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Jim is a 46 year old retired New York policeman who uses power tools to repair his house. His problem is chronic pain at the base of the thumb and wrist. The pain worsens with use of the hand, making it difficult to use the power tools. Other repetitive motions cause pain such as turning a key in a lock, unscrewing the lid of a jar, and opening the car door. Jim also has "trigger finger" involving the thumb joint, and at night, before sleep he notices tingling and numbness in the hands.

Conventional Treatment - Steroid Injection and Splint

Jim's hand pain worsened lately, so he went to a hand surgeon who gave him a steroid injection at the base of the thumb and applied a hand/wrist splint. These measures were ineffective, and his pain continued. The surgeon suggested operation. Jim came into the office to ask if anything else could be done to avoid surgery.

P-5-P, Vitamin B6, Pyridoxine for Trigger Finger

As it turns out, there is a simple and effective vitamin therapy for Jim's Trigger Finger hand condition called Pyridoxine, vitamin B6. Jim was given a bottle of pyridoxine phosphate (the activated form) and 3 weeks later, an amazed Jim returned to report that his pain and swelling is gone, and his trigger finger had also resolved. He no longer needs the operation.

John Ellis MD, The Doctor Who Looked At Hands

I first leaned of B6 for carpal tunnel from reading Dr Jonathan Wright's 2005 newsletter mentioning Dr. John Ellis, a Texas physician in the 1960's who discovered that vitamin B6 eliminates carpal tunnel syndrome, trigger finger, and other hand conditions.

Examine the backs of your hands. Have you ever noticed the backs of your hands are puffy and swollen, making the tendons obscured? Are your hands so swollen that you cant touch your palms with the tips of your fingers? That's the positive "Ellis sign," indicating extra B6 could be helpful. Usual dosage is 20 milligrams three times daily of the activated P-5-P form of B6. Old copies of Dr. Ellis' book The Doctor Who Looked at Hands originally written in 1966, are still available.

Vitamin B6 Toxicity, Monitoring Blood Levels and Dosage

Unlike other water soluble B vitamins which are safe even at high doses, vitamin B6 (pyridoxine) can be toxic at dosages above 300 mg per day causing sensory neuropathy. Having no reported toxicity is the pyridoxal-5-phosphate (P-5-P) form of B6 which is also the biologically active form of the vitamin. Therefore, P-5-P is the preferred form of the vitamin B6 to take. Make sure your B Vitamin Complex uses the P-5-P version rather than plain old pyridoxine version. We routinely measure serum P-5-P levels just to be on the safe side.

In a 2009 study in AJCN, P-5-P levels were measured, and the authors recommended the following B6 protocol: Most of the patients required 25 - 50 mg B6 daily.

For Serum P-5-P concentration greater than 3.3 ng/mL - No treatment
For 2.5 - 3.2 ng/mL - 50 mg pyridoxine HCl/d
For less than 2.5 ng/mL - daily oral dose of 50 mg
Normal reference range: 3.3 - 26 ng/mL. Dose reduction or discontinuation of maintenance therapy was based on serum concentrations 25 and 50 ng/mL, respectively.

Plasma PLP below 30 nmol/L has been used as an indicator of inadequate status while a cutoff of 20 nmol/L indicates deficient concentrations. Both cutoffs have been widely used in the literature and demonstrate utility in assessing adequacy of vitamin B6 intake.

For links and references, see here.