Chronic idiopathic axonal neuropathy and pain, treated with the endogenous lipid mediator palmitoylethanolamide: a case collection
A 55-year-old Caucasian male (born in 1957) started to suffer from pain in both feet around 20 years ago, which was initially treated by a podologist. Some years later, numbness started, especially noticeable during bursts of activity, and playing tennis became impaired. In 2008, neurologists diagnosed the patient as suffering from CIAP, based on an electrophysiological examination. Analgesic treatment with gabapentin was suggested, but the patient declined treatment due to the side effect profile. In a few years, pain grew worse up to 8 over 10 on the 11-point NRS (0–10), and treatment was started with pregabalin, 75 mg bid. This gave a reduction of pain of around 40%, with the NRS score decreasing from 8 to 5. However, the patient was unsatisfied due to side effects, especially drowsiness, difficulties concentrating, and an inability to drive a car. However, after stopping pregabalin, pain grew again in intensity to a score of 8 on the NRS. He then visited our clinic. We started treatment with PEA, 400 mg three times daily. After 2–3 weeks on PEA, pain scores were down to 4 on the NRS. The patient’s quality of life improved, as did his sleep pattern, and he remained stable until we discharged him several months later. No side effects were reported.