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.


CONCLUSION
Suppression of polyamines from the diet offers a nutrition-based treatment option for perioperative pain reduction independent of and complementary to typical analgesic approaches.
['Estebe|Jean-Pierre|JP|', 'Degryse|Cécile|C|', 'Rezzadori|Gilles|G|', 'Dimache|Florin|F|', 'Daccache|Georges|G|', 'Le Naoures|Alain|A|', 'Belbachir|Anissa|A|', 'Schoeffler|Pierre|P|', 'Sérandour|Anne-Laure|AL|']
D000328:Adult D000368:Aged D004032:Diet D004305:Dose-Response Relationship, Drug D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D010146:Pain D010349:Patient Compliance D019990:Perioperative Care D011073:Polyamines D011446:Prospective Studies D011788:Quality of Life D011795:Surveys and Questionnaires D016896:Treatment Outcome
Diet Perioperative pain Pain Polyamines NMDA receptors Spine surgery