The researchers, who pooled data from nine previous studies, found that patients given PEA in this time frame saw their mean pain intensity significantly decrease by 1.36 points on the Visual Analogue Scale (VAS) or the Numeric Rating Scale (NRS) – scales that are measures of pain intensity ranging between 0 and 10.
“These results confirm the clinically relevant and time-dependent pain-relieving effect of micron-size PEA and, therefore, the advantage of extended treatment, especially in patients with incomplete pain management,” write authors Vittorio Schweiger, associate professor at Verona University Hospital, Italy, and colleagues in Nutrients.
PEA potential in chronic pain
Between one-third and half of the global population suffer from chronic pain, which is classed as recurring or persistent pain for longer than three months, says the study, adding that it is “unrealistic” to provide complete relief for chronic pain, with management typically limited to approaches such as exercise, physical therapy and massage. Painkillers such as opioids can also be used but their benefits can vary, and risk causing side effects, it says.
PEA is an endogenous lipid molecule that is also naturally present in foods such as egg yolks and peanuts. The compound is known to have anti-inflammatory properties and can control pain intensity, making it a potential method for tackling chronic pain, Schweiger et al say. However, “the optimal timing and treatment duration have not been clearly elucidated or explored in detail until now,” they write.
Pooling PEA and chronic pain studies
The meta-analysis included studies deploying PEA that is micronized to make it easier for the body to absorb. Eligible studies assessed micron-sized PEA (mPEA) alone or as an add-on treatment for pain using the RRS or VAS at baseline, 30 and 60 days after beginning the treatment.
The nine studies included in the final analysis included a randomized controlled trial and 8 uncontrolled studies with 742 patients overall. The patients had a range of conditions including pelvic pain, low back pain, failed back surgery syndrome, lumbosciatica and fibromyalgia syndrome. A total of 614 patients received varying doses of ultra-micronized PEA (umPEA), 81 took mPEA mixed with the antioxidant polydatin (mPEAPol), 30 had a combination of mPEAPol and umPEA, and 17 started with umPEA followed by mPEAPol.
Schweiger and colleagues found that pain intensity dropped from a weighted mean of 5.93 at baseline to 3.85 by 30 days on the NRS/VAS score – a 35.1% improvement. The score dropped further to 2.49 at 60 days, which translated to an improvement of 35.4% compared with at 30 days.
The researchers observed that the improvements in pain over the treatment period were linked to an improvement in quality of life with no relevant adverse effects or interactions with pain medications. Two of the studies also suggest that taking PEA could reduce the need for pain medications and thus the potential for side effects from the medication.
Mounting evidence points to the role of neuroinflammation in the development of chronic pain, likely driven by the prolonged activation of microglia and mast cells, the study says. Oral PEA mainly reduces pain by down-regulating these cells, and early treatment is essential, add the investigators.
Schweiger et al noted that the studies were very heterogeneous due to the different pathological conditions and doses. The investigators also found that all of the included studies had a “a moderate risk of bias, since they all showed moderate bias in the outcome measurement domain.” As a result, they call for “more in-depth methodological studies” to back up their conclusions.
Source: Nutrition 2024, 16(11), 1653
“Extended Treatment with Micron-Size Oral Palmitoylethanolamide (PEA) in Chronic Pain: A Systematic Review and Meta-Analysis”
doi: https://doi.org/10.3390/nu16111653
Authors: Vittorio Schweiger et al.
