1
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Liu M, Zhu Y, Wang F. Does chili pepper consumption affect BMI and obesity risk? A cross-sectional analysis. Front Nutr 2024; 11:1410256. [PMID: 38887506 PMCID: PMC11182340 DOI: 10.3389/fnut.2024.1410256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 05/22/2024] [Indexed: 06/20/2024] Open
Abstract
Background The effects of chili intake on overweight and obesity have attracted significant interest in recent years. This study aimed to investigate the correlation between chili consumption frequency, body mass index (BMI), and obesity prevalence in the American population. Methods Data from participants in National Health and Nutrition Examination Survey (NHANES) 2003-2006 were collected. We enrolled 6,138 participants with complete information on chili intake and BMI in this cross-sectional study. Multivariate logistic regression and sensitivity analyses were conducted to explore the relationship between chili intake frequency and BMI and obesity. Subgroup analyses and interaction tests were employed to assess the stability of the observed correlation. Results Increased chili consumption frequency was linked to higher BMI values and a greater prevalence of obesity. Compared to the non-consumption group, the highest frequency group had a multivariate-adjusted β of 0.71 (95% CI: 0.05, 1.38) for BMI and an OR of 1.55 (95% CI: 1.22, 1.97) for obesity in the fully adjusted model. This positive association between chili intake frequency and obesity was more pronounced in females and older adults (≥ 60 years old). Conclusion Our findings suggest a positive association between chili intake frequency and BMI and obesity in United States adults, suggesting that controlling chili intake frequency could potentially contribute to improved weight management in the general population.
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Affiliation(s)
- Mengxue Liu
- Department of Anesthesiology, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yihao Zhu
- Department of Anesthesiology, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Fei Wang
- Department of Anesthesiology, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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Hudáková T, Šemeláková M, Očenáš P, Kožurková M, Krochtová K, Sovová S, Tóthová Z, Guľášová Z, Popelka P, Solár P. Chili pepper extracts, capsaicin, and dihydrocapsaicin as potential anticancer agents targeting topoisomerases. BMC Complement Med Ther 2024; 24:96. [PMID: 38383414 PMCID: PMC10880293 DOI: 10.1186/s12906-024-04394-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 02/07/2024] [Indexed: 02/23/2024] Open
Abstract
DNA topoisomerases regulate conformational changes in DNA topology during normal cell growth, such as replication, transcription, recombination, and repair, and may be targeted for anticancer drugs. A DNA topology assay was used to investigate DNA-damaging/protective activities of extracts from Habanero Red (HR), Habanero Maya Red (HMR), Trinidad Moruga Scorpion (TMS), Jalapeno (J), Serrano pepper (SP), Habanero Red Savina (HRS), Bhut Jolokia (BJ), and Jamaica Rosso (JR) peppers, demonstrating their inhibitory effect on the relaxation of pBR by Topo I. DNA topoisomerase II (Topo II) is proven therapeutic target of anticancer drugs. Complete inhibition of Topo II was observed for samples TMS, HR, and HMR. Extracts J and SP had the lowest capsaicin and dihydrocapsaicin content compared to other peppers. HR, HMR, TMS, J, S, HRS, BJ, JR extracts showed the anticancer effect, examined by MTS and xCell assay on the in vitro culture of human colon carcinoma cell line HCT116.
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Affiliation(s)
- Terézia Hudáková
- Department of Medical Biology, Faculty of Medicine, Pavol Jozef Šafárik University in Košice, Trieda SNP 1, 040 11, Košice, Slovakia
| | - Martina Šemeláková
- Department of Medical Biology, Faculty of Medicine, Pavol Jozef Šafárik University in Košice, Trieda SNP 1, 040 11, Košice, Slovakia
| | - Peter Očenáš
- Department of Chemistry, Biochemistry and Biophysics, University of Veterinary Medicine and Pharmacy in Košice, Komenského 73, 041 81, Košice, Slovakia
| | - Mária Kožurková
- Department of Biochemistry, Faculty of Science, Pavol Jozef Šafárik University in Košice, Moyzesova 11, 040 01, Košice, Slovakia
| | - Kristína Krochtová
- Department of Biochemistry, Faculty of Science, Pavol Jozef Šafárik University in Košice, Moyzesova 11, 040 01, Košice, Slovakia
| | - Simona Sovová
- Department of Biochemistry, Faculty of Science, Pavol Jozef Šafárik University in Košice, Moyzesova 11, 040 01, Košice, Slovakia
| | - Zuzana Tóthová
- Department of Medical Biology, Faculty of Medicine, Pavol Jozef Šafárik University in Košice, Trieda SNP 1, 040 11, Košice, Slovakia
| | - Zuzana Guľášová
- Center of Clinical and Preclinical Research MEDIPARK, Faculty of Medicine, Pavol Jozef Šafárik University in Košice, Trieda SNP 1, 040 11, Košice, Slovakia
| | - Peter Popelka
- Department of Food Hygiene, Technology and Safety, University of Veterinary Medicine and Pharmacy in Košice, Komenského 73, 041 81, Košice, Slovakia
| | - Peter Solár
- Department of Medical Biology, Faculty of Medicine, Pavol Jozef Šafárik University in Košice, Trieda SNP 1, 040 11, Košice, Slovakia.
