Normast (palmitoylethanolamide): new inroad in neuropathic pain

Meanwhile we have gathered experience in many neuropathic painstates prescribing palmitoylethanolamide, a body own fatty compound within the class of the endogenous Cannabinoids, and at the 3rd European congres for Integrated Medicine in Berlin last week I could present our approach and data related to Normast (palmitoylethanolamide). We especially see good responses in diabetic neuropathy, chronic idiopathic axonal polyneuropathy and sciatic pain. In one of our last CIAP patient we even saw a 10 m/sec increase in the disturbed nerve velocity. Would be interested for us to speak to other colleagues using this compound. See: 

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dear Jan,

I agree with you, my experince in these last 2 years have been in cancer patients and not to control neuropatich pain, I' ll check your materiel  and keep in touch

maurizio mannocci galeotti firenze

Dear Maurizio,  That is very interesting, as cancer pain has many neuropathic characteristics. Did you see any opioid sparing effects when using Normast (palmitoylethanolamide), or could you reduce or treat break through pains? Have a nice holiday and best wishes for 2011!! Jan 

Dear friand.

I'm trying to  ge t a good experience with NORMAST in neuropathic painstates,  mainly periferal neuropaties, and my personal anedoctal experience gave me contrastant feedback. What is controversial for me is the actual lack of significant evidence that could suggests as to choice NORMAST as first line approach without anyother co-prescription.

What do you think about?


Dear Luigi,

Due to the fact that there are indeed a number of positive trials, and due to the fact that side effects of palmitoylethanolamide are minor, if any (we did not see any, even in very old patients), and the fact that no drug interactions are to be expected, I would argue that Normast could be used as a first line treatment. We ourselves combine it with topical ceams based on amitriptyline (low on side effects, and nice effective)!

So, all different neuropathic painsyndromes in which Normast was tested (see below) show the same clinical effect: positive effects on 600 mg twice daily starting after 2-3 weeks of treatment.

So I believe meanwhile there is quite a bit of literature around, and here a bit of an attempt to get some idea of the pharmacology of Normast:

And there are various clinical trials with positive results in the following indications:

Temperomandibular pain and dysfunction (Costen syndrome),

Carpal tunnel syndrome, Diabetic neuropathic pain and Sciatic pain.

For sciatic pain a double blind trial with more than 600 patients has been published, but in Spanish.

And various anecdotal positive reports for pudendal neuralgia and trigeminal neuralgia

Patients from our clinic also reported positive results, such as:

Have a healthy and happy 2011! Jan

I have been researching Normast ever since a friend on another forum recommended it. However, I do not know how a person in the U.S. can get it. Can you tell me? Thanks.

Ruthanne in Wisconsin

suffering from small fiber neuropathy

If you surf to you will be able to order it, other patients of mine in the USA are doing the same. Good luck! Start with sachets for 10 days under the tongue, twice daily 600 mg and follow up with tablets. Let us here your findings...

Thank you so much. I tried google, but could not find this! 

I read on a tarlov cyst forum (I've got those, too) that a patient uses the following protocol for normast:

1) 1,200 mg. micronized powder form for 30 days

2) 600 mg. micronized for for 60 days

3) Nothing for 30 days

4) Repeat cycle

Do you recommend a similar cycle or to take it continuously?

Another question please? I am doing a trial of carbamazepine. Just one half of the 100 mg tablet 3x/day and am not tolerating it well. I just started it 2 weeks ago. My neurologist says it's OK to wean off slowly but she would rather I try to put up with it longer. Do I need to get off of it before I start the Normast? Does Normast have any known bad interactions with any drugs or other supplements? I do take B12 and some others.

Thank you so much!!!


Ruthanne in Wisconsin


You can treat small fibre neuropathic pain with carbamazepine, that is a good thing to try, as there are many other classical neuropathic pain agents you might want to use or try, from amitriptyline up to pregabaline. Please follow the instructions of your neurologist and go low and slow.

You can also ask your pharmacist to compound a 5 % amitriptyline cream for on your feet, that sometimes does wonders too.

As for Normast, I would just try no cycles, but start on 600 mg twice daily under the tongue (granules) and proceed with 600 mg twice daily tablets for 6 weeks. If find the Normast is effective continue with 300 mg twice daily. You can add Normast to any treatment regime, also to carbamazepine, no interactions are found anywhere to date.

That is the elegance of this bodyown analgesic drug, interactions and side-effects have never been described as dose limiting issues.


Thank you so much. I will certainly let you know how this works!




HI Jan.

Thank You very much for your advices adn your useful links

Happy New Year 2001


I have been carbamazepine 3 1/2 weeks. I started at 25 MG 3 times a day and now am up to 50 MG 3 times a day. I took one 600 MG dose of Normast granules before bed last night. This morning I woke up with muscle jerks all over my body. I have had muscle jerks in the past fom taking only 3 doses of Prozac. They continued for many months even after stopping the Prozac.

