Positive Health Online

Abstract

FREDIANI  and COLLEAGUES,  (1)Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA.; (2)Department of Anesthesiology, Emory School of Medicine, Atlanta, Georgia, USA.; (3)Philadelphia College of Osteopathic Medicine, Suwanee, Georgia, USA.;(4)Woodruff Health Sciences Center Library, Emory University, Atlanta, Georgia, USA. conducted a systematic review to study the efficacy of dietary interventions, vitamins, and nutritional supplementation in the management of chronic neuropathic pain in adults.

Background

Dietary interventions, vitamins, and nutritional supplementation are playing an increasingly important role in the management of neuropathic pain. Current pharmacological treatments are poorly tolerated and ineffective in many cases. This systematic review aims to study the efficacy of dietary interventions, vitamins, and nutritional supplementation in the management of chronic neuropathic pain in adults.

Methodology

The review followed PRISMA guidelines and was registered with PROSPERO (#CRD42022300312). Ten databases and gray literature [research and information produced outside of traditional commercial or academic publishing channels], including mbase.com, MEDLINE and Web of Science, were systematically searched using a combination of keywords and controlled vocabulary related to chronic neuropathic pain and oral non-pharmacological supplements. Studies on adult humans published between 2000 and 2021 were considered for inclusion. The Cochrane Handbook was used to assess risk of bias, and Grading of Recommendations Assessment, Development, and Evaluation was used to determine overall quality of evidence.

Results

Forty studies were included in the final review, and results were categorized according to pain type including pain related to chemotherapy-induced peripheral neuropathy (CIPN, 22 studies, including 3 prospective cohorts), diabetic peripheral neuropathy (DPN, 13 studies, including 2 prospective), complex regional pain syndrome (CRPS-I, 3 studies, including 1 prospective), and other (2 studies, both RCT). The CIPN studies used various interventions including goshajinkigan (4 studies), vitamin E (5), vitamin B12 (3), glutamine (3), N-acetyl-cysteine (2), acetyl-l-carnitine (2), guilongtonluofang (1), ninjin'yoeito (1), alpha-lipoic acid (1), l-carnosine (1), magnesium and calcium (1), crocin (1), and antioxidants (1), with some studies involving multiple interventions. All CIPN studies involved varying cancers and/or chemotherapies, advising caution for generalizability of results. Interventions for DPN included alpha-lipoic acid (5 studies), vitamin B12 (3), acetyl-l-carnitine (3), vitamin E (1), vitamin D (2), and a low-fat plant-based diet (1). Vitamin C was studied to treat CRPS-I (3 studies, including 1 prospective). Magnesium (1) and St. John's wort (1) were studied for other or mixed neuropathologies.

Conclusion

Based on the review, we cannot recommend any supplement use for the management of CIPN [chemotherapy-induced peripheral neuropathy], although further research into N-acetyl-cysteine, l-carnosine, crocin, and magnesium is warranted. Acetyl-l-carnitine was found to be likely ineffective or harmful. Alpha-lipoic acid was not found effective. Studies with goshajinkigan, vitamin B12, vitamin E, and glutamine had conflicting results regarding efficacy, with one goshajinkigan study finding it harmful. Guilongtonluofang, ninjin'yoeito, and antioxidants showed various degrees of potential effectiveness. Regarding DPN, our review supports the use of alpha-lipoic acid, acetyl-l-carnitine, and vitamin D. The early use of vitamin C prophylaxis for the development of CRPS-I also seems promising. Further research is warranted to confirm these findings. © 2023 World Institute of Pain. Fredia

References

i JK(1), Lal AA(2), Kim E(3), Leslie SL(4), Boorman DW(2), Singh V(2). The role of diet and non-pharmacologic supplements in the treatment of chronic neuropathic pain: A systematic review. Pain Pract.;24(1):186-210. DOI: 10.1111/papr.13291 . Epub Aug 31 2023.  Jan 2024.