Article Data

  • Views 271
  • Dowloads 41

Original Research

Open Access

Palmitoylethanolamide Versus a Nonsteroidal Anti-Inflammatory Drug in the Treatment of Temporomandibular Joint Inflammatory Pain

  • Ida Marini1,*,
  • Maria Lavinia Bartolucci1
  • Francesco Bortolotti1
  • Maria Rosaria Gatto1
  • Giulio Alessandri Bonetti1

1Department of Oral Sciences, University of Bologna, Bologna, Italy

DOI: 10.11607/jofph.2699 Vol.26,Issue 2,June 2012 pp.99-104

Published: 30 June 2012

*Corresponding Author(s): Ida Marini E-mail: idmarini@tin.it

Abstract

Aims: To carry out a randomized clinical trial to compare the effect of palmitoylethanolamide (PEA) versus ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID), for pain relief in temporomandibular joint (TMJ) osteoarthritis or arthralgia. PEA acts as an endogenous agent with an autacoid local inflammation antagonism and modulates mast cell behavior controlling both acute and chronic inflammation. Methods: A triple-blind randomized clinical trial was conducted on 24 patients (16 women and 8 men) aged 24 to 54 years and suffering from TMJ osteoarthritis or arthralgia. The patients were enrolled from a group of 120 consecutive patients referred to the University of Bologna's Department of Orthodontics. Patients were randomly divided into two groups: group A (12 subjects) received PEA 300 mg in the morning and 600 mg in the evening for 7 days and then 300 mg twice a day for 7 more days. Group B (12 subjects) received ibuprofen 600 mg three times a day for 2 weeks. Every patient recorded the intensity of spontaneous pain on a visual analog scale twice a day. Maximum mouth opening was recorded by a blind operator during the first visit and again after the 14th day of drug treatment. A t test was used for data comparisons. Results: Pain decrease after 2 weeks of treatment was significantly higher in group A than in group B (P = .0001); maximum mouth opening improved more in group A than in group B (P = .022). Conclusion: These data suggest that PEA is effective in treating TMJ inflammatory pain.


Keywords

NSAIDs; palmitoylethanolamide; TMJ arthralgia; TMJ osteoarthritis; TMJ pain


Cite and Share

Ida Marini,Maria Lavinia Bartolucci,Francesco Bortolotti,Maria Rosaria Gatto,Giulio Alessandri Bonetti. Palmitoylethanolamide Versus a Nonsteroidal Anti-Inflammatory Drug in the Treatment of Temporomandibular Joint Inflammatory Pain. Journal of Oral & Facial Pain and Headache. 2012. 26(2);99-104.

References

1. Zhang Y, Jordan JM. Epidemiology of osteoarthritis. Clin Geriatr Med 2010;26:355–369.

2. Wieland HA, Michaelis M, Kirschbaum BJ, Rudoplhi KA. Osteoarthritis—An untreatable disease? Nat Rev Drug Discov 2005;4:331–344.

3. Stegenga B. Temporomandibular joint degenerative diseases: Clinical diagnosis. In: Stegenga B, de Bont LGM (eds). Management of Temporomandibular Joint Degenerative Diseases: Biologic Basis and Treatment Outcome. Basel: Birkhauser, 1996:13–25.

4. Stegenga B, Dijkstra PU, de Bont LGM, Boering G. Temporomandibular joint osteoarthrosis and internal derangement. Part II: Additional treatment options. Int Dent J 1990;40:347–353.

5. Marini I, Gatto MR, Alessandri Bonetti G. Effects of super-pulsed low-level laser therapy on temporomandibular joint pain. Clin J Pain 2010;26:611–616.

6. Hinz B, Brune K. Pain and osteoarthritis: New drugs and mechanisms. Curr Opin Rheumatol 2004;16:628–633.

7. Boers M. NSAID and selective COX-2 inhibitors: Competition between gastroprotection and cardioprotection. Lancet 2001;357:1222–1223.

8. Farkouh ME, Greenberg BP. An evidence-based review of the cardiovascular risks of nonsteroideal anti-inflammatory drugs. Am J Cardiol 2009;103:1227–1237.

9. Hochman JR, French MR, Bermingham SL, Hawker GA. The nerve of osteoarthritis pain. Arthritis Care Res 2010;62:1019–1023.

