Capsaicin 8% Patch Versus Oral Neuropathic Pain Medications for the Treatment of Painful Diabetic Peripheral Neuropathy: A Systematic Literature Review and Network Meta-analysis

Nooten, Floortje van; Treur, M.; Pantiri, K; Stoker, Malcolm; Charokopou, M.

doi:10.1016/j.clinthera.2017.02.010

Cited by 86 publications

(67 citation statements)

References 55 publications

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“…Patches with capsaicin 8% have also been studied in painful DSPN, with conflicting results [66]. Nonetheless, some evidence points to superiority in comparison with oral pregabalin, duloxetine, and gabapentin for pain relief among DSPN patients [67]. Although not formally approved [68], a single application of this patch may provide up to 12 weeks of pain relief [69].…”

Section: Topical Treatmentmentioning

confidence: 99%

Current Pharmacological Treatment of Painful Diabetic Neuropathy: A Narrative Review

et al. 2020

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Background and Objectives: Distal symmetrical polyneuropathy (DSPN) is one of the most common chronic complications of diabetes mellitus. Although it is usually characterized by progressive sensory loss, some patients may develop chronic pain. Assessment of DSPN is not difficult, but the biggest challenge is making the correct diagnosis and choosing the right treatment. The treatment of DSPN has three primary objectives: glycemic control, pathogenic mechanisms, and pain management. The aim of this brief narrative review is to summarize the current pharmacological treatment of painful DSPN. It also summarizes knowledge on pathogenesis-oriented therapy, which is generally overlooked in many publications and guidelines. Materials and Methods: The present review reports the relevant information available on DSPN treatment. The search was performed on PubMed, Cochrane, Semantic Scholar, Medline, Scopus, and Cochrane Library databases, including among others the terms “distal symmetrical polyneuropathy”, “neuropathic pain treatment”, “diabetic neuropathy”, “diabetes complications”, ”glycaemic control”, “antidepressants”, “opioids”, and “anticonvulsants”. Results: First-line drugs include antidepressants (selective serotonin reuptake inhibitors and tricyclic antidepressants) and pregabalin. Second- and third-line drugs include opioids and topical analgesics. While potentially effective in the treatment of neuropathic pain, opioids are not considered to be the first choice because of adverse reactions and addiction concerns. Conclusions: DSPN is a common complication in patients with diabetes, and severely affects the quality of life of these patients. Although multiple therapies are available, the guidelines and recommendations regarding the treatment of diabetic neuropathy have failed to offer a unitary consensus, which often hinders the therapeutic options in clinical practice.

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Section: Topical Treatmentmentioning

confidence: 99%

Current Pharmacological Treatment of Painful Diabetic Neuropathy: A Narrative Review

et al. 2020

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“…Safe treatment is possible in specialist pain clinics, whose staff includes doctors and nurses trained in this area. Capsaicin administered at this concentration can cause blindness in contact with the cornea of the eye [41].…”

Section: Treatment Of Neuropathic Painmentioning

confidence: 98%

“…Bezpieczne leczenie jest możliwe w specjalistycznych poradniach leczenia bólu, w których pracują przeszkoleni w tym zakresie lekarze i pielęgniarki. Kapsaicyna podana w tym stężeniu, przy kontakcie z rogówką oka, może spowodować ślepotę [41].…”

Section: Leczenie Bólu Neuropatycznegounclassified

Neuropathic pain: new mechanisms of action of old drugs

Żylicz

2019

Palliat Med Pract

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Approximately 7-10% of the general population and 30% of cancer patients suffer from neuropathic pain, which is induced by the damage or disease of the neurologic structures. Sometimes neuropathic pain is caused by the pressure on a nerve but more often pain is due to the sensitization of the centers in the spinal cord and brain. Some structures become so sensitive to the peripheral pain impulses that they become totally independent of them. Recently neuropathic pain is seen as an activation process of the innate immunologic system. In this area the Toll-like receptors seems to play an important role and many drugs are able to inhibit their activation. Treatment of neuropathic pain depends on the possibility of nerve decompression. However, in many cases, the sensitization is the target for treatment. For this purpose, most useful are gabapentinoids that inhibit influx of calcium across the membrane. Antidepressants (SNRI) such as duloxetine and venlafaxine are also useful as well as tricyclic antidepressants, although the latter are characterized by significant adverse effects. In some types of neuropathic pain 8% capsaicin, as well as 5% lidocaine plasters or different opioids, are successfully used although there is still a lack of sufficient, good quality controlled clinical trials. The description of the role of Toll-like receptors in the pathophysiology of neuropathic pain is a breakthrough in thinking and hope for the future to elaborate new, more effective treatment methods.

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“…Similar to fibromyalgia, tricyclic antidepressants and opioids are commonly used to treat the symptoms of diabetic peripheral neuropathy (Javed et al, 2015;Tajti et al, 2016) and a capsaicin patch has been shown to display similar efficacy to oral drugs, albeit with limits in tolerability (van Nooten et al, 2017). Both gabapentin and pregabalin are also effective treatments, with pregabalin recommended at a dose of 300 mg to 600 mg daily resulting in a significant reduction in pain scores (Juhn et al, 2015).…”

Section: Pregabalin In Diabetic Peripheral Neuropathymentioning

confidence: 99%

Pregabalin as a Pain Therapeutic: Beyond Calcium Channels

Alles

Cain

Snutch

2020

Front. Cell. Neurosci.

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PHARMACOLOGY AND PROTEIN INTERACTIONS OF PREGABALIN Pregabalin Is a High-Affinity α2δ Subunit Ligand The alpha-2-delta (α2δ) subunits were first described as auxiliary subunits of the high voltageactivated calcium channels and are encoded by four genes: α2δ1, α2δ-2, α2δ-3 and α2δ-4. α2δ-1-3 are expressed in neurons as well as heart and skeletal muscle tissue (Gong et al., 2001), whereas α2δ-4 is found in non-neuronal cell types such as the retina and endocrine tissues (Dolphin, 2013). Pregabalin selectively binds to the α2δ-1 and α2δ-2 subunits and despite its original design as a GABA mimetic, pregabalin does not affect GABA A or GABA B receptor activity (Li et al., 2011). Interestingly, α2δ-1 expression appears to co-localize mainly with excitatory neurons whereas α2δ-2 is found largely in inhibitory neurons (Cole et al., 2005). Recently, it has been shown that gabapentin exerts differential effects on putative excitatory and inhibitory spinal dorsal horn neurons (Alles et al., 2017). It is thus possible that pregabalin has different effects on excitatory compared to inhibitory neurons through a mechanism involving α2δ-1 and α2δ-2 subunits. This distinction may represent an important pregabalin-mediated therapeutic action since excitationinhibition imbalance occurs in the spinal cord and brain in chronic pain states such as diabetic neuropathy and chronic pain accompanying multiple sclerosis (

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Capsaicin 8% Patch Versus Oral Neuropathic Pain Medications for the Treatment of Painful Diabetic Peripheral Neuropathy: A Systematic Literature Review and Network Meta-analysis

Cited by 86 publications

References 55 publications

Current Pharmacological Treatment of Painful Diabetic Neuropathy: A Narrative Review

Current Pharmacological Treatment of Painful Diabetic Neuropathy: A Narrative Review

Neuropathic pain: new mechanisms of action of old drugs

Pregabalin as a Pain Therapeutic: Beyond Calcium Channels

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