Spinal cord injury (SCI) pain treated with the natural painkiller palmitoylethanolamide

There is a new, natural painkiller available, a molecule with a difficult name, palmitoylethanolamide, it comes as the supplement PeaPure and it might be promising for spinal cord injury (SCI) patients.

While analgesics may occasionally decrease pain in spinal cord injury (SCI), very often increasing dosages are not well tolerated and patients refrain from treatment.

There is clearly an urgent need for new innovative therapies in spinal cord injury (SCI) 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 spinal cord injury (SCI), are needed to effectively alleviate symptoms.

Multimodal therapy for SCI 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 (PeaPure), a natural painkiller is most suited for such an approach. 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.(1) The compound is not only part of our body, but can be found in many foodstuffs.

Palmitoylethanolamide  harnesses the endogenous regulatory mechanisms suppressing chronic upregulation of central neuropathic pains, 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. (1)

How to use PEA in SCI: 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 an enhanced analgesic affect, but of course sadly enough there are also patients not responding to this therapy.

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.


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

2. 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

3. 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.

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