10. Lambert DM, Vandenvoorde S, Jonsson KO, Fowler CJ. The palmitoylethanolamide family: A new class of anti-inflammatory agents? Curr Med Chem 2002;9:663–674.

11. Devane WA, Hanus L, Breuer A, et al. Isolation and structure of a brain constituent that binds to the cannabinoid receptor. Science 1992;258:1946-1949.

12. Aloe L, Leon A, Levi-Montalcini R. A proposed autacoid mechanism controlling mastocyte behavior. Agents Actions 1993;39:145–147.

13. Ben-Shabat S, Fride E, Sheskin T, Tamiri T, Rhee MH, Vogel

Z. An entourage effect: Inactive endogenous fatty acid glycerol esters enhance 2-arachidonoyl-glycerol cannabinoid activity. Eur J Pharmacol 1998;353:23–31.

14. Petrosino S, Iuvone T, Di Marzo V. N-palmitoyl-ethanolamine: Biochemistry and new therapeutic opportunities. Biochimie 2010;92:724–727.

15. Dworkin SF, Le Resche L. Research diagnostic criteria for temporomandibular disorders: Review, criteria, examina- tions and specifications, critique. J Craniomandib Disord 1992;6:301–355.

16. Huskisson EC. Measurement of pain. Lancet 1974;304: 1127–1131.

17. Cohen J. Chi-square tests for goodness of fit and contingency tables. In: Cohen J (ed). Statistical Power Analysis for the Behavioral Sciences, ed 2. Hillsdale, NJ: Lawrence Erlbaum Associates, 1988:215–272.

18. Kosek E, Ordeberg G. Abnormalities of somatosensory perception in patients with painful osteoarthritis normalize following successful treatments. Eur J Pain 2000;4:229–238.

19. Kidd BL, Langford RM, Wodehouse T. Arthritis and pain: Current approaches in the treatment of arthritic pain. Arthritis Res Ther 2007;9:214.

20. Park JW, Clark GT, Kim YK, Chung JW. Analysis of thermal pain sensitivity and psychological profiles in different subgroups of TMD patients. Int J Oral Maxillofac Surg 2010;39:968–974.

21. Bjordal JM, Klovnig A, Ljunggren AE, Slordal L. Short-term efficacy of pharmacotherapeutic interventions in osteoar- thritis knee pain: A meta-analysis of randomised placebo- controlled trials. Eur J Pain 2007;11:125–138.

22. Neame R, Zhang W, Doherty M. A historic issue of the Annals: Three papers examine paracetamol in osteoarthritis. Ann Rheum Dis 2004;63:897–900.

23. Mazzari S, Canella R, Petrelli L, Marcolongo G, Leon A. N-(2-hydroxyethyl)hexadecanamide is orally active in reducing edema formation and inflammatory hyperalgesia by down-modulating mast cell activation. Eur J Pharmacol 1996;300:227–236.

24. Calignano A, La Rana G, Giuffrida A, Piomelli D. Control of pain initiation by endogenous cannabinoids. Nature 1998;394:277–281.

25. Jaggar SI, Hasnie FS, Sellaturay S, Rice AS. The anti-hyperalgesic actions of the cannabinoid anandamide and the putative CB2 ewceptor agonist palmitoylethanolamide in visceral and somatic inflammatory pain. Pain 1998;76:189–199.

26. Conti S, Costa B, Colleoni M, Parolaro D, Giagnoni G. Antiinflammatory action of endocannabinoid palmitoy- lethanolamide and the synthetic cannabinoid nabilone in a model of acute inflammation in the rat. Br J Pharmacol 2002;135:181–187.

27. Costa B, Conti S, Giagnoni G, Colleoni M. Therapeutic effect of the endogenous fatty acid amide, palmitoyle- thanolamide, in rat acute inflammation: Inhibition of nitric oxide and cyclo-oxygenase systems. Br J Pharmacol 2002;137:413–420.

28. D’Agostino G, La Rana G, Russo R, et al. Central administration of palmitoylethanolamide reduces hyperalgesia in mice via inhibition of NF-kappaB nuclear signalling in dorsal root ganglia. Eur J Pharmacol 2009;613:54–59.

29. Italian Department of Health website. http://www.salute. gov.it/imgs/C_17_pagineAree_1270_listaFile_itemName_3_ file.pdf. Accessed 30 March 2012.

