N-of-1 Randomized Trials of Ultra-Micronized Palmitoylethanolamide in Older Patients with Chronic Pain

Federico Germini, Anna Coerezza, Luca Andreinetti, Alessandro Nobili, Paolo Dionigi Rossi, Daniela Mari, Gordon Guyatt, Maura Marcucci

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Ultra-micronized palmitoylethanolamide (um-PEA) represents an attractive option for chronic pain control in complex older patients at higher risk of adverse effects with traditional analgesics. Objective: The aim of this study was to determine the effectiveness of um-PEA versus placebo on chronic pain intensity and function in individual geriatric patients. Design: We performed randomized, blinded N-of-1 trials with two 3-week um-PEA versus placebo comparisons, separated by 2-week washout periods. Participants: The study included outpatients aged ≥ 65 years with chronic, non-cancer, non-ischemic pain in the back, joints, or limbs. Intervention: Patients were randomized to Um-PEA 600 mg or placebo twice daily. Measurements: Pain intensity was measured using an 11-point visual numeric scale. Functional impairment was measured using a Back Pain Functional Scale. Impact of each N-of-1 trial was measured on the clinician’s intention to treat and confidence. Results: Ten of 11 eligible patients consented over 7 months [all female, mean age 83.2 years (SD 4.6)]. Three patients interrupted the trial: one had diarrhea (under placebo), one for low adherence, and one for intercurrent pneumonia. A small statistically significant effect in favor of um-PEA was seen at the mixed method analyses in two patients (effect size equal to 8% of the baseline pain). A statistically significant impact on function was found in one patient. After the trial, um-PEA was prescribed to four patients; in two patients the clinician changed their pre-trial intention to treat; the clinician confidence in the treatment plan either increased (5) or remained the same (2). Conclusions: Our experience confirmed that N-of-1 trials may help make personalized evidence-based decisions in complex older patients, with special feasibility considerations. ClinicalTrials.gov: NCT02699281.

Original languageEnglish
Pages (from-to)941-952
Number of pages12
JournalDrugs and Aging
Volume34
Issue number12
DOIs
Publication statusPublished - Dec 1 2017

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Chronic Pain
Placebos
Back Pain
palmidrol
Pain Measurement
Geriatrics
Analgesics
Diarrhea
Pneumonia
Outpatients
Extremities
Joints
Pain

ASJC Scopus subject areas

  • Geriatrics and Gerontology
  • Pharmacology (medical)

Cite this

N-of-1 Randomized Trials of Ultra-Micronized Palmitoylethanolamide in Older Patients with Chronic Pain. / Germini, Federico; Coerezza, Anna; Andreinetti, Luca; Nobili, Alessandro; Rossi, Paolo Dionigi; Mari, Daniela; Guyatt, Gordon; Marcucci, Maura.

In: Drugs and Aging, Vol. 34, No. 12, 01.12.2017, p. 941-952.

Research output: Contribution to journalArticle

Germini, Federico ; Coerezza, Anna ; Andreinetti, Luca ; Nobili, Alessandro ; Rossi, Paolo Dionigi ; Mari, Daniela ; Guyatt, Gordon ; Marcucci, Maura. / N-of-1 Randomized Trials of Ultra-Micronized Palmitoylethanolamide in Older Patients with Chronic Pain. In: Drugs and Aging. 2017 ; Vol. 34, No. 12. pp. 941-952.
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