Fibroset™ and neuromuscular pain: a multicentric, real world, observational, post-marketing surveillance study in Indian patients suffering from neuromuscular pain

Authors

  • Kalpen Desai Department of Orthopaedics, Sushrut Clinic, Mumbai, Maharashtra, India
  • Mohit Madan Department of Orthopaedics, My Ortho Centre, Vaishali, Ghaziabad, Uttar Pradesh, India
  • Zubair Sorathia Department of Orthopaedics, Criticare Multispeciality Hospital and Research Centre, Mumbai, Maharashtra, India
  • Madu Sridhar Department of Orthopaedics, Kedar Hospital, Chennai, Tamil Nadu, India
  • B. A. Gopalkrishna Department of Orthopaedics, Dr. GK’s Advanced Bone and Joints Clinic, Bangalore, Karnataka, India
  • Kailash Nath Jain Department of Orthopaedics, Dr. Jain’s Clinic, Delhi, India
  • Anand Halyal Department of Orthopaedics, Sumeru Ortho and Spine Centre, Bangalore, Karnataka, India
  • Manoj Kumar Gudluru Department of Orthopaedics, Care Hospital, Hyderabad, Telangana, India
  • Vikrant Vijay Department of Orthopaedics, Sanjeevani Orthopaedic Paediatric Centre, Secunderabad, Telangana, India
  • Rakesh Sapra Department of Orthopaedics, Sapra Nursing Home, New Delhi, India
  • Nirmalya Deb Department of Orthopaedics, Belle Vue Clinic, Kolkata, West Bengal, India
  • Tanoy Bose Department of Orthopaedics, Suraksha Diagnostics, Kolkata, West Bengal, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20232615

Keywords:

Fibroset™, Boscurin®, Palmitoylethanolamide, Acetyl-L-carnitine, Pain, Safety

Abstract

Background: Neuromuscular disease (NMD) is a condition due to abnormality or damage to muscles and nerves causing painful symptoms. Symptomatic management involves use of conventional painkillers, but desirable relief is not achieved due to multimodal pathophysiology of disease. This study evaluated the efficacy and safety of Fibroset™ tablets in subjects with neuromuscular pain.

Methods: Subjects with neuromuscular pain, previously unsatisfied with standard therapies, were enrolled. Subjects were advised to take Fibroset™ one tablet BID for 2 weeks with their standard therapy. Efficacy was evaluated on pain, stiffness, swelling, weakness, tenderness, and difficulty in activity of daily living (ADL) as per the visit schedule. Tolerability of therapy was also evaluated.

Results: 59 patients were enrolled in study and 46 patients were included in the final analysis. Fibroset™ supplementation significantly reduced all evaluated parameters (p<0.05 vs baseline). The mean pain score from 2.50 to 0.89, while mean stiffness score was reduced to 0.55 from 1.87 at end of study. The mean swelling score was reduced to 0.81 from 2.04, while the mean weakness score was reduced to 0.64 from baseline score of 1.79. The mean tenderness score was reduced from baseline score of 1.90 to 0.65 and the mean ADL score was reduced to 0.63 from baseline score of 2.00. No treatment related side effects were observed.

Conclusions: Fibroset™ is a potentially effective and safe therapy for subjects with neuromuscular pain. It can be used to reduce symptoms in patients with unsatisfactory results with conventionally standard care therapy.

References

Tortora GJ, Derrickson B. The Muscular System. In: Tortora GJ, Derrickson B, editors. Introduction to the Human Body: The Essentials of Anatomy and Physiology. 10th edition. Wiley. 2014; 170-219.

Moraes LA, Piqueras L, Bishop-Bailey D. Peroxisome proliferator-activated receptors and inflammation. Pharmacol Ther. 2006;110(3):371-85.

Theoharides TC, Tsilioni I, Bawazeer M. Mast Cells, Neuroinflammation and Pain in Fibromyalgia Syndrome. Front Cell Neurosci. 2019;13:353.

