Neuropathic pain
Adjunct
PEA is an endogenous fatty-acid amide widely used in Italy and Spain for chronic neuropathic pain (sciatica, diabetic polyneuropathy, post-herpetic neuralgia, carpal tunnel, pelvic pain). The Paladini meta-analysis (Pain Physician 2016) pooled 12 RCTs and observational studies with 1484 participants: at 600-1200 mg/day for 30-60 days, PEA reduced VAS pain by a mean 1.8 points versus placebo or standard care. Effect size is small, confidence intervals wide and most studies are funded by the manufacturer Epitech. Cochrane opened a 2017 review protocol on PEA for chronic pain but withdrew it in 2018 without a full review – the Cochrane Library has no quality meta-analytic base. CG173 for neuropathic pain recommends amitriptyline, duloxetine, gabapentin and pregabalin as first line; PEA is not in international guidelines. In Italy and Spain, neurologists and pain clinicians prescribe PEA off-label as adjunct therapy when first-line drugs are contraindicated. If PEA is being considered instead of pregabalin or duloxetine, discuss with a doctor – the first-line drugs have stronger evidence.
Sources
- Pain Physician (Paladini et al.): Palmitoylethanolamide, a special food for medical purposes, in the treatment of chronic pain: a pooled data meta-analysis (2016)
- CNS Neurol Disord Drug Targets (Guida et al.): Palmitoylethanolamide reduces pain-related behaviors and restores glutamatergic synapses homeostasis in the medial prefrontal cortex of neuropathic mice (2017)
- Cochrane (Derry et al.): Palmitoylethanolamide for chronic pain in adults (2017)
- NICE: Neuropathic pain in adults: pharmacological management (CG173) (2024)
- EMA / AEMPS: Palmitoiletanolamida: revision regulatoria como complemento alimenticio en Espana (2019)