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In this section English articles are published on neuropathy.

Pain with hernia and treatment with palmitoylethalonamide ( PeaPure)

Heavy neuralgia radiating to the leg is also called sciatica or lumbosacral radiculopathy. Doctors have called this neuritis or neuritis of the sciatic nerve, the Nervus Ischiadicus, for a long time. This old concept has now been given a complete new turn.

Sciatica is caused by mechanic pressure by an intervertebral disc on the beginning of the sciatic nerve, the so-called nerve root within or just outside the vertebral column. Because of that pressure the nerve becomes inflamed and then the pain starts usually quite sudden. Then an inflammation that is maintained by the pressure on that nerve, the hernia, starts. 

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Pain in Chronic idiopathic axonal polyneuropathy treated with palmitoylethalonamide (PEA)

ciap-pea.jpg There is no evidence from randomised trials of drug therapy for chronic idiopathic axonal polyneuropathy, accrding to a Cochrane review. We quote from that review. Chronic idiopathic axonal polyneuropathy is a not uncommon disorder of the elderly causing very slowly progressive numbness or weakness of the feet and lower legs, and sometimes also the hands. By definition, the cause is not known. No randomised trials of drug treatment for chronic idiopathic axonal polyneuropathy have been conducted. Trials will need sensitive outcome measures and long follow-up periods.

That is why treatments like these need attention, palmitoylethalonamide clearly resulted in decreasing pain in an intractable pain patient suffering from CIAP.

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Integrated Medicine concept for neuropathic pain at the Berlin congress (2010)

Treatment of neuropathic pain, an overview presented at the 3rd European Congress for Integrative Medicine,in Berlin, December 3rd, 2010. The founding fathers of the Institute of Neuropathic pain attended the above mentioned congress to present the integrated treatment concept for neuropathic pain to an audience of physicians interested in pain treatment. The director of research and development from the institute, professor Jan M. Keppel Hesselink, presented the multimodal therapy as it has been developed within the institute for the past years.

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Palmitoylethanolamide (PEA) combined with pregabalin in neuropathic pain

Palmitoylethanolamin (een PEA-houdend product®;PeaPure®) is a endogenous lipid with analgesic and anti-inflammatory properties. In a study were 30 patients were entered, suffering from diabetic neuropathic pain and post-herpetic pain, palmitoylethanolamide was combined with pregabalin in the treatment of neuropathic pain.

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A natural remedy for pain in Idiopathic sensory-motor polyneuropathy

ciap-neuropathie.jpg CIAP and chronic pain treated with een PEA-houdend product; palmitoylethanolamide or een PEA-houdend product is a supplement with analgesic properties and many patients find great relief if treated with this body-own compound.CIAP is also referred to as Idiopathic sensory-motor polyneuropathy, and it is an illness where sensory and motor nerves of the peripheral nervous system are affected and no obvious underlying etiology is found. In many respects, the symptoms are very similar to diabetic polyneuropathy.

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Analgesic creams from the institute of neuropathic pain


Topical treatment of neuropathic pain

Topical analgesic creams to treat pain and tingling may have many advantages over systemic treatment with analgesics: 

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Breakthrough in the treatment of Sudeck’s dystropy (Chronic Regional Pain Syndrome, CRPS)



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Diabetic Neuropathy: introduction

Diabetes and neuropathy: a simple explanation by Jan M. Keppel Hesselink, MD, PhD, professor of molecular pharmacology and director R&D of the clinic for treatment of neuropathic pain in Soest, the Netherlands. Jan Keppel Hesselink is also initiator of the professional LinkedIn group for neuropathic pain and neuropathy.

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Cancer and neuropathic pain

You are definitely familiar with symptoms as numbing, tingling, or prickling sensatiob,  after you have hit your funny bone, or your foot falls asleep. But for cancer patients, these sensations can be symptoms of either cancer itself, or, more often, a serious side effect of cancer therapy called neuropathy (injury to the nerves).

