Clinical usefulness of nutraceutics with acetyl-L-carnitine, α-lipoic acid, phosphatidylserine, curcumin, C, E and B-group vitamins in patients awaiting for carpal tunnel release during COVID-19 pandemic: a randomized controlled open label prospective study
Keywords:
Carpal tunnel syndrome, nutraceutics, Median nerve compression, neuroprotection, Curcumin, Alpha-lipoic, vitamin, COVID-19Abstract
Background and aim of the work: Carpal Tunnel Syndrome (CTS) is provoked by the compression of the median nerve, leading to nerve ischemia, endoneural edema, venous congestion, and subsequent metabolic alterations. Conservative treatments could be considered. The present study investigates the efficacy of a specific blend of a 600 mg dietary integrator composed of acetyl-L-carnitine, α-lipoic acid, phosphatidylserine, Curcumin, C, E and B1, B2, B6 and B12 vitamins in patients with mild to moderate CTS.
Methods: The present investigation involved the outpatients who were planned to undergo open surgical decompression of the median nerve awaiting surgery from June 2020 and February 2021. CTS surgery has been significantly reduced in our institutions during the COVID-19 pandemic. Patients were randomized into Group A (dietary integration 600 mg twice day for 60 days) and Group B (control group, no drug administration). Clinical and functional improvement was prospectively measured after 60 days
Results: One-hundred forty-seven patients completed the study, 69 from group A and 78 from group B. BCTQ was significantly improved with the drug administration, as well as BCTQ symptoms subscale, and the pain. BCTQ function subscale and Michigan Hand Questionnaire was not significantly improved. Ten patients in group A (14.5%) declared that they didn’t need further treatment. No major side effects were noticed.
Conclusions: Dietary integration could be considered as an option in patients who could not undergo surgery. Symptoms and pain could improve, but surgery remains the gold standard for recovery of function in mild to moderate CTS.
References
Feng B, Chen K, Zhu X, et al. Prevalence and risk factors of self-reported wrist and hand symptoms and clinically confirmed carpal tunnel syndrome among office workers in China: a cross-sectional study. BMC Public Health [Internet]. 2021 Dec 6;21(1):57. Available from: https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-020-10137-1
Atroshi I. Prevalence of Carpal Tunnel Syndrome in a General Population. JAMA [Internet]. 1999 Jul 14;282(2):153. Available from: http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.282.2.153
Lund CB, Mikkelsen S, Thygesen LC, Hansson G-Å, Thomsen JF. Movements of the wrist and the risk of carpal tunnel syndrome: a nationwide cohort study using objective exposure measurements. Occup Environ Med [Internet]. 2019 Aug;76(8):519–26. Available from: https://oem.bmj.com/lookup/doi/10.1136/oemed-2018-105619
Hulkkonen S, Shiri R, Auvinen J, Miettunen J, Karppinen J, Ryhänen J. Risk factors of hospitalization for carpal tunnel syndrome among the general working population. Scand J Work Environ Health [Internet]. 2020 Jan;46(1):43–9. Available from: http://www.sjweh.fi/show_abstract.php?abstract_id=3835
Mondelli M, Giannini F, Giacchi M. Carpal tunnel syndrome incidence in a general population. Neurology [Internet]. 2002 Jan 22;58(2):289–94. Available from: http://www.neurology.org/lookup/doi/10.1212/WNL.58.2.289
Kim JK, Koh Y Do, Kim JS, Hann HJ, Kim MJ. Oxidative stress in subsynovial connective tissue of idiopathic carpal tunnel syndrome. J Orthop Res [Internet]. 2010 Nov;28(11):1463–8. Available from: https://onlinelibrary.wiley.com/doi/10.1002/jor.21163
Monroy Guízar EA, García Benavides L, Ambriz Plascencia AR, Pascoe González S, Totsuka Sutto SE, Cardona Muñoz EG, et al. Effect of Alpha-Lipoic Acid on Clinical and Neurophysiologic Recovery of Carpal Tunnel Syndrome: A Double-Blind, Randomized Clinical Trial. J Med Food [Internet]. 2018 May;21(5):521–6. Available from: http://www.liebertpub.com/doi/10.1089/jmf.2017.0056
Passiatore M, Perna A, De-Vitis R, Taccardo G. The Use of Alfa-Lipoic Acid-R (ALA-R) in Patients with Mild-Moderate Carpal Tunnel Syndrome: A Randomised Controlled Open Label Prospective Study. Malaysian Orthop J. 2020 Mar;14(1):1–6.
