PeaPure – Palmitoylethanolamide for Nerve Pain or Migraine

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PeaPure is a glial modulator. It is available in Italy and the Netherlands as a food supplement and has been studied in multicenter clinical trials in Europe for several years. It is well tolerated with no side effects and is very helpful for neuropathic pain, headache, and osteoarthritis. It is anti-inflammatory and neuroprotective.

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Because it inhibits astrocyte activation and the over-expression of pro-inflammatory molecules and signals, it is being investigated in Alzheimer’s Disease.

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The mechanism of action of PEA was discovered in 1993 by Nobel laureate Rita Levi-Montalcini in her work on nerve growth factors. She found it is involved in metabolism of mast cells and published a series of papers on its self-healing effect of the body in response to inflammation and pain. Two recent publications from Jan M Keppel Hesselink, MD, PhD, and his colleagues at the Institute for Neuropathic Pain, Amsterdam, The Netherlands, describe case reports, one of which is the case of a woman with CRPS.

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The purpose of this post is to clarify dosing of PeaPure and how to take it for a sudden flare of pain. My apologies for failing to recall the source of these instructions which I believe was from the manufacturer and from here and here. The latter includes an excellent review of its mechanism.

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Description of PeaPure® 400 mg capsules
PeaPure® is a food supplement based on a natural and fatty-acid like compound.
The substance palmitoylethanolamide (PEA) is a physiologically active molecule that the body produces naturally.
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What the user should know prior to ingestion:
•    There are no known significant side effects.
•    PeaPure® can be taken simultaneously with other medicine. In case of doubt, it is recommended to first consult your doctor or a pharmacist.
•    Use during pregnancy is NOT recommended.
•    PeaPure® does not contain sugar, yeast, allergens, sorbitol, magnesium stearate, povidone or other ingredients.

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Dosage and administration
Administration: During or after the meal, swallow 1 capsule together with water, or sprinkle the content of the capsule on your food.

Dosage:  may use 30 mg/kg
First 2 months: 3 times 1 capsule daily
Next 2 months: In case of a positive result, 2 times 1 capsule daily
After 4 months, you can consider the following:
•    Continue taking 2 times 1 capsule daily.
•    Reduce the ingestion to 1 times 1 capsule daily.
•    Stop the ingestion.

In case of regression, it is recommended to increase the dosage to 2 or 3 times 1 capsule daily.
It is possible to continue taking PeaPure® in the correct dosage.
Do not exceed the recommended daily dosage.

Daily dosage Recommended Daily Dosage in %
palmitoylethanolamide 1200 mg (= 3 capsules)     —-


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Dosage for children [update  July 30, 2013]: Use up to 30 mg/kg body weight.

Doses up to 50 mg/kg BW have been proven safe in children and doses up to 100 mg/ kg BW in adults

PeaPure can be easily swallowed, or for patients with severe swallowing problems, the capsules can be openend and PEA can be sprinkeled over a meal or mixed with yoghurt or so.

PeaPure can also be taken easily under the tongue, by opening the special designed capsule and poring the powder on a spoon and getting it under the tongue. (Especially of use in patients suffering great pain and for instance in Lou Gehring’s disease). Or the capsule can easily be swallowed.

Dose recommendations of PeaPure

Dose recommendation: start with 1200 mg daily in 2 to 3 doses (e.g. 2 capsules after breakfast and 1 capsule after diner). In case of severe pain, migraine or for special indications such as Lou Gehrings disease it is recommended to open the capsule and put the PEA under the tongue for longer periodes of time. The PEA dissolves in the mouth and is absorbed via the oral mucosa to enter directly into the body, not being partly digested in the gut. This gives a jumpstart which might be desirable, but is not always necessary.

PEA is the body’s own modulator, and not a painkiller such as NSAIDs and morphine. It does mostly need some weeks to slowly bring the body in balance on a number of biological levels. As PEA has a number of modulating effects, both on the short term as well as slowly increasing, there are patients experiencing quick pain relief within some days. There are also patients who need more time (especially in chronic pain situations). Therefore the recommendation is to test the efficacy of PEA during two months in cases of chronic pain before deciding on its efficacy.

If pain decreases more than 30% one can reduce the dose of PeaPure to 2 times 400 mg. If pain increases under PeaPure treatment, as some chronic pain syndromes sometimes waxes and wanes (given the weather, given excercise, food, etc) it is recommended to increase the dose to 800 mg twice daily.

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Warnings

•    It is not allowed to use food supplements as replacement for a varied diet.
•    Keep this food supplement dry and at room temperature. Keep out of reach of small children.

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Content and ingredients
30 vegetarian capsules
Each capsule contains 400 mg palmitoylethanolamide (PEA).
Ingredients: palmitoylethanolamide, hydroxypropyl methylcellulose (capsule)

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Palmitoylethanolamide is sold as PeaPure, a food supplement, available from the Netherlands and imported by a local pharmacy here. I have submitted a paper for publication on the treatment of vulvodynia and proctodynia with PeaPure and a topical cream. That source will be posted once it is accepted.

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The material on this site is for informational purposes only, and is not a substitute for

medical advice, diagnosis or treatment provided by a qualified health care provider.

