Instituut voor Neuropathische Pijn

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Treatment

Several treatment modalities are available within the field of neuropathic pain and neuropathy.

PERIPHERAL INFLAMMATION IN FIBROMYALGIA

Drs N. Groven and his colleagues from Norway presented a poster at the EFIC in 2017 in Copenhagen, were they explored the peripheral inflammatory character of fibromyalgia. We often recommend palmitoylethanolamide for the treatment of fibromyalgia. This is a supplement based on an endogenous molecule inhibiting inflammation (PeaPlex, Glialia). Fibromyalgia (FM) patients often experience symptoms […]

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Topical TV-45070 8% ointment in herpes zoster pain not effective

Teva Pharmaceutical Industries Ltd. at the end of June 2017 disclosed the results of a Phase II study analysing topical TV-45070 4% and 8% oil in patients with post-herpetic neuralgia (PHN). The ointment treatment (twice a day) did not reduce the primary endpoint, pain measured via the NRS, at week four compared to placebo. However, there were […]

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What to be aware of in PEA: Pure PEA is not always Pure PEA, PEA-opt not always optimum PEA

More and more PEA preparations available. In pots, in blisters, in boxes. What about it? Which one should you choose? Most producers say a lot, for example, that they have the best absorbable PEA, that they are the only ones with ‘GMP PEA’,  and so on. It gets crazier every day. Do not be confused! […]

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MicroPEA: an essential component of modern PEA formulations!

MicroPEA is the content of special patented PEA formulations. Only these formulations have a long trackrecord of safety and efficacy.

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Rheumatism, Bechterew disease, mast cells and palmitoylethanolamide

Bechterew is a rheumatic disorder based on chronic inflammation. Since some years the treatment with the natural painkiller and anti-inflammation compound palmitoylethnanolamide in its new formulations containing micro-PEA gives new hope.

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Prostate, chronic pain and treatment with palmitoylethanolamide

Prostate Pains can be treated with the natural anti-inflammatory compound palmitoylethanolamide (PEA). We prefer PEA formulations containing micro-PEA (m-PEA, um-PEA and PEA-opt) as in PeaPure and PeaPlex.

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Treat burning and painful vagina with natural substance PEA

Vaginal pain, vaginal burning! This is quite common, more so than we think. Specifically among women older than 45 years of age. Many women don’t speak about it, but they do suffer from it. In case of vaginal pain, pain during intercourse or vaginal burning, it is obvious that the doctor or gynecologist needs to […]

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Amputation pain, phantom limb pain and treatment with palmitoylethanolamide

Post-amputation pain is a serious and difficult to treat pain, also referred to as phantom pain. Phantom pain can occur in the arms, legs, hand and feet after amputation, but also in cases of breast amputation related to cancer. Palmitoylethanolamide (PEA) is a natural and body’s own substance that has a pain relieving and anti-inflammatory […]

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MS spasms and pain treatment with body’s own substance palmitoylethanolamide

Palmitoylethanolamide is a new and promising treatment against pain and inflammation. It’s available as a supplement without prescription. PeaPure is a supplement in its purest form. Patients that suffer form MS pains and spasms can get some relief from this substance. In Italy, many neurologists are using this substance and both patients as neurologist are […]

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Endometriosis, menstruation pains and treatment with palmitoylethanolamide

Seven out of 10 menstruating women suffer from abdominal and menstruation pain. The medical term for abdominal pain during menstruation is dysmenorrhea. The so-called primary abdominal pain arises due to the ovulation, which is called primary dysmenorrhea. One of the most common causes of secondary dysmenorrhea is endometriosis. Over 1 out of 10 women suffers […]

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Study supports the significance of palmitoylethanolamide for endometriosis pain

A new study among 24 women with severe menstrual pains due to endometriosis and pain during intercourse, supports the use of palmitoylethanolamide (PEA as in PeaPure). The women experienced a clear decrease in pain, were able to take less pain medicine and experienced less pain during intercourse. The recommended dose is 400mg three times a […]

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Natural treatment of Parkinson with body’s own palmitoylethanolamide

The role of palmitoylethanolamide in Parkinson.

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Palmitoylethanolamide, PEA: key items presented

In the following sequence of presentations we bring to you the essence of knowledge around the body-own compound and supplement palmitoylethanolamide! We start with the general introduction, an overview of palmitoylethanolamide, an endogenous cellular protectant in plants, invertebrates, vertebrates and humans, tested extensively since 1970 and widely available as food supplement. Its main action is […]

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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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Trigeminus neuralgia treated with Gamma Knife surgery

Trigeminus neuralgia is difficult to treat. For those patients were medication such as carbamazepin is not helpful, the neurosurgeon can treat with the so called Gamma Knife…. 

