Can Celecoxib enhance Palmitoylethanolamide's effect in the treatment of Temporo-mandibular arthralgia in osteoarthritis patients?

Osteoarthritis (OA) is a degenerative disease of joints commonly associated with arthralgia when affecting Temporo-Mandibular Joints (TMJ). Pain management generally consists of nonsteroidal anti-inflammatory drug (NSAIDs), but due to the important side effects related to its use, Palmitoylethanolamide (PEA) has been taken into consideration. PEA acts as an endogenous agent with anti-inflammatory effect, it also has an analgesic effect starting from the fourth day of treatment. A case series analysis was retrospectively conducted in order to assess if the association of PEA and Celecoxib, a cyclooxygenase-2 inhibitor, provides a quicker reduction of pain. 12 patients were treated with this association for 4 days and with PEA alone for the following 10 days. Maximum mouth opening was also recorded. A progressive pain decrease was clearly noticeable over time allowing to reach a significant reduction after 4 days and no significant pain intensity at the end of the treatment (p = 0.0001). Maximum mouth opening also improved (p=0,0093). This data suggest that the association of PEA and Celecoxib is effective in TMJ-OA treatment without showing side effects. It should be considered as a safe and valid alternative to NSAIDs.