Instituut voor Neuropathische Pijn

Home > English articles > Treatment

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 […]

Lees meer...

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 […]

Lees meer...

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’, that they have premium Italian quality and so on. It gets crazier […]

Lees meer...

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.

Lees meer...

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.

Lees meer...

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 Normast, PeaPure and PeaPlex.

Lees meer...

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 […]

Lees meer...

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 […]

Lees meer...

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 […]

Lees meer...

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 […]

Lees meer...

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 […]

Lees meer...

Natural treatment of Parkinson with body’s own palmitoylethanolamide

The role of palmitoylethanolamide in Parkinson.

Lees meer...

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 […]

Lees meer...

Nitrates in neuropathic pain

The Indian group of Agrawal and collegues (2007) explored the analgesic effects of glyceryl trinitrate spray in neuropathic pain. They suggested that impaired nitric oxide (NO) synthesis may play an important role in the pathogenesis of painful diabetic neuropathy. Some studies demonstrated impaired neuronal nitric oxide generation in diabetic rats induces hyperalgesia and in other studies a decreased nitric oxide production was seen to to a reduction in endoneural blood flow in type 2 diabetic patients with neuropathy. Both iso-sorbide dinitrate as well as glyceryl trinitrate may act as potent nitric oxide donor and have similar pharmacological activity compared to endothelial derived relaxing factor, a nitric oxide dependent enzyme with vasodilator capacity. In our institute we have now gathered quite some experience using isosorbide dinitrate cream in neuropathic pain, with good results.

Lees meer...

Multimodal pain management, and the role of palmitoylethanolamide

As yet, no “gold standard” has emerged for multimodal pain management for neuropathic pain. The various multimodal pain protocols that have been developed, however, share similar objectives, to reduce side effects, to reduce dose and to avoid and even to eliminate narcotics leading to troublesome side-effects while reducing the quality of life. Because pain involves multiple mechanisms that rely  on different receptor systems, it is beneficial to utilize  a multimodal approach to achieve pain relief in complex pain states such as neuropathic pain. 

Lees meer...

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.

Lees meer...

Pain with hernia and treatment with palmitoylethalonamide (Normast, 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. 

Lees meer...

Amitriptyline as good as pregabalin for painful diabetic Neuropathy

Amitriptyline as good as pregabalin for painful diabetic neuropathy says a review ariticle on Diabetes in control.com, dated March 23, 2010. This is based on the results of a head to head comparison of both drugs in a group of 41 patients. The study had some methodological flaws, but the results are in line with our expectations and experiences. Both drugs have similar efficacy, but amitriptyline, if dosed higher up (>25 mg an) has more side- effects.

Lees meer...

Palmitoylethanolamide (PEA) combined with pregabalin in neuropathic pain

Palmitoylethanolamin (Normast®;PeaPure®) is a endogenous lipid with analgesic and anti-inflammatory properties. In a study were 30 patients were entered, suffering from diabetic neuropathic pain and post-herpetic pain, palmitoylethanolamide was combined with pregabalin in the treatment of neuropathic pain.

Lees meer...

Cannabis as treatment for intractable abdominal pain syndrome

Treatment resistent abdominal pain, with unknown etiology can sometimes be treated succesfully by Cannabis. It might be that this chronic pain syndrome has something to do with small fiber neuropathy in the innervation network around the gut. But, whatever its etiology, it is merely a hypothesis and very difficult to substantiate. However, having said that, there are patients suffering from for instance diabetic neuropthy, with severe gasterointestinal complaits, and we feel these pains and complaints can be due to small fiber neuropthy. As Cannabis appeared to be a useful drug for treating treatment resistant neuropathic pain, we sometimes prescribe Cannabis to patients suffering from treatment resistent abdominal pain, and we follow the so called ex juvantibus approach. This means we give the patient the befifit of the doubt, that the pain might be caused by an internal neuropathy, and if so, whether the patients responds favourable on a treatment regime withn Cannabis, orally taken.  

Lees meer...

vitamin D and chronic pain

Vitamin D could save the country about €37.5 billion in health care costs, according to a new review  of professor A. Zittermann.

Vitamin D
receptors are expressed in many other tissues beyond
the musculoskeletal system, and vitamin D plays protective
physiologic roles against several chronic diseases such
as cancer, osteoarthritis, diabetes, and cardiovascular
conditions. There is clear evidence for an association
between low vitamin D status and pain in the general
population. The chronic pain syndromes included chronic back
pain, chronic musculoskeletal pain or widespread pain, and polymyalgia and in all these cases vitamin D was suggested as the cause of such nonspecific pain.

Vitamin D through its receptor modulates neuronal differentiation as well as neuronal growth and function. In rats, the production of nerve growth factor which is required for the development and survival of both sympathetic and sensory neurons decreases in the presence of vitamin D deficiency. In fact, in vitamin D deficient diabetic animals correction of vitamin D deficiency resulted in an improvement in nerve growth factor production. Decrease in neurotrophins and defective calcium homeostasis leaves the nerve vulnerable to toxins including hyperglycemia. As a result, a deficiency of vitamin D impairs nociceptor function, worsens nerve damage, and lowers the pain threshold.