Russo EB. Clinical Endocannabinoid Deficiency Reconsidered: Current Research Supports the Theory in Migraine, Fibromyalgia, Irritable Bowel, and Other Treatment-Resistant Syndromes. Cannabis Cannabinoid Res. 2016;1(1):154-65.

Staud R, Smitherman ML. Peripheral and central sensitization in fibromyalgia: Pathogenetic role. Curr Pain Headache Rep. 2002;6(4):259-66.

Canto-Santos J, Grau-Junyent JM, Garrabou G. The Impact of Mitochondrial Deficiencies in Neuromuscular Diseases. Antioxidants. 2020;9(10):964.

Clauw DJ, Essex MN, Pitman V, Jones KD. Reframing chronic pain as a disease, not a symptom: rationale and implications for pain management. Postgrad Med. 2019;131(3):185-98.

Ketenci A, Zure M. Pharmacological and non-pharmacological treatment approaches to chronic lumbar back pain. Turkish J Phys Med Rehabil. 2021;67(1):1-10.

Pan Y, Davis PB, Kaebler DC, Blankfield RP, Xu R. Cardiovascular risk of gabapentin and pregabalin in patients with diabetic neuropathy. Cardiovasc Diabetol. 2022;21(1):170.

Skaper SD, Facci L, Fusco M, Della Valle MF, Zusso M, Costa B, et al. Palmitoylethanolamide, a naturally occurring disease-modifying agent in neuropathic pain. Inflammopharmacology. 2014;22(2):79-94.

Clayton P, Hill M, Bogoda N, Subah S, Venkatesh R. Palmitoylethanolamide: A Natural Compound for Health Management. Int J Mol Sci. 2021;22(10):5305.

Hesselink JMK. Evolution in pharmacologic thinking around the natural analgesic palmitoylethanolamide: From nonspecific resistance to PPAR-α agonist and effective nutraceutical. J Pain Res. 2013;6:625-34.

Gabrielsson L, Mattsson S, Fowler CJ. Palmitoylethanolamide for the treatment of pain: pharmacokinetics, safety and efficacy. Br J Clin Pharmacol. 2016;82(4):932-42.

Gnoni A, Longo S, Gnoni GV, Giudetti AM. Carnitine in human muscle bioenergetics: Can carnitine supplementation improve physical exercise? Molecules. 2020;25(1):182.

Youle M, Osio M. A double-blind, parallel-group, placebo-controlled, multicentre study of acetyl L-carnitine in the symptomatic treatment of antiretroviral toxic neuropathy in patients with HIV-1 infection. HIV Med. 2007;8(4):241-50.

Parisi S, Ditto MC, Borrelli R, Fusaro E. Efficacy of a fixed combination of palmitoylethanolamide and acetyl-l-carnitine (PEA+ALC FC) in the treatment of neuropathies secondary to rheumatic diseases. Minerva Med. 2021;112(4):492-9.

Yarizadh H, Shab-Bidar S, Zamani B, Vanani AN, Baharlooi H, Djafarian K. The Effect of L-Carnitine Supplementation on Exercise-Induced Muscle Damage: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. J Am Coll Nutr. 2020;39(5):457-68.

Sethi V, Garg M, Herve M, Mobasheri A. Potential complementary and/or synergistic effects of curcumin and boswellic acids for management of osteoarthritis. Ther Adv Musculoskelet Dis. 2022;14:1759720X221124545.

Bhaskar SB. Clinical trial registration: A practical perspective. Indian J Anaesth. 2018;62(1):10-5.

Hesselink JMK, Boer T de, Witkamp RF. Palmitoylethanolamide: A Natural Body-Own Anti-Inflammatory Agent, Effective and Safe against Influenza and Common Cold. Int J Inflam. 2013;151028.

Gatti A, Lazzari M, Gianfelice V, Di Paolo A, Sabato E, Sabato AF. Palmitoylethanolamide in the Treatment of Chronic Pain Caused by Different Etiopathogenesis. Pain Med (United States). 2012;13(9):1121-30.

