This patient was diagnosed with axonal painful neuropathy in one of the Dutch academic hospitals. His pain was severe and the neuropathic changes on the EMG moderate to severe. The hospital physicians tried the obvious, amitriptyline and pregabalin, but due to side effects both analgesics had to be stopped. We started a treatment regime with PEA and alpha lipoic acid. The pain decreased more than 50% and the patient was able to return to his work and stand for longer periods of time with much less pain. Furthermore, the slowly deteriorating CIAP did stabilize and furthermore the functionality, as measured by the physiotherapist on different objective tests improved in time! For CIAP this is remarkable, as functionality mostly decreases by time.

Pain in CIAP 

In a recent study from Utrecht pain in patients with chronic idiopathic axonal polyneuropathy (CIAP) was assessed . Pain in CIAP actually has never been studied in detail. In our clinic we see only patients suffering from CIAP and in great pain. That is pof course due to the fact that we are specialized in pain treatment. The aim of the Utrecht study was to investigate the pain experienced by patients with CIAP, and to determine whether pain is associated with health-related quality of life (HRQoL). The results as reported by the authors:

Sixty-three of 91 patients with CIAP reported experiencing pain, describing it as nagging (56%) and annoying (52%). Of these patients, 27 were classified in a subgroup with neuropathic pain (median VAS = 33 mm), 25 in a subgroup with non-neuropathic pain (median VAS = 34 mm), and 11 in a mixed-pain subgroup (median VAS = 25 mm). Non-neuropathic pain was as common and as painful as neuropathic pain. Pain was strongly associated with the physical functioning domain of the RAND-36 in patients in the mixed pain subgroup (r = –0.71, p < 0.05).  

So these findings we see mirrored in this patient of ours. His severe pain clearly decreased his quqality of life and as importantly decreased his ability to participate in work. So if we would calculate the costs of loss of worktime versus the costs of treatment with PEA (PeaPure) and alpha lipoic acid ...It is clear that the supplement costs should actually be reimburtsed by the insurance comapny. But sadly enought this is not the case... 

Prof. dr. Jan M. Keppel Hesselink, MD, PhD, march 2011; revision jan 2013

Erdmann PG, Teunissen LL, van Genderen FR, Notermans NC, Lindeman E, Helders PJ, van Meeteren NL. Functioning of patients with chronic idiopathic axonal polyneuropathy (CIAP). J Neurol 2007;254:1204-1211.