Modern Plastic Surgery, 2014, 4, 5-10
Published Online January 2014 (http://www.scirp.org/journal/mps)
http://dx.doi.org/10.4236/mps.2014.41002
OPEN ACCESS MPS
5
The Effect of Neuro Gen® Nerve Support Supplement on
Pillar Pain after Endoscopic Carpal Tunnel Release
Michael J. Fitzmaurice
Fitzmaurice Hand Institute, Phoenix, USA.
Email: mfitz70@me.com
Received June 14th, 2013; revised July 15th, 2013; accepted July 24th, 2014
Copyright © 2014 Michael J. Fitzmaurice. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In accor-
dance of the Creative Commons Attribution License all Copyrights © 2014 are reserved for SCIRP and the owner of the intellectual
property Michael J . Fitzmaurice. All Copyright © 2014 are guarded by law and by SCIRP as a guardian.
ABSTRACT
61 patients with clinically diagnosed and electromyographically confirmed carpal tunnel syndrome were enrolled
in a prospective study to evaluate the effectiveness of a nerve supplement on pillar pain after carpal tunnel sur-
gery. All of the patients underwent endoscopic carpal tunnel release. 15 of the patients also took the nerve sup-
port supplement NeuroGen® as part of their perioperative treatment. The supplement group demonstrated a
significantly lower amount of pillar pain (VAS) at initial follow up compared to the control group (1.13 and 4.05
respectively). 46% (7/15) of the supplement group were completely free of pillar pain compared to only 9% (4/46)
of the control group at the first follow up. 53% (8/15) of the NeuroGen® group did not require any pain medica-
tions compared to 35% (16/46) of the control group. The Nerve supplement NeuroGen® significantly reduces
pain after carpal tunnel surgery.
KEYWORDS
Carpal Tunnel; Endoscopic; ECTR; Nerve Supplement; Nerve; Supplement
1. Introduction
Pillar pain is one of the most common complications
after carpal tunnel surgery and has an occurrence from 7%
- 61% [1-8 ]. This pain is located in the palm and can li m-
it strength and delay return to daily activities and work.
Endoscopic carpal tunnel release (ECTR) has demon-
strated less pain than the traditional open procedures,
however some authors have reported rates of pillar pain
up to 50% with the endoscopic technique [3,6]. The true
incidence of pillar pain is difficult to report due to the
lack of a standardized assessment or grading system.
Several authors have used numerical (0 - 4) or nominal
(nil, mild, moderate, etc.) scales to grade the severity.
The etiology of pillar pain remains elusive, however,
four main theories are well described by Ludlow et al . [9]
These include ligamentous or muscular, altered structure
of the carpal arch, neurogenic causes and edematous
causes. The ligamentous and muscular theory includes
detachment of the hypothenar and thenar muscles from
the fascia, pulling on forming scar tissue from these
muscles and the raw edge of the slightly migrated liga-
ment as possible causes. This theory proposes that the
reason why endoscopic release causes less pillar pain is
the intact palmar aponeurosis, which is cut during open
procedures. Release of the transverse carpal ligament
alters the structures in the carpal arch. The increased vo-
lume may cause pillar pain and open techniques often
cause slightly more widening which may account for the
increased pain compared to the endoscopic release. The
altered forces over the pisotriquetral joint may cause hy-
pothenar pain and authors have suggested excision of the
pisiform as treatment for persistent pain. The neurogenic
theory suggests that pain develops when many small
transverse subcutaneous nerve branches are cut during
the procedure and the pain is more likely with the tradi-
tional single incision open procedure. The edematous
theory suggests that it is the swelling at the base of the
palm responsible for the pain, which resolves when the
swelling is reduced.
NeuroGen® is a nerve support supplement which con-
The Effect of NeuroGen® Nerve Support Supplement on Pillar Pain after Endoscopic Carpal Tunnel Release
OPEN ACCESS MPS
6
tains ingredients that have demonstrated a significant
improvement in nerve regeneration, decreased nerve pain
and less inflammation after surgical procedures. The goal
of this study was to evaluate the effectiveness of the
nerve supplement NeuroGen® to improve recovery and
decrease pillar pain after carpal tunnel surgery.
