Palmitoylethanolamide for persistent neuropathic pain following herpes zoster in a patient with reported NSAID allergy: A case report

Introduction. Persistent neuropathic pain following herpes zoster is a disabling condition that can substantially impair quality of life. Its management may be challenging in patients with limited tolerability or contraindications to standard analgesics. Palmitoylethanolamide (PEA), an endogenous lipid mediator with anti-inflammatory and analgesic properties, has been proposed as a supportive therapeutic option in the management of neuropathic pain.Methods. We report the case of a 50-year-old woman who developed persistent burning and stabbing pain in the T4-T6 dermatomes, accompanied by nocturnal exacerbations and marked interference with daily activities, 4 weeks after thoracic herpes zoster. The patient reported a history of allergy to nonsteroidal anti-inflammatory drugs (NSAIDs). Previous treatment with over-the-counter analgesics was ineffective. Gabapentin 300 mg three times daily provided limited benefit and was associated with mild drowsiness, whereas tapentadol 50 mg was self-discontinued after 2 days because of poor tolerability. The patient was referred to the Pain Therapy Clinic of the University of Campania Luigi Vanvitelli, Naples, Italy, and initiated treatment with PEA 600 mg twice daily. Pain intensity, neuropathic features, and quality of life were assessed at baseline and after 2 months. Written informed consent for anonymized data collection and publication was obtained from the patient.Results. After 2 months of treatment, pain intensity decreased from 8/10 to 4/10 on the Visual Analog Scale (VAS), while the DN4 score improved from 6/10 to 3/10. Burning pain and electric shock-like sensations were markedly reduced. The patient also reported improved physical functioning, reduced interference with daily and social activities, and improvement in anxiety and depressive symptoms.Conclusions. In this clinical case, PEA-based therapy was associated with improvements in pain intensity, neuropathic symptoms, pain-related disability, and psychological well-being. Although causal relationships cannot be established from a single case report, PEA may represent a useful therapeutic option for selected patients with persistent neuropathic pain following herpes zoster who have limited tolerability of, or contraindications to, standard treatments.