If alpha lipoic acid is useful in treating or preventing brain and nerve disorders.
Patients with diabetes and mellitus and peripheral neuropathic pain.
Main outcome measures:
The primary outcome measure in this meta-analysis was the total symptom score (TSS). The TSS is a questionnaire in which the patient is asked to assess the intensity (absent, mild, moderate, severe) and the frequency (now and then, often, continuous) of four symptoms (pain, burning, paresthesia, numbness) resulting in a scaled score in which 0 means no symptoms and 14.64 means that all four symptoms are severe and more or less continuously present. A 30% change on this scale is considered to be clinically relevant (or ≥2 points in patients with a starting score ≤4 points).
The search yielded 242 publications in Medline and 112 in Embase (Figure 1). The 112 publications found in Embase were also identified in Medline. After reviewing the titles and the abstracts of the 242 publications, 10 randomised placebo-controlled trials on alpha lipoic acid in patients with diabetic neuropathic pain were selected [15–18, 21–26]. After reading the complete articles, two studies were excluded [21, 22], because they dealt with the effects of alpha lipoic acid on autonomic instead of diabetic neuropathy. Two studies [23, 24] were excluded because the TSS was not used as an outcome measure. There was no disagreement among the reviewers regarding the studies selected for inclusion.
Based on the four level 1b randomised, placebo-controlled studies included here, there is evidence to support that alpha lipoic acid causes a significant and clinically relevant decrease in neuropathic pain when administered for a period of three weeks at a dosage of 600 mg per day (grade of recommendation A).
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