2. Methods
Patients who had nerve conduction studies, history and
an exam consistent with carpal tunnel syndrome and
wished to proceed with surgical intervention were en-
rolled in the study. A single surgeon who performed the
same technique for carpal tunnel release (ECTR) treated
all patients. The ECTR was a 2 portal release without a
post-operative splint and allowed patients full activity at
7 days. 15 patients who underwent an endoscopic carpal
tunnel procedure took the nerve support supplement
NeuroGen®. The supplement was started 5 days before
surgery and continued for 3 weeks after surgery. The
amount of pillar pain was assessed with a visual analogue
scale pain measurement at the follow up visit. The pillar
pain of those in the NeuroGen® group was compared to a
control group of patients who underwent endoscopic
carpal tunnel surgery the previous month without taking
the supplement.
3. Results
All 61 patients underwent the same endoscopic carpal
tunnel release surgery. None of the patients required
conversion to an open procedure or had any intraopera-
tive complications. 15 patients also took the NeuroGen®
nerve support supplement beginning 5 days before sur-
gery and continued for 3 weeks after surgery. The follow
up evaluation was an averag e of 14 days after surgery for
the NeuroGen® group and 12 days for the control group.
46% of the NeuroGen® group were completely free of
pillar pain compared to only 9% of the control group
(Figu re 1). The NeuroGen® group had a statistical ly sig-
nificant lower pain score (VAS) than the control group
1.13 vs. 4.05 respectively (p < 0.0 05). 53% (8/15) of the
NeuroGen® group did not require any pain medications
compare d to 35% (16/46) of t he c ontrol gr o up.
4. Discussion
Pillar pain remains on of the most common complica-
tions of carpal tunnel surgery. The discomfort in the
palm is often the limiting factor in the patient’s ability to
res ume normal activity and work. The endoscopic tech-
nique has demonstrated less pain than the traditional
open method [2,6,10-17]. Despite these improved results
with the endoscopic technique, patients still have some
degree of palm pain after surgery limiting return to activ-
ity. The patients in this study all had the same procedure
Figure 1. % of patients c ompletely free of pain.
performed (ECTR) by a single surgeon , which decreased
the likelihood of any variation in technique.
NeuroGen® is a unique patent pending nerve supple-
ment formula designed to enhance nerve recovery and
minimize post-operative inflammation and pain. The
ingredients have demonstrated significant improvement
in nerve regeneration, decreased nerve pain, improved
neural mitochondrial function, neuroprotection and de-
creased inflammatory response. Methylcobalamin, Ace-
tyl-L-Carnitine, N-Acetyl Cysteine, V itamin D, and Cur-
cumin improve nerve regeneration in a number of condi-
tions including nerve injuries (crush), nerve repair after
transection and neuropathic conditions such as diabetes
[18-55]. Curcumin, Bromelain, and Serratopeptidase de-
crease the inflammatory response and have demonstrated
improved recov ery after surgery with less pain and ear li-
er return to activity [56-68].
5. Conclusions
This is the first study to evaluate the effectiveness of a
nerve supplement with specific actions on nerve recovery
and inflammation to reduce the pillar pain experienced
after carpal tunnel surgery. The endoscopic carpal tunnel
release typically has a lower post-operative pain level
than the traditional open technique, however, the sup-
plement group reduced this pain level even further to a
minimal amount. We did not evaluate the effectiveness
of the supplement on patients who had an open procedure
but suspect that the difference would be even greater
given the higher post-operative pain reported in the lite-
rature with the open technique compared to the endos-
copic release.
NeuroGen® minimizes some of the factors thought to
cause pillar pain. The neurogenic theory suggests that the
division of small subcutaneous nerve branches causes
pillar pain. The improved nerve recovery and reduced
nerve pain demonstrated by NeuroGen® will eliminate or
significantly reduce this particular factor. The anti-in-
flammatory effect of the supplement reduces the ede-
matous theory as potential cause for pillar pain and is
The Effect of NeuroGen® Nerve Support Supplement on Pillar Pain after Endoscopic Carpal Tunnel Release
OPEN ACCESS MPS
7
well documented to enhance the recovery from trauma
and various surgeries. The ligamentous or muscular
theory suggests some aspect of muscular pull on forming
scar as a possible role in pillar pain. Several of the ingre-
dients minimize the scar tissue formation and have been
used in plastic surgery cases for this specific effect.
The NeuroGen® nerve supplement significantly im-
proves the recovery following carpal tunnel surgery by
decreasing the amount of pillar pain. This decrease in
pain results in less post-operative medication required
and an earlier return to activity. Further studies will eva-
luate the effectiveness of the supplement on nerve regen-
eration after surgical decompression.