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3
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Vachiramon V, Tanratana P, Anuntrangsee T, Palakornkitti P, Yeesibsean N, Kungvalpivat P, Fabi S. The role of topical capsaicin gel in pain management during microfocused ultrasound treatment for neck laxity. Skin Res Technol 2023; 29:e13240. [PMID: 36382669 PMCID: PMC9838747 DOI: 10.1111/srt.13240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 10/29/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND The transient receptor potential vanilloid 1 (TRPV1) provides a heat and pain sensation (nociception). Capsaicin, a TRPV1 agonist, has been shown to induce a refractory period in the nerve terminal expressing TRPV1 and create long-term nerve terminal defunctionalization. OBJECTIVE To evaluate the efficacy of capsaicin for pain reduction during microfocused ultrasound with visualization (MFU-V) treatment. METHODS AND MATERIALS A randomized, split-side study including 24 subjects was conducted. A combined 0.025% capsaicin gel and topical anesthetic were randomly applied on one side of the neck, and a topical anesthetic monotherapy was applied on the contralateral side for 30 min before MFU-V treatment. Pain score (visual analog scale, 0-10) was evaluated at T1 (before MFU-V), T2a (after the 4.5-mm transducer treatment), T2b (after the 3.0-mm transducer treatment), and T3 (after the entire treatment). Side effects were recorded. RESULTS Mean pain scores at T2a for combined and single regimens were 5.19 (±2.26) and 6.91 (±1.72), respectively (p < 0.001). The capsaicin-treated side had a lower pain score at T2b and T3 (p < 0.001). Redness was longer on the capsaicin-treated side (112.67 vs. 10.68 min, p < 0.001). No other adverse events including contact dermatitis were reported. CONCLUSION A single application of a combined 0.025% capsaicin gel with topical anesthesia produces a significantly lesser pain score during the MFU-V treatment. Defunctionalization of TRPV1 may explain the alleviation of painful sensations caused by heat from MFU-V.
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Affiliation(s)
- Vasanop Vachiramon
- Division of Dermatology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pansakorn Tanratana
- Department of Pharmacology, Faculty of Science, Mahidol University, Bangkok, Thailand
| | - Tanaporn Anuntrangsee
- Division of Dermatology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pasita Palakornkitti
- Division of Dermatology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nitina Yeesibsean
- Division of Dermatology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Division of Dermatology, Department of Medicine, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Pintusorn Kungvalpivat
- Division of Dermatology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sabrina Fabi
- Cosmetic Laser Dermatology, San Diego, California, USA.,University of California, San Diego, California, USA
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4
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Cabañero D, Villalba-Riquelme E, Fernández-Ballester G, Fernández-Carvajal A, Ferrer-Montiel A. ThermoTRP channels in pain sexual dimorphism: new insights for drug intervention. Pharmacol Ther 2022; 240:108297. [PMID: 36202261 DOI: 10.1016/j.pharmthera.2022.108297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/25/2022] [Accepted: 09/29/2022] [Indexed: 11/30/2022]
Abstract
Chronic pain is a major burden for the society and remains more prevalent and severe in females. The presence of chronic pain is linked to persistent alterations in the peripheral and the central nervous system. One of the main types of peripheral pain transducers are the transient receptor potential channels (TRP), also known as thermoTRP channels, which intervene in the perception of hot and cold external stimuli. These channels, and especially TRPV1, TRPA1 and TRPM8, have been subjected to profound investigation because of their role as thermosensors and also because of their implication in acute and chronic pain. Surprisingly, their sensitivity to endogenous signaling has been far less studied. Cumulative evidence suggests that the function of these channels may be differently modulated in males and females, in part through sexual hormones, and this could constitute a significant contributor to the sex differences in chronic pain. Here, we review the exciting advances in thermoTRP pharmacology for males and females in two paradigmatic types of chronic pain with a strong peripheral component: chronic migraine and chemotherapy-induced peripheral neuropathy (CIPN). The possibilities of peripheral druggability offered by these channels and the differential exploitation for men and women represent a development opportunity that will lead to a significant increment of the armamentarium of analgesic medicines for personalized chronic pain treatment.
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Affiliation(s)
- David Cabañero
- Instituto de Investigación, Desarrollo e Innovación en Biotecnología Sanitaria de Elche (IDiBE), Universitas Miguel Hernández, 03202 Elche, Spain
| | - Eva Villalba-Riquelme
- Instituto de Investigación, Desarrollo e Innovación en Biotecnología Sanitaria de Elche (IDiBE), Universitas Miguel Hernández, 03202 Elche, Spain
| | - Gregorio Fernández-Ballester
- Instituto de Investigación, Desarrollo e Innovación en Biotecnología Sanitaria de Elche (IDiBE), Universitas Miguel Hernández, 03202 Elche, Spain
| | - Asia Fernández-Carvajal
- Instituto de Investigación, Desarrollo e Innovación en Biotecnología Sanitaria de Elche (IDiBE), Universitas Miguel Hernández, 03202 Elche, Spain
| | - Antonio Ferrer-Montiel
- Instituto de Investigación, Desarrollo e Innovación en Biotecnología Sanitaria de Elche (IDiBE), Universitas Miguel Hernández, 03202 Elche, Spain.
