A patient: Diabetes and severe pain
A 56-old man, patient M.C. (1956) suffering from diabetes mellitus for which treated with Victosa, 1,8 ml injections, with complicated co- morbidity: diabetic neuropathy, diabetic retinopathy, morbus Scheuermann, kyphosis and fixation operation, carpal tunnel syndrome, twice operated upon, frozen shoulders, three times operated upon, hypertension, CARA.
Further medication: diovan 320 mg, omeprazol 20 mg, Cyress 10 mg, Victosa, Serevent and salbutamol.
Patient used Zaldiar since 2008, and paracetamol, as well as pregabaline without much effect.
He suffered from severe pains, mostly in feet and legs, burning, pain cold, electric shooting pain, Anesthesia Dolorosa, and scoring 9 over 10 on the DN4 scale for neuropathic pain. Cut off for neuropathic pain defined as 4.
Patient was treated with various analgesics, but was unresponsive to pregabalin three times daily 150 mg,especially since the side effects were troublesome, concentration difficulties, diarrhea, while patients needed to travel much and had to operate on a high level as a systems engineer.
Current analgesi medication on the first visit, amitriptyline 50 mg, Zaldiar and paracetamol. Pain scores were still 8 over 10, the patient complained of severe pains and disturbed sleep.
Treatment with palmitoylethanolamide 1200 mg daily reduced pain to nearly 50%. Moreover, the patient felt less stress, was more relaxed, sleep quality improved and felt less troublesome paresthesias in the legs and feet. No side effects were reported. Pain decrease remained stable for weeks.
Lady suffering from pain and diabetes
A 58-year old lady, MHM N. (1953) suffering from severe burning pains in the feet due to diabetes type II. She could not sleep well, and her pain scored between 8 and 10 on the NRS pain scale. Her complaints started in 2011 with paresthesias in the toes, instable gait and burning and stinging pain.
She was treated with pregabaline 2 times 75 and Cymbalta two times 30 mg with marginal effects.
We started treating with palmitoylethanolamide 1200 mg daily and alpha lipoic acid, 3 times 100 mg R- alpha lipoic acid, and after some weeks the pain decreased to a score of 6, and pain further decreased to a score of 3-4. The pain decrease started after 2-3 days’ treatment and her general condition also improved. No side effects.
Patients suffering from CRPS, treated with PEA
A 58-year old lady, born in 1953, suffering from CRPS type 1, Sudeck’s dystrophy, in right foot due to a minor trauma, since 2004.
The patient complained of severe pains on NRS scoring 8-10, and increasing pains after exercise.
In 2004, clear stigmata from Sudeck has been documented by the rehabilitation physician, including temperature chance, color change of skin and hyperpathia on touch. Treatment with DMSO 50% cream, naproxen, ketensin, nefedipine and physiotherapy only partly improved the complaints.
We started with vitamine D3 2000 IE/day and palmitoylethanolamide 4 times 400 mg. After some weeks pain lessened to around 6, subsequently decreased to 2-4 and patient reported to be able to do more, walk more and after exercise she recuperated easier and quicker.