REFERENCES
[1] R. A. Brown, R. H. Gelberman, J. G. Seiler, S. O. Abra-
hamsson, A. J. Weiland, J. R. Urbaniak, et al., “Carpal
Tunnel Release. A Prospective, Randomized Assessment
of Open and Endoscopic Methods,” Journal of Bone &
Joint Surgery, Vol. 75, No. 9, 1993, pp. 1265-1275.
[2] C. Dumontier, C. Sokolow, C. Leclercq and P. Chauvin,
Early Results of Conventional versus Two-Portal En-
doscopic Carpal Tunnel Release. A Prospective Study,”
Journal of Hand Surgery, Vol. 20, No. 5, 1995, pp. 658-
662. http://dx.doi.org/10.1016/S0266-7681(05)80130-5
[3] G. Foucher and J. Braga Da Silva, “Endoscopic Opening
of the Carpal Canal,” Chirurgie, Vol. 120, No. 12, 1994,
pp. 100-104.
[4] S. S. Bande, L. L. De Sme t and G. G. Fabr y, “The Results
of Carpal Tunnel Release: Open versus Endoscopic Tech-
nique,” Journal of Hand Surgery, Vol. 19, No. 1, 1994,
pp. 14-17.
http://dx.doi.org/10.1016/0266-7681(94)90039-6
[5] J. Menon, “Endoscopic Carpal Tunnel Release: Prelimi-
nary Report,” Arthroscopy, Vol. 10, No. 1, 1994, pp. 31-
38. http://dx.doi.org/10.1016/S0749-8063(05)80290-7
[6] I. Atroshi, G.-U. Larsson, E. Ornstei n, M. Hofer, R.
Johnsson and J. Ranstam, “Outcomes of Endoscopic Sur-
gery Compared with Open Surgery for Carpal Tunnel
Syndrome among Employed Patients: Randomised Con-
trolled Trial,” BMJ, Vol. 33 2, No. 7556, 2006, p. 1473.
http://dx.doi.org/10.1136/bmj.38863.632789.1F
[7] J. Oertel, H. W. S. Schroeder and M. R. Gaab, “Dual -
Portal Endoscopic Release of the Transverse Ligament in
Carpal Tunnel Syndrome: Results of 411 Procedures with
Special Reference to Technique, Efficacy, and Complica-
tions,” Neurosurgery, Vol. 59, No. 2, 2006, pp. 333-340.
http://dx.doi.org/10.1227/01.NEU.0000223500.25131.99
[8] A. Biy a ni and E. Downes, “A Open Twin Incision Tech-
nique of Carpal Tunnel De compression with Reduced In-
cidence of Scar Tenderness,” The Journal of Hand Sur-
gery: Journal of the British Society for Surgery of the
Hand, Vol. 18, No. 3, 1993, pp. 331-334.
http://dx.doi.org/10.1016/0266-7681(93)90055-K
[9] K. S. Ludlow, J. L. Merla, J. A. Cox and L. N. Hurst,
Pillar Pain as a Postoperative Complication of Carpal
Tunnel Release: A Review of the Literature,” Journal of
Hand Therapy, Vol. 10, No. 4, 2012, pp. 277-282.
[10] J. M. Agee, H. R. J. McCarroll, R. D. Tortosa, D. A.
Berry, R. M. Szabo and C. A. Peimer, “Endoscopic Re-
lease of the Carpal Tunnel: A Randomized Prospective
Multicenter Study,” Journal of Hand Surgery (American
Volume), Vol. 17, No. 6, 1992, pp. 987-995.
http://dx.doi.org/10.1016/S0363-5023(09)91044-9
[11] M. W. Erdmann, “Endoscopic Carpal Tunnel Decompres-
sion,” Journal of Hand Surgery, Vol. 19, No. 1, 1994, pp.
5-13. http://dx.doi.org/10.1016/0266-7681(94)90038-8
[12] G. G. G. Hallock and D. A. D. Lutz, “Prospective Com-
parison of Minimal Incision ‘Ope n ’ and Two-Portal En-
doscopic Carpal Tunnel Release,” Plastic and Recon-
structive Surgery, Vol. 96, No. 4, 1995, pp. 941-947.
http://dx.doi.org/10.1097/00006534-199509001-00027
[13] A. P. Worseg, R. Kuzbari, K. Kor ak , K. Höcker, C. Wie-
derer, M. Tschabitscher, et al., “Endoscopic Carpal Tun-
nel Release Using a Single-Portal System,” British Jour-
nal of Plastic Surgery, Vol. 49, No. 1, 1996, pp. 1-10.
http://dx.doi.org/10.1016/S0007-1226(96)90179-4
[14] T. Futami, “Surgery for Bilateral Carpal Tunnel Syn-
drome. Endoscopic and Open Release Compared in 10
Patients,” Acta Orthopaedica Scandinavica, Vol. 66, No.