Del Giorno R, Skaper S, Paladini A, Varrassi G, Coaccioli S. Palmitoylethanolamide in Fibromyalgia: Results from Prospective and Retrospective Observational Studies. Pain Ther. 2015;4(2):169-78.

Hesselink JMK, Kopsky DJ. Palmitoylethanolamide, a neutraceutical, in nerve compression syndromes: Efficacy and safety in sciatic pain and carpal tunnel syndrome. J Pain Res. 2015;8:729-34.

Skaper SD, Facci L. Mast cell-glia axis in neuroinflammation and therapeutic potential of the anandamide congener palmitoylethanolamide. Philos Trans R Soc B Biol Sci. 2012;367(1607):3312-25.

Okine BN, Gaspar JC, Finn DP. PPARs and pain. Br J Pharmacol. 2019;176(10):1421-42.

Roh J, Go EJ, Park J-W, Kim YH, Park C-K. Resolvins: Potent Pain Inhibiting Lipid Mediators via Transient Receptor Potential Regulation. Front Cell Dev Biol. 2020;8:584206.

Jiang X, Ma J, Wei Q, Feng X, Qiao L, Liu L, et al. Effect of Frankincense Extract on Nerve Recovery in the Rat Sciatic Nerve Damage Model. Evidence-based Complement Altern Med. 2016;3617216.

Sharma S, Kulkarni SK, Agrewala JN, Chopra K. Curcumin attenuates thermal hyperalgesia in a diabetic mouse model of neuropathic pain. Eur J Pharmacol. 2006;536(3):256-61.

Zhao X, Xu Y, Zhao Q, Chen C-R, Liu A-M, Huang Z-L. Curcumin exerts antinociceptive effects in a mouse model of neuropathic pain: descending monoamine system and opioid receptors are differentially involved. Neuropharmacology. 2012;62(2):843-54.

Liu S, Li Q, Zhang M-T, Mao-Ying Q-L, Hu L-Y, Wu G-C, et al. Curcumin ameliorates neuropathic pain by down-regulating spinal IL-1β via suppressing astroglial NALP1 inflammasome and JAK2-STAT3 signalling. Sci Rep. 2016;6:28956.

Cao H, Wei ZJ, Jia LJ, Meng B, Li J, Shan GR. Effects of curcumin on pain threshold and on the expression of nuclear factor κ B and CX3C receptor 1 after sciatic nerve chronic constrictive injury in rats. Chin J Integr Med. 2014;20(11):850-6.

Ji F-T, Liang J-J, Liu L, Cao M-H, Li F. Curcumin exerts antinociceptive effects by inhibiting the activation of astrocytes in spinal dorsal horn and the intracellular extracellular signal-regulated kinase signaling pathway in rat model of chronic constriction injury. Chin Med J (Engl). 2013;126(6):1125-31.

Di Stefano G, Di Lionardo A, Galosi E, Truini A, Cruccu G. Acetyl-L-carnitine in painful peripheral neuropathy: A systematic review. J Pain Res. 2019;12:1341-51.

Chiechio S, Copani A, GereauIV RW, Nicoletti F. Acetyl-L-Carnitine in Neuropathic Pain: Experimental data. CNS Drugs. 2007;21(1):31-8.

Grandis D De, Minardi C. Acetyl-L-Carnitine (Levacecarnine) in the Treatment of Diabetic Neuropathy. Drugs R D. 2002;3(4):223-31.

Sima AAF, Calvani M, Mehra M, Amato A. Acetyl-L-carnitine improves pain, nerve regeneration, and vibratory perception in patients with chronic diabetic neuropathy: an analysis of two randomized placebo-controlled trials. Diabetes Care. 2005;28(1):89-94.

Sun Y, Shu Y, Liu B, Liu P, Wu C, Zheng R, et al. A prospective study to evaluate the efficacy and safety of oral acetyl‑L‑carnitine for the treatment of chemotherapy‑induced peripheral neuropathy. Exp Ther Med. 2016;12(6):4017-24.

Downloads

Published

2023-08-28

Issue

Section

Original Research Articles