Multimodal stepped care approach with acupuncture and PPAR-α agonist palmitoylethanolamide in the treatment of a patient with multiple sclerosis and central neuropathic pain.
Central neuropathic pain is a common debilitating symptom in patients with multiple sclerosis. Side effects of analgesics often limit reaching therapeutic dosages. In this case report, a 61-year-old woman with chronic central neuropathic pain due to multiple sclerosis is described. Acupuncture could only partly and temporarily reduce the pain. However, after adding the natural compound palmitoylethanolamide, a glial modulator and peroxisome proliferator-activated receptor-α agonist, pain reduction was more pronounced and the interval between acupuncture sessions could be increased. A multimodal stepped care approach is demonstrated, with acupuncture and palmitoylethanolamide both influencing non-neuronal cells, such as activated glial cells, which are key factors in the development and maintenance of neuropathic pain.
Institute for Neuropathic Pain, Vespuccistraat 64-III, 1056 SN Amsterdam, The Netherlands. info@neuropathie.nu
David J
DJ
Kopsky
Jan M Keppel
JM
Hesselink
D015670:Acupuncture Therapy; D000577:Amides; D000698:Analgesia / Q000379:methods*; D000700:Analgesics / Q000494:pharmacology / Q000627:therapeutic use; D002908:Chronic Disease; D063388:Endocannabinoids; D004983:Ethanolamines; D005260:Female; D006801:Humans; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications / Q000628:therapy*; D009437:Neuralgia / Q000188:drug therapy / Q000209:etiology / Q000628:therapy*; D047493:PPAR alpha / Q000819:agonists*; D059408:Pain Management / Q000379:methods*; D010169:Palmitic Acids / Q000494:pharmacology / Q000627:therapeutic use*; D047492:Peroxisome Proliferator-Activated Receptors / Q000819:agonists
D000577:Amides; D000700:Analgesics; D063388:Endocannabinoids; D004983:Ethanolamines; D047493:PPAR alpha; D010169:Palmitic Acids; D047492:Peroxisome Proliferator-Activated Receptors; C005958:palmidrol