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5
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Leavell Y, Simpson DM. The role of the capsaicin 8% patch in the treatment of painful diabetic peripheral neuropathy. Pain Manag 2022; 12:595-609. [PMID: 35152709 DOI: 10.2217/pmt-2021-0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Treatment of painful diabetic peripheral neuropathy (PDPN) is challenging and often limited by drug tolerability and adverse effects. This review article focuses on the high-dose (8%) capsaicin patch that allows for improved efficacy and reduced application frequency in comparison to low-dose capsaicin formulations. Systemic absorption is minimal resulting in fewer systemic side effects than first-line oral medications. There is evidence that capsaicin patch treatment is well-tolerated, safe and provides effective pain relief maintained for several weeks; well-powered studies are needed to confirm these findings. The capsaicin 8% patch may benefit patients at high risk for adverse effects from oral medication, polypharmacy or inadequate pain relief from first-line therapies.
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Affiliation(s)
- Yaowaree Leavell
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA
| | - David M Simpson
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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Tan HL, Smith JG, Hoffmann J, Renton T. A systematic review of treatment for patients with burning mouth syndrome. Cephalalgia 2022; 42:128-161. [PMID: 34404247 PMCID: PMC8793318 DOI: 10.1177/03331024211036152] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 06/29/2021] [Accepted: 07/13/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Burning mouth syndrome is a chronic idiopathic intractable intraoral dysaesthesia that remains a challenge to clinicians due to its poorly understood pathogenesis and inconsistent response to various treatments. AIM This review aimed to study the short- (≤3 months) and long-term (>3 months) effectiveness and sustainable benefit of different burning mouth syndrome treatment strategies and the associated side effects. MATERIALS AND METHODS Randomised controlled trials of burning mouth syndrome treatment compared with placebo or other interventions with a minimum follow up of 2 months were searched from the PubMed, Embase and Cochrane database (published to July 2020). RESULTS Twenty-two studies were selected based on the inclusion and exclusion criteria and analysed. Nine categories of burning mouth syndrome treatment were identified: Anticonvulsant and antidepressant agents, phytomedicine and alpha lipoic acid supplements, low-level laser therapy, saliva substitute, transcranial magnetic stimulation, and cognitive behaviour therapy. Cognitive behaviour therapy, topical capsaicin and clonazepam, and laser therapy demonstrated favourable outcome in both short- and long-term assessment. Phytomedicines reported a short-term benefit in pain score reduction. The pooled effect of alpha lipoic acid (ALA) pain score improvement was low, but its positive effects increased in long term assessment. CONCLUSION A more significant volume in terms of sample size, multi-centres, and multi-arm comparison of therapeutic agents with placebo and longitudinal follow-up studies is recommended to establish a standardised burning mouth syndrome treatment protocol. Further studies are required to assess the analgesic benefits of topical clonazepam and capsaicin, alternative medicines with neurodegenerative prevention capability and psychology support in treating burning mouth syndrome and reducing systemic adverse drug reactions.Registration International Prospective Register of Systematic Reviews (PROSPERO):Protocol ID - CRD42020160892.
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Affiliation(s)
- Huann Lan Tan
- Faculty of Dentistry, Oral & Craniofacial Science, King’s College London, London, UK
- Faculty of Dentistry, The National University of Malaysia, Kuala Lumpur, Malaysia
| | - Jared G Smith
- Population Health Research Institute, St George’s, University of London, London, UK
| | - Jan Hoffmann
- Wolfson Centre for Age-Related Diseases, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- NIHR-Wellcome Trust King’s Clinical Research Facility/SLaM Biomedical Research Centre, King’s College Hospital, London, UK
| | - Tara Renton
- Faculty of Dentistry, Oral & Craniofacial Science, King’s College London, London, UK
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7
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Dupoiron D, Jubier-Hamon S, Seegers V, Bienfait F, Pluchon YM, Lebrec N, Jaoul V, Delorme T. Peripheral Neuropathic Pain Following Breast Cancer: Effectiveness and Tolerability of High-Concentration Capsaicin Patch. J Pain Res 2022; 15:241-255. [PMID: 35136354 PMCID: PMC8817739 DOI: 10.2147/jpr.s341378] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/03/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Data supporting the use of high-concentration capsaicin patches (HCCPs) in breast cancer (BC) patients and BC survivors (BCSs) with peripheral neuropathic pain (PNP) are limited. This observational study evaluated the effectiveness and safety of HCCP applications in BCSs/BC patients with PNP. Patients and Methods Data from all patients treated with HCCP in the pain department of a French comprehensive cancer centre were collected from 01-Jan-2014 to 14-Oct-2020. Independent pain specialists completed the Clinical Global Impression of Change (CGIC) for each included patient based on data extracted from patient’s electronic medical record compiled by the treating pain specialist after each HCCP application. Results Patients (N=279; mean age: 59.2 years; previous history of PNP medication: 54.5%) received on average 4.1 repeated HCCP applications (1141 HCCP applications); 68.8% received HCCP as an add-on to systemic therapy and 27.9% as first-line therapy. PNP was most frequently caused by surgery (62.4%) followed by chemotherapy (11.8%) and radiotherapy (6.5%). A complete or important analgesic effect was reported at least once by 82.3% of patients. A 6.0% reported no effect at all. For post-surgical PNP existing for <12 months and >10 years an important or complete effect was observed for 70.7% and 56.0% of applications. For chemotherapy- or radiotherapy-induced PNP, this important or complete effect was observed for 52.7% and 52.3% of applications, respectively. HCCP application was associated with site reactions in 54.4% of patients (mainly burning sensation or pain, 45.9%, or erythema, 30.8%) and high blood pressure in 7.2%. Conclusion This real-world chart review provides important effectiveness and safety information to clinicians when considering topical options to treat PNP in BCSs/BC patients.
