0.025% Capsaicin Gel for the Treatment of Painful Diabetic Neuropathy: A Randomized, Double‐Blind, Crossover, Placebo‐Controlled Trial

Kulkantrakorn, Kongkiat; Lorsuwansiri, Chakraphong; Meesawatsom, Pongsatorn

doi:10.1111/papr.12013

Cited by 60 publications

(37 citation statements)

References 17 publications

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“…Some clinical trials have demonstrated the effectiveness of lowconcentration (from 0.025% to 0.075%) capsaicin cream in DNP [11,174,175] . Higher concentrations are not indicated because of desensitization of nociceptive sensory nerve endings, which may increase the risk of skin injuries in DNP patients [173,174] . Some adverse effects include itching, stinging, erythema, transient burning sensation and initial pain at the application site, that diminishes with repeated use [132,175] , leading many patients to withdraw from the treatment [128,173] .…”

Section: Others Agentsmentioning

confidence: 99%

“…Higher concentrations are not indicated because of desensitization of nociceptive sensory nerve endings, which may increase the risk of skin injuries in DNP patients [173,174] . Some adverse effects include itching, stinging, erythema, transient burning sensation and initial pain at the application site, that diminishes with repeated use [132,175] , leading many patients to withdraw from the treatment [128,173] . Lidocaine patch: Lidocaine patches act as peripheral analgesics with minimal systemic absorption and are used in combination with other analgesic drugs [132,172] .…”

Section: Others Agentsmentioning

confidence: 99%

“…Capsaicin is the pungent component of hot chilli peppers [11] and an agonist of the transient receptor potential vanilloid 1. This receptor is a ligandgated, nonselective cation channel, predominantly expressed on unmyelinated C nerve fibers [173] , which, after repeated exposure to topical capsaicin, are depleted of their content of substance P and other neurotransmitters [173,174] . The C fibers depletion and desensitization reduce painful stimuli transmission from peripheral nerves to the central nervous system [173] .…”

Section: Others Agentsmentioning

confidence: 99%

“…This receptor is a ligandgated, nonselective cation channel, predominantly expressed on unmyelinated C nerve fibers [173] , which, after repeated exposure to topical capsaicin, are depleted of their content of substance P and other neurotransmitters [173,174] . The C fibers depletion and desensitization reduce painful stimuli transmission from peripheral nerves to the central nervous system [173] . Some clinical trials have demonstrated the effectiveness of lowconcentration (from 0.025% to 0.075%) capsaicin cream in DNP [11,174,175] .…”

Section: Others Agentsmentioning

confidence: 99%

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Diabetic neuropathic pain: Physiopathology and treatment

Schreiber

Nones

Reis

et al. 2015

WJD

353

267

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Diabetic neuropathy is a common complication of both type 1 and type 2 diabetes, which affects over 90% of the diabetic patients. Although pain is one of the main symptoms of diabetic neuropathy, its pathophysiological mechanisms are not yet fully known. It is widely accepted that the toxic effects of hyperglycemia play an important role in the development of this complication, but several other hypotheses have been postulated. The management of diabetic neuropathic pain consists basically in excluding other causes of painful peripheral neuropathy, improving glycemic control as a prophylactic therapy and using medications to alleviate pain. First line drugs for pain relief include anticonvulsants, such as pregabalin and gabapentin and antidepressants, especially those that act to inhibit the reuptake of serotonin and noradrenaline. In addition, there is experimental and clinical evidence that opioids can be helpful in pain control, mainly if associated with first line drugs. Other agents, including for topical application, such as capsaicin cream and lidocaine patches, have also been proposed to be useful as adjuvants in the control of diabetic neuropathic pain, but the clinical evidence is insufficient to support their use. In conclusion, a better understanding of the mechanisms underlying diabetic neuropathic pain will contribute to the search of new therapies, but also to the improvement of the guidelines to optimize pain control with the drugs currently available.

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Section: Others Agentsmentioning

confidence: 99%

Section: Others Agentsmentioning

confidence: 99%

Section: Others Agentsmentioning

confidence: 99%

Section: Others Agentsmentioning

confidence: 99%

See 2 more Smart Citations

Diabetic neuropathic pain: Physiopathology and treatment

Schreiber

Nones

Reis

et al. 2015

WJD

353

267

View full text Add to dashboard Cite

show abstract

“…Clinical trials have also investigated the ability of a 0.025% capsaicin patch to decrease the pain associated with diabetic neuropathy [54]. Although the patch was well tolerated in patients, it provided no relief from pain.…”

Section: Advanced Drug Delivery Systemsmentioning

confidence: 99%

Bioavailability of capsaicin and its implications for drug delivery

Rollyson

Stover

Brown

et al. 2014

Journal of Controlled Release

216

160

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The dietary compound capsaicin is responsible for the “hot and spicy” taste of chili peppers and pepper extracts. It is a valuable pharmacological agent with several therapeutic applications in controlling pain and inflammation. Emerging studies show that it displays potent anti-tumor activity in several human cancers. On a more basic research level, capsaicin has been used as a ligand to activate several types of ion-channel receptors. The pharmacological activity of capsaicin-like compounds is dependent on several factors like the dose, the route of administration and most importantly on its concentration at target tissues. The present review describes the current knowledge involving the metabolism and bioavailability of capsaicinoids in rodents and humans. Novel drug delivery strategies used to improve the bioavailability and therapeutic index of capsaicin are discussed in detail. The generation of novel capsaicin-mimetics and improved drug delivery methods will foster the hope of innovative applications of capsaicin in human disease.

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Topical analgesics for neuropathic pain: Preclinical exploration, clinical validation, future development

Sawynok

2013

European Journal of Pain

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Topical analgesics applied locally to skin or to specialized compartments modify pain by actions on sensory nerve endings and/or adjacent cellular elements. With this approach, there are low systemic drug levels, good tolerability and few drug interactions, and combination with oral formulations is feasible. The goal of this review is to provide an overview of the potential for topical analgesics to contribute to improved management of neuropathic pain. Mechanistic and preclinical studies indicate much potential for development of novel topical analgesics for neuropathic pain. In humans, two topical analgesics are approved for use in postherpetic neuralgia (lidocaine 5% medicated plaster, capsaicin 8% patch), and there is evidence for efficacy in other neuropathic pain conditions. Comparative trials indicate similar efficacy between topical and oral analgesics. Not all individuals respond to topical analgesics, and there is interest in determining factors (patient factors, sensory characteristics) which might predict responsiveness to topical analgesics. There is a growing number of controlled trials and case reports of investigational agents (vasodilators, glutamate receptor antagonists, α2-adrenoreceptor agonists, antidepressants, centrally acting drugs), including combinations of several agents, indicating these produce pain relief in neuropathic pain. There is interest in compounding topical analgesics for neuropathic pain, but several challenges remain for this approach. Topical analgesics have the potential to be a valuable additional approach for the management of neuropathic pain.

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0.025% Capsaicin Gel for the Treatment of Painful Diabetic Neuropathy: A Randomized, Double‐Blind, Crossover, Placebo‐Controlled Trial

Abstract: 0.025% capsaicin gel is safe and well tolerated, but does not provide significant pain relief in patients with PDN.

Cited by 60 publications

References 17 publications

Diabetic neuropathic pain: Physiopathology and treatment

Diabetic neuropathic pain: Physiopathology and treatment

Bioavailability of capsaicin and its implications for drug delivery

Topical analgesics for neuropathic pain: Preclinical exploration, clinical validation, future development

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