, France. Electronic address: Jean-pierre.estebe@chu-rennes.fr.
Jean-Pierre
JP
Estebe
Department of Anesthesiology, University Hospital Pellegrin of Bordeaux, Bordeaux, France.
Cécile
C
Degryse
Department of Anesthesiology, University Hospital Pasteur of Nice, Nice, France.
Gilles
G
Rezzadori
Department of Anesthesiology, University Hospital Hautepierre of Strasbourg, Strasbourg, France.
Florin
F
Dimache
Department of Anesthesiology, University Hospital of Caen, Caen, France.
Georges
G
Daccache
Department of Anesthesiology, University Hospital of Rennes, Rennes, France.
Alain
A
Le Naoures
Department of Anesthesiology, University Hospital Cochin, Paris, France.
Anissa
A
Belbachir
Department of Anesthesiology, University Hospital Gabriel Montpied of Clermont-Ferrand, France.
Pierre
P
Schoeffler
SLB Pharma, Rennes, France.
Anne-Laure
AL
Sérandour
D000328:Adult; D000368:Aged; D004032:Diet; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000178:diet therapy*; D010349:Patient Compliance; D019990:Perioperative Care; D011073:Polyamines / Q000008:administration & dosage*; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D011073:Polyamines
Diet; NMDA receptors; Pain; Perioperative pain; Polyamines; Spine surgery