Alfa-lipoic acid and superoxide dismutase in the management of chronic neck pain: a prospective randomized study

Background. Oxidative stress plays a role in several neuropathies, including chronic neck pain (CNP), and oral antioxidants may improve pain control and enhance the efficacy of physiotherapy (“multimodal therapy”). Aim. To compare 4-lipoic acid (ALA) and superoxide dismutase (SOD) in association to physiotherapy vs. physiotherapy alone in CNP patients. Design: Prospective, randomized, open study. Setting: Rehabilitation Unit, Department of Surgical and Oncological Sciences (Palermo, Italy). Population: Outpatients. Methods: Patients randomly received either ALA 600 mg and SOD 140 I.U. daily in addition to physiotherapy (Group 1; n = 51) or physiotherapy alone (Group 2; n = 45), for 60 days. Pain was assessed by visual analogue scale (VAS) and modified Neck Pain Questionnaire (mNPQ). Treatment compliance and safety were evaluated. Results: Both groups experienced a significant reduction in VAS and mNPQ scores after one month; however, while no further improvement was observed in group 2 at 60 days, group 1 showed a further VAS reduction (p < 0.001 vs. group 2). In addition, more patients in group 1 than in group 2 reported their neck pain to be improved at mNPQ at 60 days (p <0.01), and showed a higher compliance to medical prescriptions (p = 0.048). No drug reaction was observed. Conclusion: ALA/SOD association to physiotherapy may be an useful approach to CNP, being antioxidants active on nerve inflammation and disease progression. Clinical Rehabilitation interesting goals (better pain control and physical well-being) can be reached by multimodal therapy in CNP patients.