2, 1995, pp. 153-155.
http://dx.doi.org/10.3109/17453679508995510
[15] J. C. Payne, R. S. Bergman and D. J. Ettinger, “Endos-
copic Carpal Tunnel Release,” Journal of the American
Osteopathic Association, Vol. 94 , No. 4, 1994, pp. 295-
298.
[16] A. Thoma, K. Veltri, T. Haines and E. Duku, “A Syste-
matic Re view of Reviews Comparing the Effectiveness of
Endoscopic and Open Carpal Tunnel Decompression,”
Plastic and Reconstructive Surgery, Vol. 113, No. 4,
2004, pp. 1184-1191.
http://dx.doi.org/10.1097/01.PRS.0000110202.08818.C1
[17] R. Bhattacharya, P. D. Birdsall, P. Finn and J. Stothard,
A Randomized Controlled Trial of Knifelight and Open
Carpal Tunnel Release,” Journal of Hand Surgery, Vol.
29, No. 2, 2004, pp. 113-115.
http://dx.doi.org/10.1016/j.jhsb.2003.09.001
[18] A. S. Morani a nd S. L. Bodhankar, “Early Co-Adminis-
tration of Vitamin E Acetate and Methylcobalamin Im-
proves Thermal Hyperalgesia and Motor Nerve Conduc-
tion Velocity Following Sciatic Nerve Crush Injury in
Rats,” Pharmacological Reports, Vol. 62, No. 2, 2010, pp.
405-409.
[19] X. Kong, X. Sun and J. Zhang, “The Protective Role of
Mecobalamin Following Optic Nerve Crush in Adult
Rats,” Eye Science, Vol. 20, No. 3, 2004, pp. 171-177.
[20] V. V. Mikhailov and V. M. Avakumov, “Mechanism of
the Effect of Methylcobalamin on the Recovery of Neu-
romuscular Functions in Mechanical and Toxin Denerva-
tion,” Farmakologiia i Toksikologiia, Vol. 46, No. 6,
1983, pp. 9-12.
[21] K. Oka da, H. Tanaka, K. Temporin, M. Okamoto, Y. Ku-
roda, H. Moritomo, et al., “Methylcobalamin Increases
Erk1/2 and Akt Activities through the Methylation Cycle
and Promotes Nerve Regeneration in a Rat Sciatic Nerve
Injury Model,” Ex perimental Neurology, Vol. 222 , No. 2,
The Effect of NeuroGen® Nerve Support Supplement on Pillar Pain after Endoscopic Carpal Tunnel Release
OPEN ACCESS MPS
8
2010, pp. 191-203.
http://dx.doi.org/10.1016/j.expneurol.2009.12.017
[22] K. Yamatsu, T. Kaneko, A. Kitahara and I. Ohkawa,
“Pharmacological Studies on Degeneration and Regene-
ration of Peripheral Nerves. (1) Effects of Methylcobala-
min and Cobamide on EMG Patterns and Loss of Muscle
Weight in Rats with Crushed Sciatic Nerve,” Nippon Ya-
kurigaku Zasshi, Vol. 72, No. 2, 1976, pp. 259-268.
http://dx.doi.org/10.1254/fpj.72.259
[23] A. Yamatsu, R. Matsumi, H. Atomi and T. Imanaka, “Iso-
lation and Characterization of a Novel Poly(Vinyl Alco-
hol)-Degrading Bacterium, Sphingopyxis sp. PVA3,” Ap-
plied Microbiology and Biotechnology, Vol. 72, No. 4,
2006, pp. 804-811.
http://dx.doi.org/10.1007/s00253-006-0351-4
[24] T. Watanabe, R. Kaji, N. Oka, W. Bara and J. Kimura,
Ultra-High Dose Methylcobalamin Promotes Nerve Re-
generation in Experimental Acrylamide Neuropathy,”
Journal of the Neurological Sciences, Vol. 122 , No. 2,
1994, pp. 140-14 3.