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Beveiligd: een PEA-houdend product e PeaPure: informazioni palmitoilethanolamide

Er is geen samenvatting, omdat dit een beveiligd bericht is.

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een PEA-houdend product and PeaPure: questions and answers

What exactly is een PEA-houdend product  and PeaPure?

In this page many clinical and patient driven questions will be discussed. This page is under construction. A website has been created for palmitoylethanolamide related science only.

een PEA-houdend product and PeaPure are brandnames for supplements containing a body own molecule, palmitoylethanolamide, against pain and inflammation.  

een PEA-houdend product however contains magnesium stearate, a alien fat for our body, undigestable and an excipient doctors recommend to avoid.

All scientific information is discussed in this review.

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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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Neuropathic low blood pressure: Droxidopa

Patients suffering from small fibre neuropathy sometimes also suffer from difficult to treat low bloodpressure. In the Orient there is a registered drug for this dindication: L-DOPS (L-threo-dihydroxyphenylserine; Droxidopa; SM-5688). Droxidopa is a synthetic amino acid precursor which acts as a prodrug to the neurotransmitters norepinephrine (noradrenaline) and epinephrine (adrenaline). Unlike norepinephrine and epinephrine themselves, L-DOPS is capable of crossing the protective blood-brain barrier (BBB).

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Palmitoylethanolamide protects against side-effects anticancer drugs

Kahler’s disease is cancer of certain white blood cells, the plasma cells, and leads to death, mostly within 3-4 years. It is the second most frequent occuring forms of blood cancer, after non-Hodgkin’s disease. Initially patients can respond to chemotherapy, but treatment resistance often occurs. Furthermore, side effects such as nerve pain and nerve disfunctions (painful neuropathy) are dose limiting and thus optimal treatment of patients is not possible, as the chemotherapy needs to be stopped or reduced. Therfore patients cannot finish the course of chemotherapy and run a higher risk of relapse or recurrence of their cancer. Since years science searches for compounds to protect the nerve function, in order to enable patients suffering from MM to proceed being treated with chemotherapy.

Therefore it is highly important to point out that recently a natural occuring compound palmitoylethanolamide (PEA) has been identified in a clinical trial in MM patients, which indeed counteracts the side-effects of chemotherapy in blood cancer and restores nerve functions.

Italian neurologists from the neurological department of professor Cruccu, of the university of Rome, assessed the effect of PEA on pain and nerve function in patients with chemotherapy-induced painful neuropathy. 

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Evidence based medicine, patient centered medicine and the place of PEA

ebm.jpg Why the supplement PEA ( PeaPure) in chronic painstates? Is Evidence-Based Medicine Patient-Centered and Is Patient-Centered Care Evidence-Based? The patient should be the ultimate judge. Therfore Dr Painless points out that treating patients suffering chronic pain with the non-prescription drug een PEA-houdend product makes sense. Evidence-based medicine is a rather young concept that entered the scientific literature in the early 1990s.

It has basically a positivistic, biomedical perspective. Its focus is on offering clinicians the best available evidence about the most adequate treatment for their patients, considering medicine merely as a cognitive-rational enterprise. In this approach the uniqueness of patients, their individual needs and preferences, and their emotional status are easily neglected as relevant factors in decision-making. 

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Topiramate to treat neuropathic pain

Topiramate is a drug we should not forget in treating patients suffering from neuropathic pain.  Especially not for patients with refractory neuropathic pain, that is if other drugs do not help.

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Anodyne Therapy System® for neuropathy: not proven!

Surfing the net you may encounter many different treatments for neuropathy, and the anodyne therapy is one of those. In the internet you may find advertorials like the following: f you suffer from diabetic neuropathy, you may benefit from Anodyne Therapy–a non-invasive treatment that increases circulation and reduces the pain associated with peripheral neuropathy. The Anodyne Therapy System® helps to release nitric oxide from the red blood cells of patients suffering from diabetes. It does this with monochromatic infrared energy (MIRE) administered through flexible pads containing infrared diodes. 

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Thalamus pain, mast cells and PEA: a new treatment hypothesis

Thalamic pain after stroke is one of the most difficult to treat central painsyndromes. New therapeutic inroads are clearly needed, as the classical anti-neuropathic analgesics are not effective. In the future times we will need anti-gliopathic analgesics, as we pointed out elswere in our website.

The thalamus is a part of the brain were many mast cells reside. Mast cells play an important role in neuropathic pain. Palmitoylethanolamide (PEA) is a body-own fatty acid, synthetized in all our membranes, with mast cell stabilizing properties. PEA is registered in the catagory of medical food in Europe, and especially due to absence of side effects might be a promising new therapy for central thalamic pain. 

