COMBINED USE OF PALMITOYLETHANOLAMIDE + EQUISETUM AND ACETYL L-CARNITINE BEFORE AND AFTER RACZ PERIDURAL ADHESIOLYSIS AND LUMBAR GANGLION NEUROMODULATION

C. Paoletti, L.F. Nardi, F. Del Sordo | Pain Relief Surgery Unit, Casa di Cura Villa Igea, Ancona

INTRODUCTION
The management of chronic radicular pain is often complex. Characterized by burning pain, dysesthesias, and paresthesias, it often resists conventional pharmacological therapies and impairs quality of life. Racz's peridural adhesiolysis (AP) targets fibrotic adhesions in the epidural space, enhancing analgesic drug diffusion. Neuromodulation of the dorsal root ganglion (PRFDRG) is also effective in treating radicular pain. However, clinical outcomes may be hindered by neuroinflammation. PEA, an endocannabinoid-like compound given preoperatively, reduces neuroinflammation and peripheral sensitization by activating PPAR-α receptors and modulating microglia and TRPV1 channels. Equisetum (E), a perennial herb rich in minerals and nutrients, contains key bioactive compounds: flavonoids, saponins, and phytosterols. ALC, a derivative of L-carnitine, acts postoperatively by promoting axonal regeneration, mitochondrial energy production, and neurotrophic factor expression (NGF, BDNF).
OBJECTIVE
This study aims to evaluate whether the intake of PEA+E and ALC can improve outcomes in patients undergoing AP+PRFDRG.
METHODS
10 patients with chronic lumbar radicular pain (mean age: 75 years; 6 women, 3 men) underwent AP+PRFDRG using a multifunctional device (AlfaMed Voyager®). Five of these patients were pre-treated with PEA+E at a dosage of 1200/600 mg twice daily for 30 days before the procedure, and with ALC at 500 mg twice daily for 30 days afterward.
RESULTS
NRS scores at one and three months showed more favorable trends in the treated group, though not statistically significant: 80% vs. 70% at one month, and 70% vs. 65% at three months. No differences were observed at six months.
CONCLUSIONS
The combined AP+PRFDRG technique is well documented in the literature for its efficacy and safety. It involves inserting a multifunctional device via the sacral route, then navigating to the selected dorsal root ganglion. The procedure includes a ganglion approach—overcoming epidural adhesions—facilitated by drug infusion (hyperosmolar solution, anesthetics, corticosteroids) to enhance analgesic distribution, followed by neuromodulation via pulsed radiofrequency using a bipolar electrode. Both techniques are minimally invasive and well tolerated. Preoperative PEA reduces neuroinflammation and peripheral sensitization, while postoperative ALC supports axonal regeneration, mitochondrial energy production, and neurotrophic factor expression. Combining AP+PRFDRG with PEA+E and ALC appears to improve outcomes at one and three months post-procedure. Although based on a limited sample, this analysis suggests the approach may offer a rational, effective, and well-tolerated therapeutic strategy. Further studies are required to establish standardized protocols and validate these preliminary findings.