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Pfizer working on new leads in neuropathic pain

Pfizer is working on consolidating its pipeline in pain, based on some new leads and other steps to strenghten their position in the market of neuropathic pain. They are working on compounds and innovations for: 

  1. Peripheral neuropathic pain
  2. Central neuropathic pain
  3. Post-operative pain
And on combination therapy for pain: Combo therapy with PF-4880682. Furthermore they are looking into new α2δ Ligands to ‘Expand a Successful Class of Drugs’

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Pregabalin, Lyrica® not for fibromyalgia in Europe

The EMEA has adviced against the marketing authorization of Lyrica® in the indication fibromyalgia in Europe. This is their argumentation:

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Treatment of CIAP, pain, instability and tiredness

ciap_minder_moe_en_fietsen.jpgHere we present a patient suffering from CIAP with neuropathic pain, and gait instability, as well as complaints of tiredness:

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Management of diabetic painful neuropathy

More than 20 million Americans, representing around 7% of the population, have diagnosed or undiagnosed diabetes, and diabetic polyneuropathy (DPN) is a well known complication and contributes up to nearly 1/3 of all the direct medical costs associated with diabetes.  Around 1/5 of all patients with DPN are suffering from neuropathic pain. How are these patients treated and followed?

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Diabetes leading to neuropathy: video

diabetes.jpg High blood sugar, glucose, in diabetes patients can lead to diabetic neuropathy. Learn more in this simple video about how diabetic neuropathy can cause damage to the nervous system, and how a healthy lifestyle can prevent diabetic neuropathy in diabetes sufferers.

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Building together The Virtual Network for Neuropathic Pain

Let us build together on Linkedin:

The Virtual Network for

Specialists in Neuropathic Pain

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Measuring outcome in neuropathic pain trials

neupsig1.jpgDr. Nadine Attal from INSERM, discussed measurements in RCT’s of neuropathic pain and showed that there are great number of pain scales and questionnaires that have been used in clinical trials to assess the efficacy of interventions in neuropathic pain, varying from a simple visual analogue scale (VAS) or the numerical rating scale (NRS) to assess pain intensity to more complex multidimensional scales to assess pain, sleep, depression, quality or life or disability.NRS and VAS remain both the most suitable instruments to assess effects of treatment on pain intensity. Furthermore, clinical global impression of doctors (CGI) and responder rates are recommended for the assessment of overall change of neuropathic pain due to treatment.

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Auditory neuropathy

All nerves can be affected by neuropathy, even the nerves to the eye and the nerves to the ear. Auditory neuropathy is a rare discorder, and in July 2010 researcers found the cause of this afliction in the genes:

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Cannabinoids and nerve regeneration or neurogenesis

Most people and neurologist view nerves as ‘copper ropes’ conducting electricity. If the copper rope breaks, the nerve is damaged, and the damage is for the rest of our life. This creates great nihilism for therapeutic innovations. And even more disturbing, patients feel this metaphore is a desription of reality. The message patients often get from their neurologist is: nothing can be done, what is dead remains dead….

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The search for the palmitoylethanolamide receptor

pea.jpegPalmitoylethanolamide is hot. It is a body-own compound which seems quite interesting for a number of clinical reasons, and most importantly for its analgesic properties in neuropathic pain. But how does it work? 

The search for the palmitoylethanolamide receptor was the title of a publication in Life Sciences, written by pharmacologists from the Department of Experimental Pharmacology, University of Naples, and the Department of Pharmacology, University of California, Irvine, USA.

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NeurogesX to Qutenza® (capsaicin) 8% Patch in HIV-Associated Neuropathy

In a recent press release (18-10-2010) it was communicated that the company NeurogesX  U.S.will try to broaden the indications for Qutenza® (capsaicin) 8% patch to include patients with painful HIV-associated neuropathy (HIV-AN, also referred to as HIV-distal sensory polyneuropathy (HIV-DSP)). Following a recent meeting with the U.S. Food and Drug Administration (FDA), NeurogesX plans to submit a supplemental new drug application (sNDA) in the first half of 2011.

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Zoster pain and vitamine D?

The mechanisms relating to the development of post herpetic neuralgia (PHN) or zoster pain remain uncertain and many different factors are involved. 

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Adenosine agonists and neuropathic pain

Adenosine is a neuromodulator that interacs with four adenosine receptors, A(1), A(2A), A(2B) and A(3). Adenosine receptors are new inroads in treating neuropathic pain. Even better, these compounds are inroads to treating gliopathic pain. Gliopathic pain is a new name for the chronic wind-up state of glia and neurons in chronic painstates we see in diabetic neuropathy, herpes zoster and many related painstates.

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Palmitoylethanolamide (PEA), an ALIAmide regulating mast cells


Identification of palmitoylethanolamide (PEA) as regulatory mechanism for the metabolism of mast cells by Nobel Price Laureate Rita Levi Montalcini in 1993, and it’s use as a analgesic and anti-inflammatory compound

Searching for non psychoactive Cannabinoids our clinic identified in 2010 the small molecule palmitoylethanolamide (PEA) as a potent novel and promising analgesic and anti-inflammatory agent. This molecule has been developed based on the work and insights of Rita Levi Montalcini, as an off spin of her work with nerve growth factors.