And: 

In another study vitamin D levels were not only inversely proportional to a neuropathy symptoms score but also showed a statistically significant (OR 3.47 95% CI 1.04–11.56 P = 0.04) association with slower nerve conduction velocities after correction for duration of diabetes and levels of HbA1c, LDL, and urinary albumin

Two qoutes from a recent report were a patient suffering from severe neuropathic diabetic pain, refractory to analgesics, experienced cler pain relief after the correction of the vitamine D deficiency. 

Lees meer...

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. 

Lees meer...

Dolori dell’ernia e trattamento con palmitoiletanolamide

pea_in_normast_peapure_pelvilen.png

Normast e PeaPure: informazioni palmitoilethanolamide:PEA è disponibile come PeaPure, Normast, Pelvilen e attraverso gli altri nomi commerciali. Normast in Italia attraverso la farmacia e ottenere PeaPure è realizzato nei Paesi Bassi e in tutto il mondo come un supplemento inviato.

I neutraceutici PeaPure® e Normast®, sia palmitoiletanolamide antidolorifico naturale (PEA) contengono, aprendo la strada a un nuovo metodo naturale di trattamento del dolore cronico. Entrambi i prodotti sono realizzati secondo i più alti standard (GMP). Perché PEA nei Paesi Bassi solo dal 2010, e abbiamo anche molte domande per telefono, ecco un elenco di domande e risposte. Anche domande e commenti da parte di persone su Fori di discussione su PEA parlare, abbiamo elaborato.

Fine anno del 2012 nei Paesi Bassi, sono decine di migliaia di pazienti trattati con PEA. Non ci sono effetti collaterali significativi segnalati. PEA può essere senza problemi, oltre a prendere altri farmaci e medicinali.

Nel 2012 un preparato palmitoiletanolamide nuovo introdotto. PeaPure contiene il più alto contenuto di PEA (vedi tabella). Solo PeaPure un certificato di analisi disponibili su Internet.

 

Lees meer...

Acupuncture recommended by anesthesiologists

In April 2010 a new guideline was issued on the treatment of chronic pain: Practice Guidelines for Chronic Pain Management: An Updated Report by the American Society of Anesthesiologists Task Force on Chronic Pain Management and the American Society of Regional Anesthesia and Pain Medicine. 

In this guideline anesthesiologists of name and fame gathered and analysed all approaches to chronic pain. For acupuncture their assessment was:  

Lees meer...

Pharmacologic Treatment of Central Post-Stroke Pain

Pharmacologic Treatment of Central Post-Stroke Pain By:  A. Frese, I.W. Husstedt, E.B. Ringelstein, and S. Evers:  ClinJ Pain 2006;22:252–260: 

Treatment Recommendation for CPSP Based on Evidence Level

Short term pain control:
Lidocaine IV 5 mg/kg over 5 minutes

Propofol IV (Gaba-ergic) 0.3 mg/kg per hour  

Oral treatment:
Drugs of first choice(based on controlled trials):  

amitriptyline(anti-depressant) at least 75 mg per day

lamotrigine(glutamatergic) (at least 200mg per day

Drugs of second choice(based on open studies and experts’ opinion):

Mexiletineupto10 mg/kg per day

Fluvoxamin up to 125mg per day

Gabapentinat least 1200mg per day

Lees meer...

Natalizumab in chronic inflammatory demyelinating polyneuropathy (CIDP)

Natalizumab, a humanized monoclonal antibody against the 4 integrin did not help in treating a patient suffering from chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). Although experimental evidence in an animal model pointed out that targeting 4 integrins in the inflamed peripheral nervous system may have clinical relevant effects, this was not the case in a patient.

Lees meer...

Occipital Neuralgia Responding to Palmitoylethanolamide

Under the titel ’Occipital Neuralgia Responding to Palmitoylethanolamide’ Rocco Salvatore Calabrò and Placido Bramanti reported a case in ‘Headache’, a female patient affected by occiptal-treatment-refractory-neuralgia that greatly improved after oral intake of palmitoylethanolamide (PEA).

Lees meer...

PRECISION TM Spinal Cord Stimulator (SCS) System

PRECISION TM Spinal Cord Stimulator (SCS) System : clinical studies forming the base of the registration of this device. Here a summary of the various studies supporting the registration of the precision spinal stimulator.

Lees meer...

PEA influences PPAR

One of the recent insights regarding the workingmechanism of PEA (palmitoylethanolamide) is that this molecule influences PPAR-alpha. PPAR-apha is a receptor located in the nucleus of the cel with a long name: peroxisome proliferator-activatedreceptor alpha. PEA is available in its purest form as PeaPure. PeaPure contains PEA only. Normast contains PEA too, but around 60%; Pevliven contains between 60-40% PEA.

Lees meer...

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…. 

Lees meer...