LeBlanc KE, Cestia W. Carpal tunnel syndrome. Am Fam Physician [Internet]. 2011 Apr 15;83(8):952–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21524035
Verdugo RJ, Salinas RA, Castillo JL, Cea G. Surgical versus non-surgical treatment for carpal tunnel syndrome. Cochrane Database Syst Rev [Internet]. 2008 Oct 8; Available from: https://doi.wiley.com/10.1002/14651858.CD001552.pub2
National Council on Compression Insurance. Tallying the true Ncost of on-the- job cumulative trauma disorder. Carpal Tunnel Disease News. 1993;2:1–10. National Council on Compression Insurance. Tallying the true Ncost of on-the- job cumulative trauma disorder. Carpal Tunnel Disease News. 1993;2:1–10.
Chen P-C, Chuang C-H, Tu Y-K, Bai C-H, Chen C-F, Liaw M-Y. A Bayesian network meta-analysis: Comparing the clinical effectiveness of local corticosteroid injections using different treatment strategies for carpal tunnel syndrome. BMC Musculoskelet Disord [Internet]. 2015 Dec 19;16(1):363. Available from: http://www.biomedcentral.com/1471-2474/16/363
Chesterton LS, Blagojevic-Bucknall M, Burton C, et al. The clinical and cost-effectiveness of corticosteroid injection versus night splints for carpal tunnel syndrome (INSTINCTS trial): an open-label, parallel group, randomised controlled trial. Lancet [Internet]. 2018 Oct;392(10156):1423–33. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0140673618315721
Page MJ, Massy-Westropp N, O’Connor D, Pitt V. Splinting for carpal tunnel syndrome. Cochrane Database Syst Rev [Internet]. 2012 Jul 11; Available from: https://doi.wiley.com/10.1002/14651858.CD010003
Li Z-J, Wang Y, Zhang H-F, Ma X-L, Tian P, Huang Y. Effectiveness of low-level laser on carpal tunnel syndrome. Medicine (Baltimore) [Internet]. 2016 Aug;95(31):e4424. Available from: https://journals.lww.com/00005792-201608020-00049
Notarnicola A, Maccagnano G, Tafuri S, Fiore A, Pesce V, Moretti B. Comparison of shock wave therapy and nutraceutical composed of Echinacea angustifolia, alpha lipoic acid, conjugated linoleic acid and quercetin (perinerv) in patients with carpal tunnel syndrome. Int J Immunopathol Pharmacol [Internet]. 2015 Jun 7;28(2):256–62. Available from: http://journals.sagepub.com/doi/10.1177/0394632015584501
Di Geronimo G, Caccese AF, Caruso L, Soldati A, Passaretti U. Treatment of carpal tunnel syndrome with alpha-lipoic acid. Eur Rev Med Pharmacol Sci [Internet]. 13(2):133–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19499849
Notartomaso S, Mascio G, Bernabucci M, et al. Analgesia induced by the epigenetic drug, L-acetylcarnitine, outlasts the end of treatment in mouse models of chronic inflammatory and neuropathic pain. Mol Pain [Internet]. 2017 Jan 15;13:174480691769700. Available from: http://journals.sagepub.com/doi/10.1177/1744806917697009
De Grandis D, Santoro L, Di Benedetto P. L-Acetylcarnitine in the Treatment of Patients with Peripheral Neuropathies. Clin Drug Investig [Internet]. 1995 Dec;10(6):317–22. Available from: http://link.springer.com/10.2165/00044011-199510060-00001
Ruhnau KJ, Meissner HP, Finn JR, et al. Effects of 3-week oral treatment with the antioxidant thioctic acid (alpha-lipoic acid) in symptomatic diabetic polyneuropathy. Diabet Med [Internet]. 1999 Dec;16(12):1040–3. Available from: http://www.ncbi.nlm.nih.gov/pubmed/10656234
Ametov AS, Barinov A, Dyck PJ, et al. The sensory symptoms of diabetic polyneuropathy are improved with alpha-lipoic acid: the SYDNEY trial. Diabetes Care [Internet]. 2003 Mar;26(3):770–6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12610036
Ziegler D, Ametov A, Barinov A, et al. Oral treatment with alpha-lipoic acid improves symptomatic diabetic polyneuropathy: the SYDNEY 2 trial. Diabetes Care [Internet]. 2006 Nov;29(11):2365–70. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17065669
