Possible role of alpha-lipoic acid in the treatment of peripheral nerve injuries

Dear Editors,We read with great interest the paper: ''Intraperitoneal alpha-lipoic acid to prevent neural damage after crush injury to the rat sciatic nerve'' by Senoglu and colleagues published in the November issue 2009 of the Journal of Brachial Plexus and Peripheral Nerve Injury [1]. We congratulate the Journal for the interest in this topic. This innovative study demonstrated the protective effect of α-lipoic acid (α-LA) administration in rat sciatic nerve crush injury by reducing the oxidative stress [1].This paper has aroused our attention because these findings can provide confirmation on the usefulness of α-LA administration in humans in a very common disease as back pain [2], which produces adverse effects on activities of daily living. Back pain is a common and disabling musculoskeletal disorder that often occurs in a working-age population. Sciatic nerve injury is a common consequence of low back pain caused by lumbar disc herniation that occurs with radicular pain, radiculopathy, or both [3]. Nerve injury may depend on length of time of crush insult. In fact, after the tissue destruction, free oxygen radicals can increase and cause tissue damage [1]. Many patients are affected by sub-acute and chronic low back pain and/or sciatica: this exerts an important impact on the quality of life, causing interference of sleep and enjoyment of life.Many clinical studies have compared the efficacy of surgery versus prolonged conservative treatment in the low back pain and/or sciatica [4], concluding there is no clear evidence that surgery is more beneficial than conservative treatment. Moreover often patients are affected by neuropathic pain also after the surgery. It is common knowledge that conservative treatments are tried first and surgery must be the last resort, as drug therapy (paracetamol, tramadol, nonsteroidal anti-inflammatory drugs, myorelaxant, steroids, antidepressants, etc.) and physical exercise (aerobic work, Back School, Mc Kenzie, Global Postural