ALA has documented efficacy in treatment of diabetic neuropathy [

ALA has documented efficacy in treatment of diabetic neuropathy [17], where it reduces pain and symptoms of peripheral neuropathy [18, 19] and improves nerve conduction [13, 20]. Recent studies have shown that ALA also reduces pain, paresthesia, and numbness in patients with compressive radiculopathy syndrome CAL-101 datasheet from disc–nerve root conflict [21] and other types of neuropathies, such as carpal tunnel syndrome [22]. In addition, combination treatment with ALA and γ-linolenic acid within a rehabilitation program for 6 weeks I-BET-762 mw reduced sensory symptoms and neuropathic pain in patients with compressive radiculopathy syndrome from disc–nerve root conflict, compared

with patients undergoing a rehabilitation

program alone for 6 weeks [23, 24]. Superoxide dismutase (SOD) is one of the most important antioxidant enzymes, being responsible for neutralization of superoxide, the free radical occurring in the cellular respiration. SOD is endowed with a powerful anti-inflammatory action due to its antioxidant property and direct action on neutrophils, inducing their apoptosis; thus, SOD has a key role in inhibiting the inflammatory response, which is closely correlated with attenuation of hyperalgesia [25]. Furthermore, SOD inhibits biosynthesis of some principal inflammatory cytokines and avoids apoptosis of nerves [26]. Since during inflammation—whether acute or chronic—endogenous SOD is not AMN-107 chemical structure sufficient to completely neutralize oxygen free radicals, dietary supplementation of SOD has been investigated in some diseases, such as arthritis [27], and it has been shown that orally administered SOD not only has antioxidant activity but also works as an effective nerve protector [28, 29]. With this background 4-Aminobutyrate aminotransferase in mind, our attention was captured by a marketed combination of ALA 600 mg and SOD 140 IU and, therefore, we aimed to investigate its efficacy on sensory symptoms and neuropathic pain in patients

with CNP, when added to a standard rehabilitation program (physiotherapy), compared with the rehabilitation program alone. We hypothesized that the proposed multimodal approach would improve most of the clinical parameters and that it would be more effective than physiotherapy alone. 2 Patients and Methods In accordance with a prospective, randomized, open study design, patients were screened between March 2010 and April 2011 in the Rehabilitation Unit of the Department of Surgical and Oncological Sciences at the University Policlinic in Palermo, Italy. All participants were recruited from consecutive new patients presenting to an interventional pain management practice with CNP. Patients with a history of chronic function-limiting neck pain lasting at least 3 months were included in the study.

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