Chronic idiopathic axonal neuropathy and pain, treated with the endogenous lipid mediator palmitoylethanolamide: a case collection
An 81-year-old female patient (born in 1932) started to suffer from pain in both feet in 2003; pain was progressive in nature. We saw this patient first in 2013; her pain score was 8 over 10 on the numeric rating scale (NRS) when she visited our clinic. The pain was located in both legs from the knees downwards, and the patient experienced subjective feelings as if walking on a pillow. Clinical examination showed absence of Achilles tendon reflex and absence of vibration sense in the feet up to the knee. Previous neuropathic pain treatments did not result in any pain reduction, neither amitriptyline 50 mg nor duloxetine 30 mg. The diagnosis axonal polyneuropathy was confirmed by electrophysiological examination in 2008. Symptoms grew worse, and increasingly she complained about strange feelings in both feet, as if walking on a ball, dead feelings of toes, and difficulty walking due to pain. She did not wish to be treated with pregabalin or opioids. We started treating with palmitoylethanolamide (PeaPure), 400 mg three times daily. Within 7 days, pain scores were reduced by 50%, and after 2 weeks the patient reported absence of pain. No side effects were reported.