http://dx.doi.org/10.1016/0022-510X(94)90290-9
[25] K. Yamazaki, K. Oda, C. Endo, T. Kikuchi and T. Wa-
kabayashi, “Methylcobalamin (Met hyl-B12) Promotes Re-
generation of Motor Nerve Terminals Degenerating in
Anterior Gracile Muscle of Gracile Axonal Dystrophy
(GAD) Mutant Mouse,” Neuroscience Letters, Vol. 170,
No. 1, 1994, pp. 195-197.
http://dx.doi.org/10.1016/0304-3940(94)90272-0
[26] W. C. Liao, J. R. C hen , Y. J. Wang and G. F. Tseng,
Methylcobalamin, but Not Methylprednisolone or Pleio-
trophin, Accelerates the Recovery of Rat Bice ps after Ul-
nar to Musculocutaneous Nerve Transfer,” Neuroscience,
Vol. 171, No. 3, 2010, pp. 934-949.
http://dx.doi.org/10.1016/j.neuroscience.2010.09.036
[27] A. A. Sima, M. Calvani, M. Mehra and A. Amato,
Acetyl-L-Carnitine Improves Pain, Nerve Regeneration,
and Vibratory Perception in Patients with Chronic Di-
abetic Neuropathy: An Analysis of Two Randomized
Placebo-Controlled Trials,” Diabetes Care, Vol. 28, No.
1, 2004, pp. 89-94.
http://dx.doi.org/10.2337/diacare.28.1.89
[28] C. De Angel is, C. Scarfò, M. Falcinelli, E. Perna, E. Re da,
M. T. Ramacci, et al., “Acetyl-L-Carnitine Prevents Age-
Dependent Structural Alterations in Rat Peripheral Nerves
and Promotes Regeneration Following Sciatic Nerve In-
jury in Young and Senescent Rats,” Experimental Neu-
rology, Vol. 128, No. 1, 1994, pp. 103-114.
http://dx.doi.org/10.1006/exnr.1994.1117
[29] Z. T. Kokkalis, P. N. Soucacos and J. K. Terzis, “Effect
of Acetyl-L-Carnitine on Axonal Sprouting Following
Donor Nerve Injury Distal to an End-to-Side Neurorrha-
phy Model,” Journal of Reconstructive Microsurgery,
Vol. 25, No. 8, 2009, pp. 483-495.
http://dx.doi.org/10.1055/s-0029-1234027
[30] C. De Angelis, C. Scarfò, M. Falcinelli, E. Reda , M. T.
Ramacci and L. Angelucci, “Levocarnitine Acetyl Stimu-
lates Peripheral Nerve Regeneration and Neuromuscular
Junction Remodelling Following Sciatic Nerve Injury,”
International Journal of Clinical Pharmacology Research,
Vol. 12, No. 5-6, 1992, pp. 269-279.
[31] E. Fernandez, R. Pallini, L. Lauretti, E. Marchese, V.
Bozzini, A. Sbriccoli, et al., “Levocarnitine Acetyl Pro-
motes The Regeneration of Peripheral Sensory Axons and
Reduces the Hypertrophy of Axotomized Spinal Cord
Motoneurons in Rats,” Drugs under Experimental and
Clinical Research , Vol. 17, No. 12, 1991, 563-570.
[32] A. McKay Hart, M. Wiberg and G. Terenghi, “Pharma-
cological Enhancement of Peripheral Nerve Regeneration
in the Rat by Systemic Acetyl-L-Carnitine Treatment,”
Neuroscience Letters, Vol. 334, No. 3, 2002, pp. 181-185.
http://www.sciencedirect.com/science/article/pii/s030439
4002009825
http://dx.doi.org/10.1016/S0304-3940(02)00982-5
[33] A. D. H. Wilson, A. Hart, M. Wiberg and G. Terenghi,
Acetyl-l-Carnitine Increases Nerve Regeneration and
Target Organ Reinnervation—A Morphological Study,”
Journal of Plastic, Reconstructive & Aesthetic Surgery,
Vol. 63, No. 7, 2009, pp. 1186-1195.
http://dx.doi.org/10.1016/j.bjps.2009.05.039
[34] S. Karsidag, A. Akcal, S. Sahin, S. Karsi dag, F. Kabuk-
cuoglu and K. Ugurlu, “Neurophysiological and Morpho-
logical Responses to Treatment with Acetyl-L-Carnitine
in a Sciatic Nerve Injury Model: Preliminary Data,”
Journal of Hand Surgery (European Volume), Vol. 37,
No. 6, 2012, pp. 529-536.
