Muller Ryan, Dranoff Jonathan, Grimshaw Alyssa A, Bastian Lori, Gunderson Craig
Physical Medicine and Rehabilitation, Pain Research, Informatics, Multi-morbidities, and Education (PRIME) Center, Veterans Affairs (VA) Connecticut Healthcare System, West Haven, USA.
Gastroenterology, Veterans Affairs (VA) Connecticut Healthcare System, West Haven, USA.
Cureus. 2024 Jul 18;16(7):e64859. doi: 10.7759/cureus.64859. eCollection 2024 Jul.
Despite the high prevalence of pain and challenges associated with traditional pharmacological pain management in patients with cirrhosis, little is known about the safety and effectiveness of non-pharmacological management of pain in this patient population. A systematic literature search of published studies was conducted in nine databases from inception through January 11, 2023, including any clinical trial, cohort, or case-control study of non-pharmacological pain interventions in adult patients with cirrhosis. Studies using nutritional supplements were included. The primary and secondary outcomes for this review were pain/analgesic effect and safety, respectively. Two reviewers independently performed data extraction and risk of bias assessment. Of the 4,087 studies initially screened, 11 studies representing 340 patients ultimately met inclusion criteria, including seven observational and four randomized controlled trials. Five studies reported muscle cramp severity, four reported muscle cramp frequency, and two reported non-cramp pain. Oral zinc sulfate, L-carnitine, and taurine were reported to decrease cramp frequency. Oral vitamin E, oral zinc sulfate, L-carnitine, taurine, and pickle juice decreased cramp severity. Curcumin supplementation, resistance training, and stretching and walking programs improved non-cramp pain. Mild adverse events were reported in four studies. The risk of bias was moderate to high for all studies, largely due to missing data, study design, and a lack of blinding of participants. Numerous nutritional and non-pharmacological interventions have been reported to be safe and effective for the treatment of pain and painful muscle cramps in patients with cirrhosis. However, further research is needed to better determine the efficacy, safety, and optimal frequency and dosage of interventions.
尽管肝硬化患者疼痛的患病率很高，且传统药物疼痛管理存在挑战，但对于该患者群体非药物疼痛管理的安全性和有效性知之甚少。我们对九个数据库进行了系统的文献检索，涵盖从数据库建立至2023年1月11日发表的研究，包括任何关于成年肝硬化患者非药物疼痛干预的临床试验、队列研究或病例对照研究。使用营养补充剂的研究也包括在内。本次综述的主要和次要结局分别为疼痛/镇痛效果和安全性。两名评审员独立进行数据提取和偏倚风险评估。在最初筛选的4087项研究中，最终有11项研究（代表340名患者）符合纳入标准，包括7项观察性研究和4项随机对照试验。5项研究报告了肌肉痉挛的严重程度，4项报告了肌肉痉挛的频率，2项报告了非痉挛性疼痛。据报道，口服硫酸锌、左旋肉碱和牛磺酸可降低痉挛频率。口服维生素E、口服硫酸锌、左旋肉碱、牛磺酸和腌菜汁可减轻痉挛严重程度。补充姜黄素、进行阻力训练以及伸展和步行计划可改善非痉挛性疼痛。4项研究报告了轻微不良事件。所有研究的偏倚风险为中度至高度，主要原因是数据缺失、研究设计以及参与者缺乏盲法。据报道，许多营养和非药物干预措施对于治疗肝硬化患者的疼痛和疼痛性肌肉痉挛是安全有效的。然而，需要进一步研究以更好地确定干预措施的疗效、安全性以及最佳频率和剂量。
