Palmitoylethanolamide in severe sciatic pain

Heavy neuralgia radiating to the leg is also called sciatica or lumbosacral radiculopathy. Doctors have called this in the past neuritis of the sciatic nerve, the Nervus Ischiadicus.

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.

The vicious circle of inflammation, and increasing pain, pain neurotransmitters and increasing inflammation can be stopped by palmitoylethanolamide (PEA, brandnames PeaPure and een PEA-houdend product), an endogenous fatty acid amide analogue of the endocannabinoid anandamide. [1]

Here a patient, who is a MD and a past president of a big hospital, with severe sciatic pain, treated with PEA:

PEA belongs to an entire new class of pain-killing drugs that are not addictive, and do not have dose limiting side efects, and are stomach friendly.

PEA belongs to the class of N-Acylethanolamides (NAEs) (amides of ethanolamine with long-chain fatty acids) and these are defined as endogenously generated lipid-signaling molecules. These lipids are widely distributed in a variety of plant, invertebrate, and mammalian tissues. They are produced as a biological meaningful answer in inflammation, as a self-regulating servo mechanism. Now we have the possibility to administer PEA as a medical food supplement and regulate the detrimental cascade in sciatic pain.

In 2010 a Spanish publication described clinical meaningful effects of the treatment of lumbosciatic pain with this endogenous cannabinoid, palmitoylethanolamide, PEA. These results were published in Dolor (2010;25:35-42).

Palmitoylethanolamide (NORMAST®) effective in lumbosciatic pain

The study was double blind, placebo controlled and two different dosages of palmitoylethanolamide were evaluated in a three weeks treatment regime.[1] Two different doses were compared, 300 mg and 600 mg daily and a third study arm was the placebo arm. Six hundred and thirty-six patients patients suffering from lumbosciatic pain due to radicular compression of the sciatic nerve and discopathy were included.

Primary endpoint was measured via the the visual analogue scale (VAS), in order to quantify the intensity of the pain, and by the Roland- Morris disability questionnaire (RDQ) to evaluate the quality of life. There were only few dropouts; seventeen patients. At the end of the three weeks treatment period both the pain reduction and the quality of life were significantly different between the three treatment groups (ANOVA; p < 0.001), and the daily dose of 600 mg was the most effective dose.

The decrease on the VAS was in the highest dose group a reduction from 7.1 to 2.1, which is more than 50% pain reduction, this is in general considered as a robust clinical response. In the placebo arm the painscore did decrease from 6.6 to 4.6.

Also in elderly een PEA-houdend product can be useful

Analgesic treatments with a low side effect profile such as palmitoylethalonamide are quite relevant for elderly patients, due to its benign side-effect profile. [2][3][4][5].

Especially the absence of sedative side effects is important. A great number of elderly patients have been treated without side effect or dose limiting problems, or interaction problems. Furthermore, combination therapy with pregabalin seems feasable and even clinically useful. [6]

Within the context of clinical studies more then 350 elderly patients have been treated with palmitoylethanolamide without side effect problems, and also in our hands, we did not detect any clinical relevant side effects, even not in a patient aged 90. To date the following numbers of elderly patients treated with palmitoylethanolamide ( PeaPure) have been evaluated in the double blind ischialgia study:

  • 111 patients between 65 and 70 years old
  • 116 patientsbetween 71 and 75 y.o.
  • 63 patients between 76 and 80 y.o.
  • 45 patients between 81 and 85 y.o.
  • 20 patients between 86 and 90 y.o. (een Italiaans bedrijf data on file)

PEA seems to have a great many biological effects, and might be quite interestng for a number of varying disorders. Recently a review summerized all biological actions of PEA, and we quote:[7]:

Analgesia

  • Acute pain ↓
  • Inflammatory pain ↓
  • Neuropathic pain ↓

Anti-Inflammation

  • Mast cell activation ↓
  • iNOS expression ↓
  • COX-2 expression ↓
  • Neutrophil influx ↓

Neuroprotection

  • Convulsions ↓
  • Excitotoxicity ↓

Anti-viral

  • Incidences of acute respiratory diseases ↓

 

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