Multimodal stepped care approach with acupuncture and PPAR-α agonist palmitoylethanolamide in the treatment of a patient with multiple sclerosis and central neuropathic pain

Acupunct Med. 2012 Mar;30(1):53-5. doi: 10.1136/acupmed-2011-010119. Epub 2012 Feb 1.


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.

Publication types

  • Case Reports

MeSH terms

  • Acupuncture Therapy*
  • Amides
  • Analgesia / methods*
  • Analgesics / pharmacology
  • Analgesics / therapeutic use
  • Chronic Disease
  • Endocannabinoids
  • Ethanolamines
  • Female
  • Humans
  • Middle Aged
  • Multiple Sclerosis / complications
  • Multiple Sclerosis / therapy*
  • Neuralgia / drug therapy
  • Neuralgia / etiology
  • Neuralgia / therapy*
  • PPAR alpha / agonists*
  • Pain Management / methods*
  • Palmitic Acids / pharmacology
  • Palmitic Acids / therapeutic use*
  • Peroxisome Proliferator-Activated Receptors / agonists


  • Amides
  • Analgesics
  • Endocannabinoids
  • Ethanolamines
  • PPAR alpha
  • Palmitic Acids
  • Peroxisome Proliferator-Activated Receptors
  • palmidrol