Shay KP, Moreau RF, Smith EJ, Smith AR, Hagen TM. Alpha-lipoic acid as a dietary supplement: Molecular mechanisms and therapeutic potential. Biochim Biophys Acta - Gen Subj [Internet]. 2009 Oct;1790(10):1149–60. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0304416509002153
Cruccu G, Di Stefano G, Fattaposta F, et al. l-Acetyl-carnitine in Patients with Carpal Tunnel Syndrome: Effects on Nerve Protection, Hand Function and Pain. CNS Drugs [Internet]. 2017 Dec 20;31(12):1103–11. Available from: http://link.springer.com/10.1007/s40263-017-0476-2
Wells RE, Baute V, Wahbeh H. Complementary and Integrative Medicine for Neurologic Conditions. Med Clin North Am [Internet]. 2017 Sep;101(5):881–93. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0025712517300603
Hellhammer J, Vogt D, Franz N, Freitas U, Rutenberg D. A soy-based phosphatidylserine/ phosphatidic acid complex (PAS) normalizes the stress reactivity of hypothalamus-pituitary-adrenal-axis in chronically stressed male subjects: a randomized, placebo-controlled study. Lipids Health Dis [Internet]. 2014 Dec 31;13(1):121. Available from: https://lipidworld.biomedcentral.com/articles/10.1186/1476-511X-13-121
Monteleone P, Beinat L, Tanzillo C, Maj M, Kemali D. Effects of Phosphatidylserine on the Neuroendocrine Response to Physical Stress in Humans. Neuroendocrinology [Internet]. 1990;52(3):243–8. Available from: https://www.karger.com/Article/FullText/125593
Naftelberg S, Ast G, Perlson E. Phosphatidylserine improves axonal transport by inhibition of HDAC and has potential in treatment of neurodegenerative diseases. Neural Regen Res [Internet]. 2017;12(4):534. Available from: http://www.nrronline.org/text.asp?2017/12/4/534/205082
Bochner R, Ziv Y, Zeevi D, et al. Phosphatidylserine increases IKBKAP levels in a humanized knock-in IKBKAP mouse model. Hum Mol Genet [Internet]. 2013 Jul 15;22(14):2785–94. Available from: https://academic.oup.com/hmg/article-lookup/doi/10.1093/hmg/ddt126
Epstein J, Sanderson IR, MacDonald TT. Curcumin as a therapeutic agent: the evidence from in vitro , animal and human studies. Br J Nutr [Internet]. 2010 Jun 14;103(11):1545–57. Available from: https://www.cambridge.org/core/product/identifier/S0007114509993667/type/journal_article
Kulkarni S, Dhir A. An overview of curcumin in neurological disorders. Indian J Pharm Sci [Internet]. 2010;72(2):149. Available from: http://www.ijpsonline.com/text.asp?2010/72/2/149/65012
Esatbeyoglu T, Huebbe P, Ernst IMA, Chin D, Wagner AE, Rimbach G. Curcumin-From Molecule to Biological Function. Angew Chemie Int Ed [Internet]. 2012 May 29;51(22):5308–32. Available from: https://onlinelibrary.wiley.com/doi/10.1002/anie.201107724
Kapoor S. Curcumin and Its Emerging Role in Pain Modulation and Pain Management. Korean J Pain [Internet]. 2012 Jul 31;25(3):202–3. Available from: http://www.epain.org/journal/view.html?doi=10.3344/kjp.2012.25.3.202
Sádaba LM, Fernández-Robredo P, Rodríguez JA, García-Layana A. Antioxidant effects of vitamins C and E, multivitamin-mineral complex and flavonoids in a model of retinal oxidative stress: The ApoE-deficient mouse. Exp Eye Res [Internet]. 2008 Mar;86(3):470–9. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0014483507003569
Rafighi Z, Shiva A, Arab S, Mohd Yousof R. Association of Dietary Vitamin C and E Intake and Antioxidant Enzymes in Type 2 Diabetes Mellitus Patients. Glob J Health Sci [Internet]. 2013 Mar 20;5(3). Available from: http://www.ccsenet.org/journal/index.php/gjhs/article/view/23988
Fujii A, Matsumoto H, Yamamoto H. Effect of vitamin B complex on neurotransmission and neurite outgrowth. Gen Pharmacol Vasc Syst [Internet]. 1996 Sep;27(6):995–1000. Available from: https://linkinghub.elsevier.com/retrieve/pii/0306362395020721