As PEA, trade names PeaPure and is gaining more and more international recognition as a break through molecule in the treatment of chronic pain and inflammation, it is worth while to shortly analyze how the mast cell modulation concept, palmitoylethanolamide and the ALIA concepts came into existence.

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CIDP associated with MGUS treated with palmitoylethanolamide and low dose naltrexone

mgus.jpg MGUS is a very rare peripheral neuropathy, usually late-onset in terms of the sufferer’s age. It is one of the chronic demyelinating polyneuropathy group, that are mixed motor-sensory nerve affected and symmetrical in the damage caused. Paraproteinaemic Demyelinating Neuropathy may be known by a variety of other titles: MGUS-associated neuropathy, polyneuropathy, Paraprotein-associated demyelinating neuropathy, Paraprotein associated neuropathy/polyneuropathy, CIDP associated with a paraprotein, CIDP associated with MGUS, paraprotein-related or associated demyelinating neuropathy, demyelinating paraproteinaemic neuropathy, MGUS polyneuropathy and Peripheral Neuropathy associated with benign monoclonal gammopathy. We treated the pain, which was refractory to classical analgesics, with a combination of palmitoylethanolamide and low dose naltrexone, and a tiny amount of pregabaline (25 mg and 50 mg) and could reduce the pain for around 50%.

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CRPS treated with amitritpyline 10%

A patient with CRPS got hold on our article  in the treatment of CRPS with analgesic creams. Here you can read her story and the effect of the analgesic cream.

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Astra-Zeneca compound AZD2423 fails in neuropathic pain: posttraumatic neuralgia.

The Astra-Zeneca compound AZD2423, a novel chemokine receptor 2 (CCR2) antagonist, fails in treating neuropathic pain in posttraumatic neuralgia. This is the result of a phase II trial dose-finding in 133 patients with posttraumatic neuralgia. Patients were equally randomized to 28days’ oral administration of 20mg AZD2423, 150mg AZD2423 or placebo.


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Advising R&D for neuropathic pain

jan-keppel-hesselink-neuropathy-rd.jpg Many patients suffering from neuropathic pain are currently not optimal treated using the drugs on the market. The total value of the neuropathic pain market is supposed to double from 2006 to reach over $7 billion by 2016. There is a lot of space in the marketplace for  improved pain management.

In our institute we are specialized in the treatment of neuropathic pain and adbvising R&D processes related to the identification of new potential painkillers for neuropathic pain. A short explanation of the experience we have in helping pharmaceutical companies developing new drugs, by professor Jan M. Keppel Hesselink, MD, PhD, consultant.

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Multimodal therapy in neuropathic pain: 2 is more than 1!

The famous Dutch surgeon Noordenbos wrote in 1959: "One-one synaptic transmission must be the exception rather than the rule in the nervous system. Any nerve cell located in the anterior horn. . . could hardly be expected to synapse at higher level with one such similar cell only. It will probably send ramifications to many other locations, and in turn be acted upon by the ramifications of many other cells. . . Far from being a continuous chain of short neurons, these fibres must constitute links in an extremely complicated nerve net in which, within limits, everything synapses more or less with everything else." It is clear that half a century later our therapy of pain is based on these deep insights of Noordenbos, and multimodal therapy is now the hallmark of how to treat neuropathic pain. This is because it is difficult to treat neuropathic pain with one drug only. In our centre we nearly always prescribe two or more oral drugs and mostly also topical creams and supplements together to get the patients out of the red zone of discomfort.

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Nerve Growth Factors as new inroads in chronic and neuropathic pain

Stakeholder Opinions: Targeting Nerve Growth Factor for Pain Therapy – Groundbreaking class to breathe new life into saturated market – this is the somewhat pompous and overdone title a new market research report from companiesandmarkets.com, published in 2010, on a new potential class of analgesics for neuropathic pain.

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Ziconotide in chronic pain requiring intraspinal analgesia: orphan drug

Ziconotide is a man-made equivalent of a molecule composed of a 25-amino acid chain, which is found in the venom of a fish-eating marine snail, Conus magus. Ziconotide blocks the action of specific molecules found in nerve tissue, called N-type voltage-sensitive calcium channels. These molecules play an important role in chronic pain. Ziconotide is expected to decrease pain by blocking the function of these molecules.

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