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.

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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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