Ryan-Harshman M, Aldoori W. Carpal tunnel syndrome and vitamin B6. Can Fam Physician [Internet]. 2007 Jul;53(7):1161–2. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17872812
Ellis JM, Folkers K, Levy M, et al. Response of vitamin B-6 deficiency and the carpal tunnel syndrome to pyridoxine. Proc Natl Acad Sci [Internet]. 1982 Dec 1;79(23):7494–8. Available from: http://www.pnas.org/cgi/doi/10.1073/pnas.79.23.7494
Ang CD, Alviar MJM, Dans AL, et al. Vitamin B for treating peripheral neuropathy. Cochrane Database Syst Rev [Internet]. 2008 Jul 16; Available from: https://doi.wiley.com/10.1002/14651858.CD004573.pub3
Padua L, LoMonaco M, Gregori B, Valente EM, Padua R, Tonali P. Neurophysiological classification and sensitivity in 500 carpal tunnel syndrome hands. Acta Neurol Scand [Internet]. 2009 Jan 29;96(4):211–7. Available from: https://onlinelibrary.wiley.com/doi/10.1111/j.1600-0404.1997.tb00271.x
Heybeli N, Kutluhan S, Demirci S, Kerman M, Mumcu Ef. Assessment of Outcome of Carpal Tunnel Syndrome: A Comparison of Electrophysiological Findings and a Self-Administered Boston Questionnaire. J Hand Surg Am [Internet]. 2002 Jun 7;27(3):259–64. Available from: http://journals.sagepub.com/doi/10.1054/jhsb.2002.0762
Passiatore M, De Vitis R, Cilli V, et al. The Italian Version of the Michigan Hand Outcomes Questionnaire (MHQ): Translation, Cross-Cultural Adaptation and Validation. J Hand Surg (Asian-Pacific Vol [Internet]. 2021 Jun 17; Available from: https://www.worldscientific.com/doi/abs/10.1142/S242483552150065X
Pajardi G, Bortot P, Ponti V, Novelli C. Clinical Usefulness of Oral Supplementation with Alpha-Lipoic Acid, Curcumin Phytosome, and B-Group Vitamins in Patients with Carpal Tunnel Syndrome Undergoing Surgical Treatment. Evidence-Based Complement Altern Med [Internet]. 2014;2014:1–7. Available from: http://www.hindawi.com/journals/ecam/2014/891310/
Evangelista M, Cilli, De Vitis R, Militerno A, Fanfani F. Ultra-micronized Palmitoylethanolamide Effects on Sleep-wake Rhythm and Neuropathic Pain Phenotypes in Patients with Carpal Tunnel Syndrome: An Open-label, Randomized Controlled Study. CNS Neurol Disord - Drug Targets [Internet]. 2018 Jul 6;17(4):291–8. Available from: https://www.eurekaselect.com/161455/article
Huisstede BM, Fridén J, Coert JH, Hoogvliet P. Carpal Tunnel Syndrome: Hand Surgeons, Hand Therapists, and Physical Medicine and Rehabilitation Physicians Agree on a Multidisciplinary Treatment Guideline—Results From the European Handguide Study. Arch Phys Med Rehabil [Internet]. 2014 Dec;95(12):2253–63. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0003999314009332
Basnet P, Skalko-Basnet N. Curcumin: An Anti-Inflammatory Molecule from a Curry Spice on the Path to Cancer Treatment. Molecules [Internet]. 2011 Jun 3;16(6):4567–98. Available from: http://www.mdpi.com/1420-3049/16/6/4567
Bremer J. Carnitine--metabolism and functions. Physiol Rev [Internet]. 1983 Oct 1;63(4):1420–80. Available from: https://www.physiology.org/doi/10.1152/physrev.1983.63.4.1420
Taglialatela G, Navarra D, Cruciani R, Ramacci M, Alema G, Angelucci L. Acetyl-l-carnitine treatment increases nerve growth factor levels and choline acetyltransferase activity in the central nervous system of aged rats. Exp Gerontol [Internet]. 1994 Jan;29(1):55–66. Available from: https://linkinghub.elsevier.com/retrieve/pii/0531556594900620
Curran MWT, Morhart MJ, Olson JL, Hachisuka A, Chan KM. Acetyl-L-Carnitine to Enhance Nerve Regeneration in Carpal Tunnel Syndrome. Plast Reconstr Surg [Internet]. 2019 Jan;143(1):111e-120e. Available from: http://journals.lww.com/00006534-201901000-00032
De Vitis R, Passiatore M, Perna A, Proietti L, Taccardo G. COVID-19 contagion and contamination through hands of trauma patients: what risks and what precautions? The Journal of hospital infection. England; 2020.
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