Modern Plastic Surgery, 2014, 4, 5-10
Published Online January 2014 (
The Effect of Neuro Gen® Nerve Support Supplement on
Pillar Pain after Endoscopic Carpal Tunnel Release
Michael J. Fitzmaurice
Fitzmaurice Hand Institute, Phoenix, USA.
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.
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.
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
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
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.
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