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Affiliation(s)
- Denis Dupoiron
- Département Anesthésie – Douleur, Institut de Cancérologie de l’Ouest, Angers, France
- Correspondence: Denis Dupoiron, Département Anesthésie – Douleur, Institut de Cancérologie de l’Ouest, Angers, France, Tel +33 2 41 35 28 73, Email
| | - Sabrina Jubier-Hamon
- Département Anesthésie – Douleur, Institut de Cancérologie de l’Ouest, Angers, France
| | - Valerie Seegers
- Département de biométrie, Institut de Cancérologie de l’Ouest, Angers, France
| | - Florent Bienfait
- Département Anesthésie – Douleur, Institut de Cancérologie de l’Ouest, Angers, France
| | - Yves Marie Pluchon
- Centre d’étude et de traitement de la douleur (CETD), Centre hospitalier départemental Vendée, La Roche-sur-Yon, France
| | - Nathalie Lebrec
- Département Anesthésie – Douleur, Institut de Cancérologie de l’Ouest, Angers, France
| | - Virginie Jaoul
- Département Anesthésie – Douleur, Institut de Cancérologie de l’Ouest, Angers, France
| | - Thierry Delorme
- Département Anesthésie – Douleur, Institut de Cancérologie de l’Ouest, Angers, France
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8
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Capsaicin 8% Dermal Patch for Neuropathic Pain in a Pain Unit. Pain Manag Nurs 2022; 23:452-457. [DOI: 10.1016/j.pmn.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 12/06/2021] [Accepted: 12/30/2021] [Indexed: 11/30/2022]
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9
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Capsaicin 8% Patch and Chronic Postsurgical Neuropathic Pain. J Pers Med 2021; 11:jpm11100960. [PMID: 34683101 PMCID: PMC8537698 DOI: 10.3390/jpm11100960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 09/23/2021] [Accepted: 09/25/2021] [Indexed: 01/19/2023] Open
Abstract
(1) Background: Surgery is a frequent cause of persistent pain, defined chronic post-surgical pain (CPSP). The capsaicin 8% patch (Qutenza®) is approved for the treatment of postherpetic neuralgia (PHN) and for diabetic peripheral neuropathy (DPN) of the feet. We propose a review of the literature on use of the capsaicin 8% patch to treat neuropathic pain associated with surgery; (2) Methods: We identified the articles by searching electronic databases using a combination of such terms as “capsaicin 8% patch”, “Qutenza®”, and “chronic postsurgical pain”; (3) Results: We identified 14 selected studies reporting on a total of 632 CPSP cases treated with capsaicin 8% patch. Treatment with the capsaicin 8% patch significantly reduced the average pain intensity. Only 5 studies reported adverse events (AEs) after the patch application. The most common AEs were erythema, burning sensation and pain; (4) Conclusions: Our review indicate that capsaicin 8% patch treatment for CPSP is effective, safe and well tolerated, but randomized controlled trials on efficacy, safety and tolerability should be conducted.
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Casale R. Capsaicin 179-mg cutaneous patch in the treatment of post-surgical neuropathic pain: a scoping review of current evidence and place in therapy. Expert Rev Neurother 2021; 21:1147-1158. [PMID: 34461799 DOI: 10.1080/14737175.2021.1974842] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The use of topical agents has been suggested for post-surgical neuropathic pain. A high-concentration capsaicin 179-mg cutaneous patch (Qutenza™) is licensed in adults for chronic neuropathic pain in the EU, and neuropathic pain with post-herpetic neuralgia and neuropathic pain with diabetic peripheral neuropathy in the USA. This article aims to describe the use of a topical capsaicin 179-mg cutaneous patch in the treatment of PSNP. AREA COVERED This narrative review presents the relevant clinical aspects of the use of a topical capsaicin 179-mg cutaneous patch for the treatment of post-surgical neuropathic pain (PSNP). Randomized control trials, observational studies, case series, and reports investigating the clinical use of the capsaicin patch were searched through MEDLINE, EMBASE, AMED, Cochrane Library, CINAHL, Web of Science, and ROAD databases. Trials from citation lists of reviewed articles and hand-searching were added. The search concluded in September 2020. 10/20 articles were considered. EXPERT OPINION Some clinical studies demonstrated the efficacy of the capsaicin 179-mg patch in PSNP as monotherapy and concomitant treatment with oral treatments. This topical treatment of PSNP is better tolerated and accepted compared with systemic treatments. To maximize the effectiveness of the treatment, correct administration recommendations should be followed.
