Background & Aims
Integrative medicine is a treatment that involves both non-pharmacological and pharmaceutical approaches. Nutritional management is one of the non-pharmacological pain remedies now under investigation. Indonesia is the number 7th for producing Theobroma cacao in the world. Theobroma cacao as well known as chocolate, is believed to have analgesic effects from its metabolites such as flavonoids, alkaloids, xanthine (theobromine, caffeine), polyphenols, and tryptophan. The expected research output includes the most current discoveries in the use of cacao extract as an adjuvant for oral morphine, which has been the major therapy for cancer pain in the form of articles. This is a pilot research to give the most sophisticated pain treatment for cancer patients utilizing natural ingredients. It is expected that cacao bean industrialization in Indonesia would provide economic value not only as a chocolate snack but also as a medicinal material.
Methods
This study used raw cacao beans from the Jember Coffee and Cacao Research Centre (Puslitkoka). The beans were obtained from one batch (location, types and harvested season). They were fermented in natural process under the sunlight, then processed and extracted with 70% ethanol and distilled water in Natural Product Medicine Research and Development lab in Universitas Airlangga. The study was divided into 8 groups using mice (Mus musculus) which were given v/v acetic acid for the writhing tests. The groups were placebo (CMC Na), morphine 5mg (MOIR), diclofenac 50mg, ethanol extract- raw cacao, water- raw cacao, water-non-alkalized cacao, water-alkalized cacao, and combine ethanol extract- raw cacao + morphine 5mg. The cacao dose were 2000mg/kg. The mice were given the solution orally (gavage) 30 min before injected with acetic acid and then examined for movement in 45 minutes. The metabolite properties of extracted cocoa beans are also examined using Thick Layer Chromatography (TLC).
Results
The combination of ethanol extract-raw cacao + morphine had the best analgesic efficacy (66.25%) when compared to the positive control group of morphine (65.9%) and diclofenac (62.01%). This combination also significantly improved the efficacy of raw cacao bean extract as an adjuvant for oral morphine when compared to ethanol extract-raw cacao, which only provided an analgesic effect of 55.48%, and water-raw cacao, which provided an analgesic effect of 36.22%. However, the group water-non-alkalized cacao exhibited the same analgesic effectiveness as water-raw cacao, 36.22%. This was higher than the water-alkalized cacao (26.68%). Ethanol extract-raw cacao has a yellowish-brown tint in TLC analysis, which was consistent with theobromine and caffeine.
Conclusions
According to this research, raw cacao beans have strong analgesic potential. This is demonstrated by the efficacy of ethanol extract-raw cacao administered as an adjuvant & as a single dose to mice given acute discomfort with 1% v/v acetic acid. When ethanol extract-raw cacao was combined with morphine, which is a definitive therapy for individuals with severe pain, the efficacy was enhanced. This opens up the possibility of developing novel treatments based on natural products, as cacao is a common daily food. This study is only concerned with the potentiation of the effects of cocoa bean extract as a food-based analgesic. TLC analysis of cacao beans found that theobromine and caffeine content dominated the metabolite compounds that may act as pain killer agents. Further study into chemical characterization, molecular identification, toxicity, and active metabolite features is still being conducted to determine the specific mechanism of action of compounds that serve as analgesics.
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Presenting Author
Herdiani Sulistyo Putri
Poster Authors
Herdiani Sulistyo Putri
MD., FIP.
Doctoral Program in Biomedical Science at Faculty of Medicine, Universitas Airlangga
Lead Author
Nancy Margarita Rehatta
Prof.
Department of Anesthesiology and Reanimation, Airlangga University
Lead Author
Suharjono Suharjono (Prof. MS.
Apt. PhD)
Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga
Lead Author
Aty Widyawaruyanti (Prof. MSi.
Apt. PhD)
Department of Pharmaceutical Sciences, Faculty of Pharmacy, Universitas Airlangga
Lead Author
Archie Arman Dwiyatna (MD)
Department of Anesthesiology and Reanimation, Faculty of Medicine, Universitas Airlangga
Lead Author
Topics
- Treatment/Management: Complementary and Alternative therapies