A Randomized Vehicle-Controlled Trial of Topical Capsaicin in the Treatment of Postherpetic Neuralgia

Watson, C. Peter N.; Tyler, Kenneth L.; Bickers, David R.; Millikan, Larry E.; Smith, Sharon R.; Coleman, Edward

doi:10.1097/00132586-199404000-00039

Cited by 116 publications

(139 citation statements)

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“…The fact that such sprouting results in A-fiber input entering an area of cord that normally only processes C-fiber input may help to explain the pain associated with C-fiber neuropathies. Interestingly, several clinical studies have reported the beneficial use of low-dose capsaicin cream applied to hypersensitive skin in conditions like postherpetic neuralgia (Watson et al, 1993), diabetic neuropathy (Tandan et al, 1992), and trigeminal neuralgia (Fusco and Alessandri, 1992). Because many patients receiving such treatment already have allodynia, it will be difficult to assess whether it introduces a novel neuropathic pain.…”

Section: Discussionmentioning

confidence: 99%

Collateral Sprouting of Uninjured Primary Afferent A-Fibers into the Superficial Dorsal Horn of the Adult Rat Spinal Cord after Topical Capsaicin Treatment to the Sciatic Nerve

et al. 1996

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That terminals of uninjured primary sensory neurons terminating in the dorsal horn of the spinal cord can collaterally sprout was first suggested by Liu and Chambers (1958), but this has since been disputed. Recently, horseradish peroxidase conjugated to the B subunit of cholera toxin (B-HRP) and intracellular HRP injections have shown that sciatic nerve section or crush produces a long-lasting rearrangement in the organization of primary afferent central terminals, with A-fibers sprouting into lamina II, a region that normally receives only C-fiber input (Woolf et al., 1992). The mechanism of this A-fiber sprouting has been thought to involve injury-induced C-fiber transganglionic degeneration combined with myelinated A-fibers being conditioned into a regenerative growth state.In this study, we ask whether C-fiber degeneration and A-fiber conditioning are both necessary for the sprouting of A-fibers into lamina II. Local application of the C-fiber-specific neurotoxin capsaicin to the sciatic nerve has previously been shown to result in C-fiber damage and degenerative atrophy in lamina II. We have used B-HRP to transganglionically label A-fiber central terminals and have shown that 2 weeks after topical capsaicin treatment to the sciatic nerve, the pattern of B-HRP staining in the dorsal horn is indistinguishable from that seen after axotomy, with lamina II displaying novel staining in the identical region containing capsaicin-treated C-fiber central terminals.These results suggest that after C-fiber injury,uninjuredA-fiber central terminals can collaterally sprout into lamina II of the dorsal horn. This phenomenon may help to explain the pain associated with C-fiber neuropathy.

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Section: Discussionmentioning

confidence: 99%

Collateral Sprouting of Uninjured Primary Afferent A-Fibers into the Superficial Dorsal Horn of the Adult Rat Spinal Cord after Topical Capsaicin Treatment to the Sciatic Nerve

et al. 1996

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“…Watson et al 17 evaluated the efficacy of topically applied capsaicin 0.075% cream in a double-blind, vehicle-controlled study in 143 patients with chronic postherpetic neuralgia (PHN), for at least of 6 months. An open-label study for up to 2 years to assess the safety and efficacy of long-term application of topical capsaicin was also carried out.…”

Section: Capsaicinmentioning

confidence: 99%

Promising treatments for neuropathic pain

Schestatsky

Vidor

Winckler

et al. 2014

Arq. Neuro-Psiquiatr.

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In the last few years the understanding of mechanisms and, consequently, the diagnosis of neuropathic pain (NP) has becoming progressively clearer in clinical practice. However, the treatment of such condition remains challenging so far. One of the reasons for such difficulty is the diversity of mechanisms involved in NP generation and its persistency. In the present review we discuss several treatment modalities for NP that are scantily applied in daily clinical practice. For that, we collected positive clinical evidence of unusual and SECS (Safe, Easy, Cheap, and Sensible) approaches for NP. The aim of this review is not to establish the "state of the art" or rigid guidelines for NP treatment. In a different way, we only want bring new possibilities of treatment to the readers and also to motivate investigators to confirm those positive preliminary but promising results for NP reliev.Keywords: neuropathic pain, treatment, unconventional, alternative, evidence-based medicine. RESUMONos últimos anos, a compreensão dos mecanismos e consequentemente do diagnóstico da dor neuropática (DN) têm se tornado cada vez mais claros na prática clínica. Entretanto, o tratamento desta condição continua sendo um desafio. Uma das razões para tal dificuldade é diversidade de mecanismos envolvidos na geração e perpetuação da DN. Na presente revisão, os autores discutem várias modalidades de tratamento para DN pouco utilizadas na prática clínica diária. Para isso, selecionamos evidências clínicas positivas de abordagens para DN consideradas não-convencionais e do tipo "SFBR" (Seguro, Fácil, Barato e Racional). O objetivo desta revisão não é estabelecer o "estado da arte" ou diretrizes rígidas para o tratamento da DN. Diferente disso, pretendemos apenas trazer aos leitores novas possibilidades de tratamento assim como motivar pesquisadores a confirmar estes resultados preliminares, mas promissores para o alívio da DN.Palavras-chave: dor neuropática, tratamento, alternativo, medicina baseada em evidência.Neuropathic pain is defined as pain caused by lesion or dysfunction of the somatosensory system 1 and is most commonly consequence from several clinical conditions, such as diabetes, chemotherapy, herpes zoster infection, chronic alcohol abuse and other idiopathic conditions, such as idiopathic small fiber neuropathy and trigeminal pain. Patients with NP usually complain of burning and tingling sensations over the skin that almost always correspond to a plausible body distribution. Antidepressants and antiepileptic drugs are the mainstay of therapy, but they usually relieve only 40-50% of the pain 2 . Since the diagnosis of NP has becoming clearer in the last few years with the advent of new neurophysiological and histological tools, it is believed that the diversity of pathophysiological mechanism might explain the refractoriness of NP to the conventional therapeutic approaches. Therefore, several lines of investigation have been developed in parallel with the sophistication of usual drugs used in NP patients. Some of these...