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Affiliation(s)
- Roberto Casale
- Opusmedica Persons, Care & Research - PC&R, Piacenza, Italy
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11
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Capsaicin 8% patch Qutenza and other current treatments for neuropathic pain in chemotherapy-induced peripheral neuropathy (CIPN). Curr Opin Support Palliat Care 2021; 15:125-131. [PMID: 33905384 DOI: 10.1097/spc.0000000000000545] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE OF REVIEW Current oral treatments for neuropathic pain associated with chemotherapy-induced peripheral neuropathy (CIPN) have limited clinical efficacy, and undesirable side-effects. Topically delivered treatments have the advantage of avoiding CNS side-effects, while relieving pain. We have reviewed treatments of neuropathic pain associated with CIPN, focusing on the Capsaicin 8% patch, which can provide pain relief for up to 3 months or longer after a single 30-60-min application. RECENT FINDINGS Capsaicin 8% patch is a licensed treatment in the EU/UK for neuropathic pain and shown to be safe and effective in providing pain relief for patients with CIPN. Repeated daily oral or topical administrations are not required, as with other current treatments. The side-effects are transient and restricted to the time around patch application. New evidence suggests the Capsaicin 8% patch can promote the regeneration and restoration of skin nerve fibres in CIPN, in addition to the pain relief. SUMMARY The Capsaicin 8% patch is now often a preferred a treatment option for localised neuropathic pain conditions, including the feet and hands in patients with CIPN. Capsaicin 8% patch can be repeated three-monthly, if needed, for a year. In addition to pain relief, it may have a disease-modifying effect.
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12
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Zhang D, Sun X, Battino M, Wei X, Shi J, Zhao L, Liu S, Xiao J, Shi B, Zou X. A comparative overview on chili pepper (capsicum genus) and sichuan pepper (zanthoxylum genus): From pungent spices to pharma-foods. Trends Food Sci Technol 2021. [DOI: 10.1016/j.tifs.2021.03.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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13
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Maihöfner C, Diel I, Tesch H, Quandel T, Baron R. Chemotherapy-induced peripheral neuropathy (CIPN): current therapies and topical treatment option with high-concentration capsaicin. Support Care Cancer 2021; 29:4223-4238. [PMID: 33624117 PMCID: PMC8236465 DOI: 10.1007/s00520-021-06042-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 02/03/2021] [Indexed: 12/25/2022]
Abstract
Cancer diagnosis and treatment are drastic events for patients and their families. Besides psychological aspects of the disease, patients are often affected by severe side effects related to the cancer itself or as a result of therapeutic interventions. Particularly, chemotherapy-induced peripheral neuropathy (CIPN) is the most prevalent neurological complication of oral or intravenous chemotherapy. The disorder may require dose reduction of chemotherapy and is accompanied by multiple symptoms with long-term functional impairment affecting quality of life (QoL), e.g., sensory and functional deteriorations as well as severe pain. Although CIPN may reverse or improve after termination of the causative chemotherapy, approximately 30–40% of patients are faced with chronicity of the symptoms. Due to the advantages in cancer diagnosis and treatments, survival rates of cancer patients rise and CIPN may occur even more frequently in the future. In this review, we summarize current recommendations of leading national and international societies regarding prevention and treatment options in CIPN. A special focus will be placed on current evidence for topical treatment of CIPN with high-dose capsaicin. Finally, an algorithm for CIPN treatment in clinical practice is provided, including both pharmacologic and non-pharmacologic modalities based on the clinical presentation.
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Affiliation(s)
- Christian Maihöfner
- Department of Neurology, Fürth General Hospital, Jakob-Henle-Straße 1, 90766, Fürth, Germany.
| | - Ingo Diel
- Praxisklinik Am Rosengarten, Mannheim, Germany
| | - Hans Tesch
- Department of Oncology, Bethanien Hospital, Frankfurt am Main, Germany
| | | | - Ralf Baron
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
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14
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Herbal Medicine for Pain Management: Efficacy and Drug Interactions. Pharmaceutics 2021; 13:pharmaceutics13020251. [PMID: 33670393 PMCID: PMC7918078 DOI: 10.3390/pharmaceutics13020251] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/01/2021] [Accepted: 02/04/2021] [Indexed: 11/29/2022] Open
Abstract
Complementary and alternative medicines such as herbal medicines are not currently part of the conventional medical system. As the popularity of and global market for herbal medicine grows among all age groups, with supporting scientific data and clinical trials, specific alternative treatments such as herbal medicine can be reclassified as a practice of conventional medicine. One of the most common conditions for which adults use herbal medicine is pain. However, herbal medicines carry safety concerns and may impact the efficacy of conventional therapies. Unfortunately, mechanisms of action are poorly understood, and their use is unregulated and often underreported to medical professionals. This review aims to compile common and available herbal medicines which can be used as an alternative to or in combination with conventional pain management approaches. Efficacy and safety are assessed through clinical studies on pain relief. Ensuing herb–drug interactions such as cytochrome modulation, additive and synergistic effects, and contraindications are discussed. While self-management has been recognized as part of the overall treatment strategy for patients suffering from chronic pain, it is important for practitioners to be able to also optimize and integrate herbal medicine and, if warranted, other complementary and alternative medicines into their care.
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Abrams RMC, Pedowitz EJ, Simpson DM. A critical review of the capsaicin 8% patch for the treatment of neuropathic pain associated with diabetic peripheral neuropathy of the feet in adults. Expert Rev Neurother 2021; 21:259-266. [PMID: 33428495 DOI: 10.1080/14737175.2021.1874920] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Diabetes is an increasingly prevalent disorder affecting nearly 1-in-5 adults, of which half will experience diabetic peripheral neuropathy (DPN) and a quarter will suffer from diabetic peripheral nerve pain (DPNP), severely impacting quality of life. The currently approved treatment options are typically centrally acting agents whose use is limited by systemic effects and drug interactions. The capsaicin 8% dermal patch was recently approved by the U.S. FDA for the treatment of DPNP. AREAS COVERED The authors review the available literature regarding the use of high-concentration capsaicin 8% patch for the treatment of diabetic peripheral neuropathy and neuropathic pain and discuss implementing its use in clinical practice. EXPERT OPINION The high-concentration capsaicin 8% patch is an effective and well-tolerated treatment option for treating DPNP. Capsaicin 8% patch may be used alone or in combination with other oral therapies and can provide rapid and sustained neuropathic pain relief following a single application and is safe and effective when used long term.
