PEA is short for palmitoylethanolamide. PEA is an N-acylethanolamine - naturally occurring lipid mediator molecules composed of a fatty acid and ethanolamine.
These are endogenous molecules which are activated in the body by different types of tissue damage or stimulation of inflammatory responses and nociceptive fibers. Another example of such molecules is anandamide.
· PEA is reported to have actions at the TRPV1 receptor and cannabinoid-like G coupled receptors and acts as a mediator in the resolution of inflammatory processes.
· It is synthesized by microglia and mast cells and acts to downregulate activation of both.
· PEA is increased in brain regions implicated in nociception and in the spinal cord following the induction of neuropathic pain.
· Endogenous levels of PEA are altered in pathological conditions where cell damage and inflammation are present
· Increases in PEA are documented in diabetic neuropathy and atopic dermatitis.
· Various studies document a role for PEA in resolution of inflammation.
· PEA acts on several cell types which play a role in neuroinflammation – examples being a reduction in activity of mast cells and glial cells.
PEA is a lipid and therefore insoluble in water. Bioavailability is limited by molecular size and water solubility. A micronisation process has been developed to reduce particle size and increase bioavailability – referred to as ultramicronisation.
A review by Della Rocca et al (2021) lists the significant body of pre-clinical evidence pointing towards a benefit of PEA in pain management. One study (Della Rocca et al 2023) in dogs investigated the addition of palmitoyl-glucosamine co-micronized with curcumin to an analgesic plan for osteoarthritis. The study documented the ability to reduce the dose of meloxicam in 90% of dogs – with effects documented at 2 and 10 weeks after meloxicam withdrawal. There are some study limitations to be aware of here – the paper is open access so please have a read and draw your conclusions.
Positive effects are documented in canine atopic dermatitis (Noli et al 2015) and PEA is widely used in some countries for dermatological conditions.
Work by Gatti et al (2012) reports a positive effect when used in human patients suffering from chronic pain, alongside their existing analgesic regime.
It is this type of study which we see as being possible in veterinary medicine. With a few other pain specialists we are currently looking at a pilot study in dogs with chronic pain who are already treated with a bespoke analgesic plan. Our outcome measures are pain scores and quality of life measures. Each dog is provided with a PEA supplement with the intention that the remainder of their analgesic management remains unchanged. Our outcome measures will look at changes in pain scores, caregiver reported outcome measures (CROMs) and quality of life scores. With data from the pilot study, we will then proceed to seek ethical approval for a randomised controlled study.
Watch this space for further updates on PEA!
PEA is a nutritional supplement and therefore is not subject to the licensing process. The product we are using is Palmidol, produced by a French company MP Labo and distributed in the UK by Samaxia Ltd.
References
Della Rocca G, Schievano C, Di Salvo A, Conti MB, Della Valle MF. Palmitoyl-glucosamine co-micronized with curcumin for maintenance of meloxicam-induced pain relief in dogs with osteoarthritis pain. BMC Vet Res. 2023 Feb 7;19(1):37. doi: 10.1186/s12917-023-03594-4. PMID: 36747264; PMCID: PMC9903516.
Della Rocca G, Gamba D. Chronic Pain in Dogs and Cats: Is There Place for Dietary Intervention with Micro-Palmitoylethanolamide? Animals (Basel). 2021 Mar 29;11(4):952. doi: 10.3390/ani11040952. PMID: 33805489; PMCID: PMC8065429.
Gatti A, Lazzari M, Gianfelice V, Di Paolo A, Sabato E, Sabato AF. Palmitoylethanolamide in the treatment of chronic pain caused by different etiopathogenesis. Pain Med. 2012 Sep;13(9):1121-30. doi: 10.1111/j.1526-4637.2012.01432.x. Epub 2012 Jul 30. PMID: 22845893.
Noli C, Della Valle MF, Miolo A, Medori C, Schievano C; Skinalia Clinical Research Group. Efficacy of ultra-micronized palmitoylethanolamide in canine atopic dermatitis: an open-label multi-centre study. Vet Dermatol. 2015 Dec;26(6):432-40, e101. doi: 10.1111/vde.12250. Epub 2015 Aug 18. PMID: 26283633.
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