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“…Capsaicin is another topical agent that has shown efficacy in randomized clinical trials. 17,18 However, the burning sensation associated with the application of capsaicin often limits its clinical use. Patients should be advised that the burning sensation decreases with continued use of capsaicin.…”

Section: Topical Agentsmentioning

confidence: 99%

Herpes Zoster (Shingles) and Postherpetic Neuralgia

Sampathkumar

Drage

Martin

2009

Mayo Clinic Proceedings

343

202

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Herpes zoster (HZ), commonly called shingles, is a distinctive syndrome caused by reactivation of varicella zoster virus (VZV). This reactivation occurs when immunity to VZV declines because of aging or immunosuppression. Herpes zoster can occur at any age but most commonly affects the elderly population. Postherpetic neuralgia (PHN), defined as pain persisting more than 3 months after the rash has healed, is a debilitating and difficult to manage consequence of HZ. The diagnosis of HZ is usually made clinically on the basis of the characteristic appearance of the rash. Early recognition and treatment can reduce acute symptoms and may also reduce PHN. A live, attenuated vaccine aimed at boosting immunity to VZV and reducing the risk of HZ is now available and is recommended for adults older than 60 years. The vaccine has been shown to reduce significantly the incidence of both HZ and PHN. The vaccine is well tolerated, with minor local injection site reactions being the most common adverse event. This review focuses on the clinical manifestations and treatment of HZ and PHN, as well as the appropriate use of the HZ vaccine. © 2009 Mayo Foundation for Medical Education and ResearchOn completion of this article, you should be able to (1) recognize the common presentation of herpes zoster, (2) summarize appropriate treatment for acute herpes zoster and postherpetic neuralgia, and (3) select patients for whom herpes zoster vaccine is appropriate.H erpes zoster (HZ), commonly called shingles from the Latin cingulum, meaning belt, 1 is a distinctive syndrome caused by reactivation of varicella zoster virus (VZV). The risk of HZ increases with age; approximately half of all cases occur in persons older than 60 years. One of the most common and debilitating sequelae of HZ is postherpetic neuralgia (PHN), defined as pain persisting more than 3 months after the rash has healed. CLINICAL MANIFESTATIONS AND DIAGNOSISHerpes zoster is a painful, blistering skin eruption in a dermatomal distribution. After primary infection with varicella (ie, chicken pox), the virus persists asymptomatically in the ganglia of sensory cranial nerves and spinal dorsal root ganglia. As cellular immunity to VZV decreases with age or because of immunosuppression, the virus reactivates and travels along the sensory nerves to the skin, causing the distinctive prodromal pain followed by eruption of the rash. It is estimated that approximately 1 in 3 people will develop HZ during their lifetime, resulting in an estimated 1 million episodes in the United States annually. 2 Herpes zoster can occur at any age but is generally less severe in children and young adults, with the greatest morbidity and mortality seen in older adults and in immunocompromised patients. A recent population-based study in Olmsted County, Minnesota, found that the incidence of HZ was 3.6 per 1000 patientyears. 3 In that study, the incidence of HZ and the rate of HZassociated complications increased with age, with 68% of cases occurring in those aged 50 years and older. Prodromal...

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A Randomized Vehicle-Controlled Trial of Topical Capsaicin in the Treatment of Postherpetic Neuralgia

Cited by 116 publications

References 0 publications

Collateral Sprouting of Uninjured Primary Afferent A-Fibers into the Superficial Dorsal Horn of the Adult Rat Spinal Cord after Topical Capsaicin Treatment to the Sciatic Nerve

Collateral Sprouting of Uninjured Primary Afferent A-Fibers into the Superficial Dorsal Horn of the Adult Rat Spinal Cord after Topical Capsaicin Treatment to the Sciatic Nerve

Promising treatments for neuropathic pain

Herpes Zoster (Shingles) and Postherpetic Neuralgia

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