30. Calabró RS, Gervasi G, Marino S, Mondo PN, Bramanti P. Misdiagnosed chronic pelvic pain: Pudendal neuralgia responding to a novel use of palmitoylethanolamide. Pain Med 2010;11:781–784.

31. Indraccolo U, Barbieri F. Effect of palmitoylethanolamidepolydatin combination on chronic pelvic pain associated with endometriosis: Preliminary observations. Eur J Obstet Gynecol Reprod Biol 2010;150:76–79.

32. Nigrovic PA, Lee DM. Synovial mast cells: Role in acute and chronic arthritis. Immunol Rev 2007;217:19–37.

33. De Filippis D, D’Amico A, Iuvone T. Cannobinomimetic control of mast cell mediatore release: New perspective in chronic inflammation. J Neuroendocrinol 2008;20 (suppl 1):20–25.

34. Guo W, Wang H, Zou S, Wei F, Dubner R, Ren K. Long lasting pain hypersensitivity following ligation of the tendon of the masseter muscle in rats: A model of myogenic orofacial pain. Mol Pain 2010;6:40–52.

35. Garrett FG, Durham PL. Differential expression of connexins in trigeminal ganglion neurons and satellite glial cells in response to chronic or acute joint inflammation. Neuron Glia Biol 2008;4:295–306.

36. Chiang CY, Dostrovsky JO, Iwata K, Sessle BJ. Role of glia in orofacial pain. Neuroscientist 2011;17:303–320.

37. Loría F, Petrosino S, Mestre L, et al. Study of the regulation of the endocannabinoid system in a virus model of multiple sclerosis reveals a therapeutic effect of palmitoylethanolamide. Eur J Neurosci 2008;28:633–641.

38. Costa B, Comelli F, Bettoni I, Colleoni M, Giagnoni G. The endogenous fatty acid amide, palmitoylethanolamide, has anti-allodynic and anti-hyperalgesic effects in a murine model of neuropathic pain: Involvement of CB(1), TRPV1 and PPARgamma receptors and neurotrophic factors. Pain 2008;139:541–550.

39. Masek K, Perlík F, Klíma J, Kahlich R. Prophylactic efficacy of N-2-hydroxyethyl palmitamide (impulsin) in acute respiratory tract infections. Eur J Clin Pharmacol 1974;7: 415–419.

40. Plesník V, Havrlantová M, Jancová J, Januska J, Macková O. Impulsin in the prevention of acute respira- tory diseases in school children. Cesk Pediatr 1977;32: 365–369.

41. Kahlich R, Klíma J, Cihla F, et al. Studies on prophylactic efficacy of N-2-hydroxyethyl palmitamide (Impulsin) in acute respiratory infections. Serologically controlled field trials. J Hyg Epidemiol Microbiol Immunol 1979;23:11–24.

42. Wiedermannová D, Lokaj J, Wiedermann D. Prophylactic administration of impulsin to clinically healthy children. The effect on T and B lymphocytes in peripheral blood [in Czech]. Cas Lek Cesk 1979;118:1249–1251.

43. Scheiman JM. The impact of nonsteroidal anti-inflamma- tory drug-induced gastropathy. Am J Manag Care 2001;7 (suppl 1):S10–S14.

44. Singh G, Ramey DR, Morfeld D, et al. Gastrointestinal tract complications of nonsteroidal anti-inflammatory drug treatment in rheumatoid arthritis. A prospective observa- tional cohort study. Arch Intern Med 1996;156:1530–1536.

45. Warner TD, Mitchell JA. COX-2 selectivity alone does not define the cardiovascular risks associated with nonsteroidal anti-inflammatory drugs. Lancet 2008;371:270–273.

46. Ahmad M, Hollender L, Anderson Q, et al. Research diagnostic criteria for temporomandibular disorders (RDC/ TMD): Development of image analyses criteria and examiner reliability for image analysis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;107:844–860.

47. Re G, Barbero R, Miolo A, Di Marzo V. Palmitoylethanolamide, endocannabinoids and related cannabimimetic compounds in protection against tissue inflammation and pain: Potential use in companione animals. Vet J 2007;173:23–32.


Abstracted / indexed in

Science Citation Index (SCI)

Science Citation Index Expanded (SCIE)

BIOSIS Previews

Scopus

Cumulative Index to Nursing and Allied Health Literature (CINAHL)

Submission Turnaround Time

Conferences

Top