http://dx.doi.org/10.1177/1753193411426969
[35] A. D. H. Wilson, A. Har t, T. Brännström, M. Wiberg and
G. Terenghi, “Primary Sensory Neuronal Rescue with
Systemic Acetyl-L-Carnitine Following Peripheral Axo-
tomy. A Dose-Response Analysis,” British Journal of
Plastic Surgery, Vol. 56, No. 8, 2003, pp. 732-739.
http://dx.doi.org/10.1016/j.bjps.2003.08.005
[36] A. M. Hart, M. Wiberg, M. You le and G. Terenghi, “Sys -
temic Acetyl-L-Carnitine Eliminates Sensory Neuronal
Loss after Peripheral Axotomy: A New Clinical Ap-
proach in the Management of Peripheral Nerve Trauma,
Experimental Brain Research, Vol. 145, No. 2, 2002, pp.
182-189.
[37] E. Fernandez, R. Pallini, C. Gangitano, A. Del Fá, C. O.
Sangiacomo, A. Sbriccoli, J. R. Ricoy and G. F. Rossi,
“Effects of L-Carnitine, L-Acetylcarnitine and Ganglio-
sides on the Regeneration of the Transected Sciatic Nerve
in Rats,Neurological Research, Vol. 11, No. 1, 1989, pp.
57-62.
[38] V. K. Kostopoulos, C. L. Davis and J. K. Terzis, “Effects
of Acetylo-L-Carnitine in End-to-Side Neurorrhaphy: A
Pilot Study,” Microsurgery, Vol. 29, No. 6, 2009, pp.
456-463. http://www.ncbi.nlm.nih.gov/pubmed/19308954
[39] G. Terenghi, A. Ha r t and M. Wiberg, “The Nerve Injury
and the Dying Neurons: Diagnosis and Prevention,” Jour-
nal of Hand Surgery, European Volume, Vol. 36, No. 9,
2011, pp. 730-734.
http://scholar.google.com/scholar?q=related:Me0jiiPdpc0
J:scholar.google.com/&hl=en&num=30&as_sdt=0,5&as_
ylo=2011&as_yhi=2011
[40] E. Fernandez, R. Pal lini, C. Gangitano, A. D el Fá, C. Oli-
vieri-Sangiacomo, A. Sbriccoli, J. Ricoy and G. F. Rossi,
“Studies on the Degenerative and Regenerative Pheno-
mena Occurring after Transection and Repair of the Scia-
tic Nerve in Rats: Effects of Acetyl-L-Carnitine,” Inter-
The Effect of NeuroGen® Nerve Support Supplement on Pillar Pain after Endoscopic Carpal Tunnel Release
OPEN ACCESS MPS
9
national Journal of Clinical Pharmacology Research, Vol.
10, No. 1-2, 1990, pp. 85-99.
[41] E. Fernandez, R. Pallini, L. Lauretti, F. La Marca, A.
Scogna and G. F. Rossi, “Motonuclear Changes after
Cranial Nerve Injury and Regeneration,” Archives Ita-
liennes Biologie, Vol. 135, No. 4, 1997, pp. 343-351.
[42] R. De Simone, L. Aloe, L. Ferraris and M. T. Ramacci,
“Levocarnitine Acetyl Treatment Promotes Iris Reinner-
vation Following 6-Hydroxydopamine-Induced Noradre-
nergic Denervation in Rats,” Int ernational Journal of
Clinical Pharmacology Research, Vol. 12, No. 5-6, 1992,
pp. 281-287.
[43] K. Kotil, M. Kirali, M. Eras, T. Bilge and H. Uzun,
“Neuroprotective Effects of Acetyl-L-Carnithine in Ex-
perimental Chronic Compression Neuropathy. A Prospec-
tive, Randomized and Placebo-Control Trials,” Turkish
Neurosurgery, Vol. 17, No. 2, 2007, pp. 67-77.
[44] A. D. H. Wilson, A. Hart, T. Brännström, M. Wiberg and
G. Terenghi, “Delayed Acety l -L-Carnitine Administration
and Its Effect on Sensory Neuronal Rescue after Peri-
pheral Nerve Injury,” Journal of Plastic Reconstructive &
Aesthetic Surgery, Vol. 60, No. 2, 2007, pp. 114-118.
[45] E. Fernandez, R. Pallini, L. Lauretti, E. Marchese, C.