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Affiliation(s)
- Rory M C Abrams
- Neurology, Mount Sinai School of Medicine, 1468 Madison Avenue, New York, NY 10019
| | - Elizabeth J Pedowitz
- Department of Geriatrics and Palliative Medicine, Mount Sinai School of Medicine, 1468 Madison Avenue, New York, 10029, NY
| | - David M Simpson
- Neurology, Mount Sinai School of Medicine, 1468 Madison Avenue, New York, NY 10019
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Huygen F, Kern KU, Pérez C. Expert Opinion: Exploring the Effectiveness and Tolerability of Capsaicin 179 mg Cutaneous Patch and Pregabalin in the Treatment of Peripheral Neuropathic Pain. J Pain Res 2020; 13:2585-2597. [PMID: 33116801 PMCID: PMC7569173 DOI: 10.2147/jpr.s263054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/31/2020] [Indexed: 11/23/2022] Open
Abstract
Background and Objective Treatment of peripheral neuropathic pain (PNP) remains a challenge. In the absence of clear predictors of response, clinical decision-making involves trial and error. While many classes of pharmacological agent are used and have shown efficacy, one of the most commonly used first-line treatments is pregabalin. However, in the 60% of PNP cases in which the pain is localized, a local treatment may be more suitable. This article will summarize the evidence for the relative effectiveness and tolerability of the capsaicin 179 mg patch and pregabalin in the treatment of PNP and highlight the expert opinion of the authors based on their own clinical experiences. Results When compared in a head-to-head trial in patients with PNP, capsaicin 179 mg patch provided non-inferior pain relief compared with an optimized dose of pregabalin, as well as a reduction in dynamic mechanical allodynia, faster onset of action, fewer systemic side effects, and greater treatment satisfaction. Adverse events associated with capsaicin patch are mainly application site reactions, compared with systemic and central nervous system effects with pregabalin. Studies indicate that capsaicin 179 mg patch is associated with a lower burden of therapy than pregabalin in terms of improved tolerability, lack of a daily pill burden, lack of drug-drug interactions, and increased regimen flexibility. Conclusion In localized neuropathic pain, evidence supports a pragmatic approach of using a local treatment before considering a systemic treatment. For treatment selection, the patient profile (eg, concomitant medication use, age) and the treatments' efficacy and tolerability profiles should be considered.
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Affiliation(s)
- Frank Huygen
- Department of Anesthesiology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Kai-Uwe Kern
- Institute for Pain Medicine/Pain Practice Wiesbaden, Wiesbaden, Germany
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Modulation of TRPV1 channel function by natural products in the treatment of pain. Chem Biol Interact 2020; 330:109178. [DOI: 10.1016/j.cbi.2020.109178] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 05/22/2020] [Accepted: 06/09/2020] [Indexed: 01/01/2023]
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Bonezzi C, Costantini A, Cruccu G, Fornasari DM, Guardamagna V, Palmieri V, Polati E, Zini P, Dickenson AH. Capsaicin 8% dermal patch in clinical practice: an expert opinion. Expert Opin Pharmacother 2020; 21:1377-1387. [DOI: 10.1080/14656566.2020.1759550] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Cesare Bonezzi
- Pain Therapy Unit, Istituti Clinici Scientifici Maugeri, Pavia, Italy
| | | | - Giorgio Cruccu
- Department of Human Neurosciences, “Sapienza” University of Rome, Rome, Italy
| | - Diego M.M. Fornasari
- Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
| | - Vittorio Guardamagna
- Palliative Care and Pain Therapy Division, IRCCS European Institute of Oncology (IEO), Milan, Italy
| | - Vincenzo Palmieri
- Pain Therapy and Palliative Care Unit, Gaetano Rummo Hospital, Benevento, Italy
| | - Enrico Polati
- Anestesia E Rianimazione, Terapia del Dolore. Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
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[Treatment of polyneuropathy: autonomic symptoms and pain]. Internist (Berl) 2020; 61:270-276. [PMID: 32030435 DOI: 10.1007/s00108-020-00739-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND The treatment of polyneuropathy includes symptomatic therapy of sensory, motor and autonomic dysfunctions. AIM This article provides an overview of the current treatment recommendations for polyneuropathy, focusing on pain. METHODS Current treatment guidelines will be discussed based on a literature research. RESULTS Calcium-channel anticonvulsants gabapentin/pregabalin as well as antidepressants duloxetine and amitriptyline are recommended as first line therapeutics. Alternatively, topical therapeutics can be used in the case of localized disorders. In individual cases, opioids or other antidepressants/anticonvulsants may be effective. Pharmacological treatment is often limited due to adverse events, which affect the central nervous system in particular. DISCUSSION In general, treatment for polyneuropathy should follow a multimodal concept and include the treatment of other symptoms. When choosing pain medication, comorbidities, patient's age and adverse events need to be taken into consideration. Phenotype-based stratification may support specialized pain therapy and achieve the best medical treatment.