I there any reason to believe this is the Normast? Or is it a coincidence? Is this common with carbmazepine? I am not sure what to do.

Thank you.




Dear Ruth, in the data available  there are no indications that this is a side effect of palmitoylethanolamide. Highly unlikely as it is a natural endogenous compound you can also find in peanuts, eggs and soja products. But for the question you poses, you should ask your neurologist. You should aways look for direct advice from your treating physician, as these things are not possible to steer and understand via internet and fora sites like these. Best regards! Jan

Thank you. My doctor did finally respond and believes it is the carbamazepine. She told me to reduce the carbamazepine by one third.

She is not familiar with Normast and has no opinion on it. This is typical of US doctors. I wish I could fly to the Netherlands and get a doctor who knows about these things!

I am glad to hear that this is not a noted reaction for Normast. I cannot read the Normast box and google translator comes up with some very funny translations for some of the things written on it.

Thank you for your help.  I have a friend who take Normast and says it helps her tremendously with her peripheral neuropathy. I am hopeful that it will help me, too. I have only taken one dose, so too soon to tell.


Dear Jan,

How do you compound amitriptylene cream, what should  the base be and how often do you use it. What is the absorption rate. Here in the US we do not use things like this . My compounding pharmacist is not sure about these facts.

Thank you for your help.

Dr. Werner

Dear Werner,


We have compounded amitriptyline 5 % and 10% cream as well as gabapentine 10%cream, but there are some issues, you have to look for the patent literature not to infringe and the stability is an issue. Our first prototypes could not bear cold and were instable. Furthermore, after some double blind placebo controlled  n of one trials we came to the conclusion that the cream works locally as well as systemically; systemically as a CR formulation with a low peak. We will publish soon our results in central MS neuropathic pain. No side effects!!

Probably the best would be to order some samples at our compouding pharmacist and start exploring the effiacy in your population. Meanwhile we have some colleagues in NL who also use our cream and with positive effects. The price for a tube of 30 gram is around 25 Euro I believe, but I should ask our pharmacist. In NL the health insurance covers the costs.


Best regards, Jan


I am writting from Spain. I have suffered for low back pain for two years even if the IRN doesn't show very big problems (degenerated L5-S1 disc and a little hernia that seemed to have disappeared in the last control). I got Normast yesterday hier in Madrid. They sell just tablets and I am taking 2 tablets of 300 mg in the morning and in the evening.

 I take Alprazolam too and my doctor told me to take amitriptyline, but I don't dare. The question is this: Is it possible to get the amitriptyline cream en Western European countries? Which name has it?


Thank you very much





I have been on Normast for 6 weeks and have seen some improvement, maybe about 25% less pain. Please tell me your reason for reducing the Normast dose at 6 weeks. My pain was completely debilitating before Normast and I do not want to go back to where I was before. I could not bear it.

Thank you.



Ruthanne, that is nice to hear, but please mind you my advices here are not meant to substitute the formal contact you should have with your treating physician!

How to use Normast?

I treat my patients step by step. First 10 days ultra mironized Normast under the tongue, to fill up the cells with this analgesic/antiphlogistic compound. Than continue for 6 weeks twice daily with tablets 600 mg. If pain does not decrease more than 30% I insert a period of 10 days with the powder under the tongue and do not lower the dose for another 6 weeks. If the pain starts decreasing more than 30% and reached 50% it is time to reduce the dose to twice daily 300 mg. Always use this food for medical purposes in the context of a treatment cycle supervised by your own physician.

As for the question from Spain, always start with twice daily 600 mg, see here above.

best regards, Jan

Thank you, Jan. I have switched physicians because my previous physician would not help me with this. My new doctor is very interested in treatments used in Europe. She has been reading on the internet (your web site and others) about Normast and is monitoring my use of it.

She also suggested the amitriptyline cream for my feet, but it must be compounded and my government insurance will not pay for compounded drugs. At any rate, the pain that is most bothersome right now is in my eyes, nose, and mouth, so cream will not work. 

I am now completely off of the prescription durgs that were so bothersome to me. I now take Normast and alpha lipoic acid. I have no trouble with these and am very relieved.

Thank you again for the wonderful work you do. I was in complete despair before the Normast started to work. I have idiopathic small fiber neuropathy that continues to spread. The Normast has turned down the intensity of the pain even as it spreads. Life is not wonderful, but it is bearable. It was not before.

With thanks,



Dear Jan.
There is a patient, with a lower trunk chronic neuroma. It might have been there for some 10 years or so. So far is not painful but there is quite significant muscle atrophy. He is scare of surgery, there is a possibility for neuropathic pain after it. Do you think Normast might help to improve peripheral nerve metabolism and obtain some results in his lumbricals and hand amiotrophy? 

Thank you

Eduardo Tello

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