Gangitano, A. Del Fá, C. Olivieri-Sangiacomo, A. Sbric-
coli and G. F. Rossi, “Levoc arnitine Acety l Prevents Cell
Death Following Long-Term Section of the Vagus Nerve
in Rats,” International Journal of Clinical Pharmacology
Research, Vol. 12, No. 5-6, 1992, pp. 289-297.
[46] A. Love, M. A. Cotter and N. E. Cameron, “Effects of the
Sulphydryl Donor N-Acetyl-L-Cysteine on Nerve Con-
duction, Perfusion, Maturation and Regeneration Follow-
ing Freeze Damage In Diabetic Rats,” European Journal
of Clinical Investigation, Vol. 26 , No. 8, 1996, pp. 698-
706.
[47] D. Weli n, L. N. Novikova, M. Wiberg, J.-O. Kellerth and
L. N. Novikov, “Effects of N-Acetyl-Cysteine on the
Survival and Regeneration of Sural Sensory Neurons in
Adult Rats,” Brain Research, Vol. 1287, 2009, pp. 58-66.
[48] T. Karlidag, M. Yildiz, S. Yalcin, N. Colakoglu, I. Kay-
gusuz and E. Sapmaz, “Evaluation of the Effect of Me-
thylprednisolone and N-Acetylcystein on Anastomotic
Degeneration and Regeneraton of the Facial Nerve,” Au-
ris Nasus Larynx , Vol. 39, No. 2, 2012, pp. 145-150.
[49] J. Brown, J. I. Bianco, J. J. McGrath and D. W. Eyles,
“1,25-Dihydroxyvitamin D3 Induces Nerve Growth Fac-
tor, Promotes Neurite Outgrowth and Inhibits Mitosis in
Embryonic Rat Hippocampal Neurons,” Neuroscience
Letters, Vol. 343, No. 2, 2003, pp. 139-143 .
http://dx.doi.org/10.1016/S0304-3940(03)00303-3
[50] M. Fukuoka, K. Sakurai, T. Ohta, M. Kiyoki and I. Ka-
tayama, “Tacalcitol, an Active Vitamin D3, Induces
Nerve Growth Factor Production in Human Epidermal
Keratinocytes,” Skin Pharmacology and Skin Physiology,
Vol. 14, No. 4, 2001, pp. 226-233.
http://dx.doi.org/10.1159/000056351
[51] J.-F. Chabas, O. Alluin, G. Ra o, S. Garcia, M.-N. Lavaut,
J. J. Risso, et al ., “Vitamin D 2Potentiates Axon Regene-
ration,” Journal of Neurotrauma, Vol. 25, No. 10, 2008,
pp. 1247-1256.
http://dx.doi.org/10.1089/neu.2008.0593
[52] M. Goudarzvand, M Javan, J. Mirnajafi-Zadeh, S. Moza-
fari and T. Tiraihi, “Vitamins E and D3 Attenuate De-
myelination and Potentiate Remyelination Processes of
Hippocampal Formation of Rats Following Local Injec-
tion of Ethidium Bromide,” cellular and Molecular Neu-
robiology, Vol. 30, No. 2, 2010, pp. 289-299.
[53] Y. Xu, B. Ku, L. Cui, X. Li, P. A. Barish, T. C. Foster
and W. O. Ogle, “Curcumin Reverses Impaired Hippo-
campal Neurogenesis and Increases Serotonin Receptor
1A mRNA and Brain-Derived Neurotrophic Factor Ex-
pression in Chronically Stressed Rats,” Brain Research,
Vol. 1162, 2007, pp. 9-18.
[54] K.-K. Liao, M.-J. Wu, P.-Y. Chen, S.-W. Huang, S.-J.
Chiu, C.-T. Ho and J. H. Yen, “Curcuminoids Promote
Neurite Outgrowth in PC12 Cells through MAPK/ERK-
and PKC -Dependent Pathways,” Journal of Agricultural
Food Chemistry, Vol. 60, No. 1, 2012, pp. 433-443.
[55] M. A. Jalaludin, “Methylcobalamin Treatment of Bell’s
Pal sy ,Methods and Findings in Experimental and Clini-
cal Pharmacology, Vol. 17, No. 8, 1995, pp. 539-544.
[56] A. D. Kandhare, K. S. Raygude, P. Ghosh, A. E. Ghule
and S. L. Bodhankar, “Therapeutic Role of Curcumin in
Prevention of Biochemical and Behavioral Aberration
Induced by Alcoholic Neuropathy in La boratory Animals,”
Neuroscience Letters, Vol. 511, No. 1, 2012, pp. 18-22.