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Capsaicin 8% dermal patch in peripheral neuropathic pain: a profile of its use. DRUGS & THERAPY PERSPECTIVES 2020. [DOI: 10.1007/s40267-019-00701-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Anand P, Dickenson A, Finco G, Marinangeli F, Polati E, Romualdi P, Tzschentke TM, Canonico PL. Novel insights on the management of pain: highlights from the ‘Science of Relief’ meeting. Pain Manag 2019; 9:521-533. [DOI: 10.2217/pmt-2019-0031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The ‘Science of Relief’ event, held in Milan on 10–11 May 2019, was aimed at promoting dialog between different stakeholders among scientific associations, pharma industry, healthcare services and related institutions. The goal was to renew interest and attention on the management of pain, sharing new solutions in order to bring the patients and their quality of life to the center of attention. An international group of scientists and clinicians presented and discussed new and known evidence in the field of chronic pain, from physiopathology and diagnosis to the choice of appropriate and timely pharmacological treatments. This paper reports the highlights of those presentations.
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Affiliation(s)
- Praveen Anand
- Department of Neurology, Imperial College London, Hammersmith Hospital, London, UK
| | | | - Gabriele Finco
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università degli Studi di Cagliari. UOC Anestesia e Rianimazione, Centro Terapia del Dolore Azienda Ospedaliero-Universitaria di Cagliari
| | - Franco Marinangeli
- Dipartimento di Medicina clinica, Università degli Studi, Sanità pubblica, Scienza della vita e dell’ambiente dell’Aquila
| | - Enrico Polati
- Anestesia, Rianimazione e Terapia del Dolore, Università di Verona, Verona, Italy
| | - Patrizia Romualdi
- Dipartimento di Farmacia e Biotecnologie, Università di Bologna, Bologna
| | | | - Pier Luigi Canonico
- Dipartimento di Scienze del Farmaco, Università del Piemonte Orientale “Amedeo Avogadro”, Novara, Italy
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[Long-term effectiveness of topical analgesics]. Schmerz 2019; 34:21-32. [PMID: 31562537 DOI: 10.1007/s00482-019-00416-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Neuropathic pain consistently presents a significant therapeutic challenge. Topically applied analgesics have the advantage of showing low systemic side effects, but data on long-term effectiveness are lacking. Consequently, interviews were carried out with all patients being treated with topical analgesics in hospital. METHODS Ethics 16-5690, German Clinical Trials Register (DRKS) 00011877. Between 2008 and 2017 a total of 265 patients were treated at least once with either capsaicin 8% (C), lidocaine 5% (L) and/or perineural botulinum toxin type A (B). From this sample, 205 patients (77%) were interviewed by telephone for feedback on pain reduction (first/last treatment: low/moderate/very good), the possible reduction of analgesic prescription and if applicable the reasons for discontinuation of use (time of interview C: 26 ± 19 months, L: 61 ± 23 months, B: 11 ± 6 months after start). Further pretreatment data and diagnoses were obtained from the in-house documentation system. Responders or long-term responders were defined as patients with at least one moderate pain reduction after the first or last treatment, as long as the effect was adequately maintained. RESULTS In all treatment groups (56 ± 13 years, 62% male, C: 80, L: 84, B: 58 patients) patients with a long history of pain (C: 60 ± 73 months, L: 59 ± 66 months, B: 67 ± 71 months) and high pain intensity (numeric rating scale, NRS, C: 7 ± 2, L: 7 ± 2, B: 6 ± 2), were predominant. The highest primary and long-term responder rates were exhibited by L (57%/60%, B: 52%/37%, C: 23%/15%). With B, long-term responders were most frequently able to reduce analgesic use (74%, C: 58%, L: 38%). DISCUSSION Despite the long duration of the disease, the most used off-label topical drugs L and B demonstrated a high primary response rate (in contrast to C), with most benefiting from long-term treatment.
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Abstract
The adhesive capsaicin dermal patch (Qutenza®) delivers a high concentration (8% w/w) of synthetic capsaicin, a highly selective agonist of transient receptor potential vanilloid-1 (TRPV-1), directly to the site of pain. The capsaicin 8% dermal patch is indicated in the EU for the treatment of peripheral neuropathic pain (PNP) in adults, either alone or in combination with other medicinal products for pain. In patients with painful diabetic peripheral neuropathy, a single 30-min application of the capsaicin 8% dermal patch provided 12 weeks of pain relief and improved sleep quality compared with placebo. Repeat treatment with the capsaicin 8% dermal patch plus standard of care over 52 weeks provided sustained pain relief, with no negative neurological effects compared with standard of care alone. The capsaicin 8% dermal patch was non-inferior to oral pregabalin in relieving pain in patients with non-diabetic PNP, with a faster onset of action and greater treatment satisfaction. A single 60-min application of the capsaicin 8% dermal patch provided rapid and sustained pain relief in patients with postherpetic neuralgia. Results in patients with HIV-associated neuropathy were equivocal, with a significant improvement in pain intensity observed in one trial, but not in the other. The capsaicin 8% dermal patch was generally well tolerated; transient application-site reactions were the most common adverse events. In conclusion, the capsaicin 8% dermal patch is a useful addition to the treatment options currently available for patients with PNP.
