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How to use Palmitoylethanolamide (PEA) in CRPS?

There is a new, natural painkiller available, a molecule with a difficult name, palmitoylethanolamide, it comes as the supplement PeaPure and seems very promising for CRPS patients. (1)

While analgesics may occasionally decrease pain in CRPS, very often increasing dosages are not well tolerated and patients refrain from treatment.

There is clearly an urgent need for new innovative therapies in CRPS that are not only effective, but also have a favorable profile in terms of side effects and drug interactions. In particular, multimodal treatment strategies for complex pain syndromes, such as neuropathic pain and CRPS, are needed to effectively alleviate symptoms. Multimodal therapy for CRPS means a optimal combination of analgesics, chosen in such a way to enhance efficacy and minimize the risk for side effects and drug-drug interactions.

Palmitoylethanolamide (Pea), a natural painkiller is most suited for such an approach. (1) Palmitoylethanolamide is a body-own compound produced in our body to bring balance in states of chronic pain and inflammation. Its safety and efficacy has been proven in many clinical trials in a total of many thousands of patients.(2) The compound is not only part of our body, but can be found in many foodstuffs.

Palmitoylethanolamide  harnesses the endogenous regulatory mechanisms suppressing chronic neurogenic inflammation, and can be well combined with all other analgesics and co-analgeiscs as well as with topical compounded analgesic creams, such as ketamine or amitriptyline creams.

Combination of PEA with analgesics, such as tramadol, pregabalin, gabapentin, amitriptyline, and duloxetine, has not thus far been reported to create adverse interactions. (2)

How to use PEA in CRPS: dose recommendations

The first weeks one should (could) start with 3 times 400 mg PEA, either given three times daily, or in the morning 2 capsules and 1 capsule in the evening. After some weeks, in the case of insufficient effects, one should (could) increase the dose to two capsules three times daily (or two times daily). Response mostly occurs in the first 1-2 months.

The first things to notice are a general feeling of increased comfort, and a decrease of the intense peaks of pain. In the following weeks responders note a less intense inflammation (less swelling, less temperature differences, less redness or bluishness).

PEA is very safe and even in children doses up to 50 mg per kg Bodyweight were tolerated without side effects. For adults the max dose tested was 100 mg/ kg Bodyweight.

If after 2 months not sufficient results have been seen, one can either increase further (up to 30 mg PEA/ kg bodyweight) or try a week 3 times daily the content of a capsule under the tongue. Let it melt. The resorption via the oral mucosa might give an extra impulse in non-responders. As said, PEA can be combined with any kind of other medicine.

Patient example: 13 years of swollen feet and wheelchair

The case report published in article (1) describes a patient suffering from intractable CRPS type 1 for 13 years. Due to her swollen painful feet and left knee she is wheelchair-bound. The combination of palmitoylethanolamide and ketamine 10% cream reduced her pain by more than 50% after 1 month of treatment, and a marked reduction in swelling and skin discoloration was noticed. Furthermore, she could walk independently again and she experienced no side effects. In a video the case is also presented. The value of PEA in other neuropathic pain states can be followed in referencse 3-5.

1. Keppel Hesselink, JM Treatment of chronic regional pain syndrome type 1 with palmitoylethanolamide and topical ketamine cream: modulation of nonneuronal cells
Journal of Pain Research Volume 2013:6 Pages 239 – 245
DOI: https://dx.doi.org/10.2147/JPR.S42417.

2. Keppel Hesselink JM. New targets in pain, non-neuronal cells, and the role of palmitoylethanolamide. Open Pain J. 2012;5:12–23.

3. Keppel Hesselink JM, Hekker TA. Therapeutic utility of palmitoylethanolamide in the treatment of neuropathic pain associated with various pathological conditions: a case series. Journal of Pain Research, October 2012 Volume 2012:5: Pages 437 – 442

4. 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. 2012 Sep;13(9):1121-30.

5. Palmitoylethanolamide in neuropathic sciatic pain: clinical results; https://neuropathie.nu/https://neuropathie.nu/gliopathic-pain/een PEA-houdend product-palmitoylethanolamide-in-neuropathic-pain-clinical-re.html