[57] D. J. Fitzhugh, S. Shan, M. W. Dewhirst and L. P. Hale,
“Bromelain Treatment Decreases Neutrophil Migration to
Sites of Inflammation,” Clinical Immunology, Vol. 128,
No. 1, 2008, pp. 66-74.
[58] L. Gaspani, E. Limiroli, P. Ferrario and M. Bianchi, “In
Vivo and in Vitro Effects of Bromelain on PGE(2) and SP
Concentrations in the Inflammatory Exudate in Rats,”
Pharmacology, Vol. 65, No. 2, 2002, pp. 83-86.
[59] L. P. Hale, M. Chichlowski, C. T. Trinh and P. K. Greer,
“Dietary Supplementation with Fresh Pineapple Juice De-
creases Inflammation and Colonic Neoplasia in IL-10-
Deficient Mice with Colitis,” Inflammatory Bowel Dis-
eases, Vol. 16, No. 12, 2010, pp. 2012-2021.
[60] S. Muller, R. Marz, M. Schmolz, B. Drewelow, K. Esch-
mann and P. Meiser, “Placebo-Controlled Randomized
Clinical Trial on the Immunomodulating Activities of
Low- and High-Dose Bromelain after Oral Administra-
tion—New Evidence on the Antiinflammatory Mode of
Action of Bromelain,” P hyt ot herapy Research, Vol. 27,
No. 2, 2012, pp. 199-204.
[61] F. Inchingolo, M. Ta tullo, M. Marrelli, A. M. Inchingolo,
V. Picciariello, A. D. Inchingolo, G. Di palma, D. Verme-
san and R. Cagiano, “Clinical Trial with Bromelain in
Third Molar Exodontia,” European Review of Medi cal
Pharmacological Sc iences, Vol. 14, No. 9, 2010, pp. 771-
774.
[62] M. Ma sson , “Bromelain in Blunt Injuries of the Locomo-
tor Syste m. A Study of Observe d Applications in General
Practice,Fortschritte der Medizin, Vol. 113, No. 19,
1995, pp. 303-306.
[63] S. Jadav, N. Patel, T. Shah, M. Gajera, H. Trivedi and B.
Shah, “Comparison of Anti-Inflammatory Activity of
Serratiopeptidase and Diclofenac in Albino Rats,” Jour-
The Effect of NeuroGen® Nerve Support Supplement on Pillar Pain after Endoscopic Carpal Tunnel Release
OPEN ACCESS MPS
10
nal of Pharmacology & Pharmacotherapeutics, Vol. 1,
No. 2, 2010, pp. 116-117.
[64] A. H. M. Viswanatha Swamy and P. A. Patil, “Effect of
Some Clinically Used Proteolytic Enzymes on Inflamma-
tion in Rats,” Indian Journal of Pharmacetical Sciences,
Vol. 70, No. 1, 2008, pp. 114-117.
[65] A. Mazzone, M. Catalani, M. Costanzo, A. Drusian, A.
Mandoli, S. Russo, E. Guarini and G. Vesperini , “Evalua-
tion of Serratia peptidase in Acute or Chronic Inflamma-
tion of Otorhinolaryngology Pathology: A Multicentre,
Double-Blind, Randomized Trial Versus Placebo,” Jour-
nal of International Medic al Research, Vol. 18, No. 5,
1990, pp. 379-388.
[66] T. H. Al-Khateeb and Y. Nusair, “Effec t of the Proteolyt-
ic Enzyme Serrapeptase on Swelling, Pain and Trismus
after Surgical Extraction of Mandibular Third Molars,
International Journal of Oral and Maxillofacial Surgery,
Vol. 37, No. 3, 2008, pp. 264-268.
[67] P. M. Esch, H. Gerngross and A. Fabian, “Reduction of
Postoperative Swelling. Objective Measurement of Swel-
ling of the Upper Ankle Joint in Treatment with Serra-
peptase—A Prospective Study,Fortschr itte der Medizin,
Vol. 107, No. 4, 1989, pp. 67-68,71-72.
[68] M. Tachibana, O. Mizukoshi, Y. Harada, K. Kawamoto
and Y. Nakai, “A Multi-Centre, Double-Blind Study of
Serrapeptase versus Placebo in Post-Antrotomy Buccal
Swelling,” Pharmatherapeutica, Vol. 3, No. 8, 1984, pp.
526-530.