Alpha lipoic acid and superoxide dismutase in the treatment of chronic low back pain

Background. Neuropathic mechanisms largely contribute to low back pain (LBP) and oxidative stress is acknowledged as one of the causes of nerve damage typical of neuropathic pain: antioxidant agents may be a useful choice in the multimodal treatment strategy for chronic LBP patients. Aim. The aim of this study was to detect changes in perceived pain, functional activity and in the assumption of analgesics in patients with chronic LBP treated with a combination of alpha-lipoic acid (ALA) and superoxide dismutase (SOD). Design. Prospective non-randomized open-label study. Setting. Outpatient at TAMMEF (Therapeutic Application of Musically Modulated Electromagnetic Fields) Centre of the University of Siena. Population. The study enrolled 98 adult patients with chronic (>= 12 weeks) LBP with or without radiculopathy and without neoplastic or inflammatory pathologies. Methods. Patients were treated for 60 days with 600 mg ALA and 140 UI SOD/die. The Roland Morris Disability Questionnaire and Pain Rating Scale were used and concomitant use of medications (with particular attention to analgesics) and adverse events (toxicity) were recorded during treatment. Differences between all the study time points were calculated for the scores of the two tools and for the need of concomitant treatment with analgesics. Results. At the end of the study only 8% of patients still used analgesics versus 73.5% registered at baseline (P<0.01). Regarding self-reported tools, a statistically significant improvement both for perceived pain and functional disabilities occurred: pain ameliorated after 40 days of therapy and the improvement was significant both statistically (P<0.05) and clinically. Only 4 patients stopped the treatment due to unacceptable pain (not related to the treatment). Conclusion. Oral treatment with ALA and SOD improves functionality and reduces the use of analgesics in chronic LBP patients. Clinical Rehabilitation Impact. Oral combination of ALA and SOD may be a powerful adjuvant in multimodal therapy of chronic LBP patients.