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Treatment of CRPS pain acc to protocol including ketamine (&DMSO) creams

In our clinic we developed a new treatment protocol for pains in CRPS, Sudeck’s dystrophic pains. We combine various treatments, all with a low propensity for side-effects. Basically our treatment protocol consists of:

1. Topical analgesic creams:

a. start with ketamine 10% racemic cream and on top of it (if necessary) DMSO 50% cream. 

b. or switch to amitriptyline 10% cream ( with/without DMSP 50%)

c. switch to een PEA-houdend product cream on top of either one of the creams before (consisting of the immune-modulator adelmidrol and capsaicine low concentration)

Creams in addition to:

2. een PEA-houdend product (palmitoylethanolamide) 600 mg twice daily.

Start with 20-30 days on een PEA-houdend product powder sublingually (melt in saliva under tongue, not to swallow, but to resorp in the mounth, and after treat with een PEA-houdend product 600 mg tablets twice daily. (order by www.ergomax.nl)

Topical creams in CRPS: background 

Chronic severe pain in Sudeck or CRPS we treat with a combination of various topical creams, especially a 10% ketamine cream, in severe cases together with DMSO 50% cream. Topical analgesics have clearly advantages over systemically administered medications. This is especially true for racemic ketamine. The reduction or elimination of side-effects is one of the major advantages.

Many patients are totally unable to ingest ketamine, but as a cream the application of ketamine is no problem. We treated already 40 patients without any problems, and a Canadian academic group decribed another group of 60 patients. Topical analgesics differ from transdermal delivery methods in that prescribers use topical applications to deliver local, rather than systemic effects.

In our institute we have developed a variety of special-compounded creams to improve our patients’ experience with intractable pain due to Sudeck / CRPS. Ketamine 10% is one example.We also developed amitriptyline cream, baclofen cream and gabapentine creams. 

Our compounded ketamine 10% cream can be used for specific patients in e.g. the Netherlands, Germany and the UK if the physicians order a prescription document at infoneuropathie.nu.gif

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Vitamin E protection for neuropathy due to chemotherapy

Vitamin E protects against nerve damage from chemotherapy, showed by French researchers, in a study of more than 100 patients, a study published in 2010.

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Low dose naltrexone for neuropathic pain

Low dose naltrexone is popular in the alternative treatment world. It is a bit strange, as this molecule is quite non-alternative. But low dose naltrexone (LDN) is recommended on lay internetsites for a multitude of diseases, from MS to cancer. That always provokes anti-bodies by doctors, but naltrexone indeed has anti-inflammatory properties. It might be an interesting treatment option for  treatment refractory neuropathic pain patients.

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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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Palmitoylethanolamide (PEA): information for MD’s

pea.jpeg

Palmitoylethanolamide (‘PEA’) is a endogenous compound and is in Europe available for the treatment of chronic pain and chronic inflammation. Most clinical data have been gathered and published around its efficacy in various neuropathic painstates, such as in diabetes, carpal tunnel syndrome, sciatic pain, and we outline these indications and the clinical and preclinical data below. 

Under the follow link an extensive review for specialists can be downloaded. The article appeared in The Open Pain Journal (2012) 

Palmitoylethanolamide has be described as an endogenous fatty acid amide, belonging to the class of lipid signaling molecules (autocoids). Since 50 years of research around this molecule, the last decade the number of scientific papers on PEA’s biological and clinical activity has been expanded to nearly 400.

PEA has been demonstrated to bind to a receptor in the cell-nucleus (a nuclear receptor, PPAR), a number of other receptors, and therefore it exerts a great varity of biological functions related to chronic pain and inflammation. It is considered as a breakthourgh in the treament of chonic pain, and with PEA a new mechanism of action in the world of analgesics has been introduced and validated in a great number of studies.

PEA can be seen as a glia modulator and proof of principle (POP) as well as proof of concept (POC) has been generated via PEA studies of glia as an important factor in the genesis of neuropathic pain.

Brandnames of drugs containing PEA 

PEA is available under various brandnames: een PEA-houdend product and een PEA-houdend product in Italy and Spain, and as PeaPure (JP Russell Science Ltd) for the rest or the world. PeaPure is available in Europe as a food supplement. 

In een PEA-houdend product and the active ingredient is palmitoylethanolamide. In een PEA-houdend product and een PEA-houdend product excipients like magnesium stearate, povidone and polisorbate are added. In the een PEA-houdend product sachets a sweetener has been added, sorbitol.

In PeaPure the sole content is palmitoylethanolamide (no excipients). 

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Regional analgesia, nerve block, in painful neuropathy

Until recently, regional anesthesia provided for the patient with a preexisting neuropathy has received scant attention. A review of major reference works dedicated to regional anesthesia spanning 87 years, and more than 4,700 total pages, found only 5 pages wherein the issue of central neuraxial anesthesia or PNB was discussed in the context of neuropathy. 

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