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Please understand that it is not legal for me to give medical advice without a consultation.

If you wish an appointment, please telephone my office or contact your local psychiatrist.

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For My Home Page, click here:  Welcome to my Weblog on Pain Management!

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12 Responses to “PeaPure – Palmitoylethanolamide for Nerve Pain or Migraine”

  1. palmitoylethanolamide4pain Says:

    Reblogged this on palmitoylethanolamide4pain and commented:
    A recent entry of the USA painspecialist Dr Nancy Sajben, MD on the use of palmitoylethanolamide (PeaPure) in chronic pain states, such as neuropathic pain, headache and osteoartrhitis.

  2. Chris Anthony Says:

    Hi Dr. Sajben!

    How do your patients usually obtain PeaPure? Over the internet?

    Thanks!

    • Nancy Sajben MD Says:

      PJ’s Prescription Shoppe is a compounding pharmacy in San Diego that carries PeaPure. They order in bulk from the Netherlands. Customs has stopped the shipment but they have learned to work with that.

      • Laura HInkle Says:

        I cannot get it from PJ’s since their order is in FDA holding. I ordered it directly from the Netherlands and MY ORDER of less than $400 is in holding by the FDA. What’s happening!? PEAPure has and is working for my RSD pain. I’m off all narcotics for my pain and just take PEAPure. I don’t want to go on the narcotics. I WANT my PEAPure! it actually works! And I recommend it to others. Laura from MI

        • Nancy Sajben MD Says:

          Just heard today from a man who received his direct from Netherlands. It just takes a few days.

          • Laura HInkle Says:

            I just wanted people to know that while my early May order of PEAPure is STILL held up by the FDA, I did get my end of May re-try order! So, I’m back treating my RSD with PEAPure and in less pain! So, I guess there’s some type of random stopping procedure happening. Try another order if it happens to you.

          • pam Says:

            Dear Dr. Shaven, I have also received a direct shipment from the Netherlands back in May, it also only took a few days to receive.

  3. palmitoylethanolamide4pain Says:

    Palmitoylethanolamide: new data on safety, safe up to 100 mg/kg BW:

    http://palmitoylethanolamide4pain.com/2013/07/16/palmitoylethanolamide-normast-peapure-safe-up-to-100-mgkg-bw/

    • Nancy Sajben MD Says:

      That link suggests these dosage changes:

      Dose recommendation PEA (PeaPure, Normast)

      First 4 weeks dose 1200 mg/day
      If not enough response double the dose after 4 weeks for another month.
      If good response, reduce dose after 4 weeks to see what dose keeps you stable
      If response is not as expected, stop PEA after 8 weeks, it is unlikely to kick in in the majority of patients when they have been on PEA for 8 weeks.

    • Nancy Sajben MD Says:

      Thank you! That link discuses the evidence announced recently that PEA Inhibits TLR4.

      Quoting from them:
      “At the EFIC (a Congress for European Pain Specialists) 2013 Dr Svik Assaw and colleagues from the School of Life Sciences, Medical School, University of Nottingham, United Kingdom presented new exciting data on the mechanism of action of the fatty acid amide N-Palmitoyethanoalamide (PEA) and presented the effects of PEA after activation of toll-like receptors (TLRs) by the inflammatory substance carrageenan.”

  4. Laura Hinkle Says:

    Dr. Sajben: I’ve had RSD since I fell climbing up to Grinnell Glacier in Aug. 1994. Obviously, it has changed my life and my family. I have tried/done all the conventional treatment out there that my pain clinic knew. This past Aug. with a very high level of pain and after being on narcotics/opiods for over 15 years, I developed LQT that was way too high. That meant a month of de-toxing off of the narcotics/opiods, mainly Methadone, for a month. I was allergic to the de-tox med, so I had to do it cold turkey. Not fun. A month later, I returned to the pain clinic and was immediately put on a methadone patch. I wore it for 2 hours and wondered what I was doing. I ripped it off. I had been in MORE pain being on the pain killer methadone than I was in being off of meth. That was when I decided to search the internet for treatments. The more I read about PEAPure, the more I wanted to try it. Naturally occurring, safe, no real side effects, helps pain. I took a lot of info into my doctor and was told that if I wanted to waste my money trying it, I could. I had decided it was either change doctors or try it. I tried PEAPure. For the first week, I felt no change. But then I read that I could take 2 capsules in the AM and 1 in the afternoon. As soon as I started taking it that way, I immediately noticed an improvement. I made it through 1.5″ of rain in 24 hours and could still walk. I’ve never ever been able to walk on a rainy day, let alone a heavy rain like that. I’ve been off of PEAPure for a week, after being on it for a month. I’ve gotten worse again. So, I’ve just called PJ’s and re-ordered. The gal I spoke with is where you’ll be for Thanksgiving. They’re great there. Keep up the great work that YOU do in keeping us informed about treatments. My doctor is now thinking about suggesting others try PEAPure. I have also gotten her to prescribe LDN for me. I think I’m they’re guinea pig! But having had RSD for so long, and having not taken charge of my treatment until now, this is such a change for me. Some of it is just having a brain again after being the methadone. I had no idea what it had done to me. PEAPure RULES!!! Thanks one last time. Laura from MI


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