According to the American Pain society, in 2016, the prevalence of chronic pain in the US was 35.5%. Treatment of chronic pain can often be quite challenging and debilitating. Palmitoylethanolamide (PEA) is emerging as a novel therapy for chronic pain syndromes, including inflammatory based and neurogenic based pain. Use of PEA for chronic pain has a good safety record and minimal interactions with other medications.
What is PEA?
PEA is an endogenous fatty acid amide, meaning it is produced in our own tissue. Not only is PEA produced by our own bodies, it is also along a compound that is present in certain foods, like eggs and milk. It is thought that it is might be due to our body’s familiarity with this compound that there have been no serious side effects reported and no drug-drug interactions seen. The only side effects seen to date were a feeling of heaviness in stomach after supplementation and rarely GI discomfort/diarrhea.
How Does PEA Work?
According to the Journal of Pain and Research, PEA performs a great variety of biological functions and is effective in decreasing pain in peripheral neuropathies such as:
- Diabetic neuropathy
- Chemotherapy-induced peripheral neuropathy
- Carpal tunnel syndrome
- Sciatic pain
- Low-back pain
- Failed back surgery syndrome
- Dental pains
- Neuropathic pain in stroke and multiple sclerosis
- Chronic pelvic pain
- Post-herpetic neuralgia
- Vaginal pains
- Lyme disease
It has been proven to be safe and effective in many clinical trials and in more than 5000 documented patients.
Neuro-inflammation, which is the root of chronic pain, it caused by an infiltration of immune cells, which activate mast and glial cells, leading to the production of inflammatory mediators in both the peripheral and the central nervous system. The release of inflammatory mediators lead to the sensation of chronic pain. Therapy with PEA is targeting both anti-inflammatory and pro-resolving mediators that act on immune cells, in particular mast and glial, to decrease or abolish neuro-inflammation altogether. The inflammation present in chronic pain often leads to the turning off of the enzyme responsible for the production PEA. This mechanism explains why supplementation with PEA would naturally lead to the body become better equipped to decrease pain and inhibit inflammation.
Dosing is recommended at 400mg three times daily for the first 2 months. If after 1 month there is not enough relief, dose can be increased up to 800mg three times daily. After a couple of months at the higher dose, a maintenance dose of 400mg twice daily is recommended. (The higher doses can be used again if pain flares up later on.)
Given that so many people experience chronic pain, especially neuropathic pain, and given the safety profile of PEA, I think this supplement is underutilized. I am certainly going to be recommending it for more of my Lyme patients, for whom chronic, neuropathic pain is an ongoing burden that can be very hard to relieve.
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Einaudi, Via Luigi, and Giustino Varrassi. “Palmitoylethanolamide, a special food for medical purposes, in the treatment of chronic pain: a pooled data meta-analysis.” Pain Physician 19 (2016): 11-24.
Hesselink, Jan M. Keppel, and Thecla AM Hekker. “Therapeutic utility of palmitoylethanolamide in the treatment of neuropathic pain associated with various pathological conditions: a case series.” Journal of Pain Research 5 (2012): 437.