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Affiliation(s)
- Hannah A Blair
- Springer, Private Bag 65901, Mairangi Bay, Auckland, 0754, New Zealand.
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Anand P, Elsafa E, Privitera R, Naidoo K, Yiangou Y, Donatien P, Gabra H, Wasan H, Kenny L, Rahemtulla A, Misra P. Rational treatment of chemotherapy-induced peripheral neuropathy with capsaicin 8% patch: from pain relief towards disease modification. J Pain Res 2019; 12:2039-2052. [PMID: 31308732 PMCID: PMC6613356 DOI: 10.2147/jpr.s213912] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 06/13/2019] [Indexed: 12/30/2022] Open
Abstract
Purpose Chemotherapy-induced peripheral neuropathy (CIPN) with associated chronic pain is a common and disabling condition. Current treatments for neuropathic pain in CIPN are largely ineffective, with unfavorable side-effects. The capsaicin 8% patch (capsaicin 179 mg patch) is approved for the treatment of neuropathic pain: a single topical cutaneous application can produce effective pain relief for up to 12 weeks. We assessed the therapeutic potential of capsaicin 8% patch in patients with painful CIPN, and its mechanism of action. Patients and methods 16 patients with chronic painful CIPN (mean duration 2.5 years), in remission for cancer and not receiving chemotherapy, were treated with 30 min application of capsaicin 8% patch to the feet. Symptoms were monitored using the 11-point numerical pain rating scale (NPRS), and questionnaires. Investigations were performed at baseline and three months after patch application, including skin biopsies with a range of markers, and quantitative sensory testing (QST). Results Patients reported significant reduction in spontaneous pain (mean NPRS: −1.27; 95% CI 0.2409 to 2.301; p=0.02), touch-evoked pain (−1.823; p=0.03) and cold-evoked pain (−1.456; p=0.03). Short-Form McGill questionnaire showed a reduction in neuropathic (p=0.0007), continuous (p=0.01) and overall pain (p=0.004); Patient Global Impression of Change showed improvement (p=0.001). Baseline skin biopsies showed loss of intra-epidermal nerve fibers (IENF), and also of sub-epidermal nerve fibers quantified by image analysis. Post-patch application skin biopsies showed a significant increase towards normalization of intra-epidermal and sub-epidermal nerve fibers (for IENF: structural marker PGP9.5, p=0.009; heat receptor TRPV1, p=0.027; regenerating nerve marker GAP43, p=0.04). Epidermal levels of Nerve Growth Factor (NGF), Neurotrophin-3 (NT-3), and Langerhans cells were also normalized. QST remained unchanged and there were no systemic side-effects, as in previous studies. Conclusion Capsaicin 8% patch provides significant pain relief in CIPN, and may lead to regeneration and restoration of sensory nerve fibers ie, disease modification.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Amin Rahemtulla
- Hematology, Imperial College London, Hammersmith Hospital, London W12 0NN, UK
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Perrot S, Lantéri-Minet M. Patients' Global Impression of Change in the management of peripheral neuropathic pain: Clinical relevance and correlations in daily practice. Eur J Pain 2019; 23:1117-1128. [PMID: 30793414 DOI: 10.1002/ejp.1378] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 01/31/2019] [Accepted: 02/17/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Patient-Reported Outcome (PRO) instruments have been developed to evaluate pain management in daily practice; the Patients' Global Impression of Change (PGIC) is particularly recommended by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials. The prospective non-interventional multicenter PRO-QURE study aimed at assessing correlations between PGIC and pain measurements and treatment effects in patients followed in French pain centres. METHODS Respectively, 495 and 379 patients with peripheral neuropathic pain initiating treatment with capsaicin 8% cutaneous patch(es) (female, 62.6%; mean age, 54.0 ± 14.8 years; post-surgical or traumatic pain, 52.7%; mean pain duration, 42.2 ± 54.1 months; DN4 score >4, 92.9%) completed the PGIC and several other PRO instruments before (baseline) and 3 months (M3) after treatment application. RESULTS At M3, improvement ("much improved" or "very much improved") was observed in 23.0% of patients, associated with decreases of -3.0 ± 2.2, -2.5 ± 2.4, and -23.1 ± 19.7 in BPI pain intensity, BPI pain interference and NPSI total scores, respectively. The highest Spearman's rank correlation coefficients with PGIC were found for pain intensity (BPI: r = -0.479, p < 0.001), satisfaction with current state (Patient Acceptable Symptomatic State: r = 0.455, p < 0.001), and treatment effectiveness (TSQM: r = 0.431, p < 0.001); correlation coefficients were lower for all NPSI scores, BPI pain interference score, HAD scores and EQ-5D-3L index. CONCLUSIONS In daily clinical practice, significant improvement in peripheral neuropathic pain, as assessed by PGIC scores, significantly correlated with changes in well-established measures of pain intensity, pain interference with activities of daily living, mood and quality of life, confirming its clinical interest as PRO measure in real-world conditions. SIGNIFICANCE Clinically important improvement in peripheral neuropathic pain, as assessed by PGIC scores, significantly correlated with well-established measures of pain intensity, pain interference in daily life and treatment efficacy. This result, associated with the ease of administration and scoring, encourages the widespread use of the PGIC in daily practice.
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Affiliation(s)
- Serge Perrot
- INSERM U987, Centre d'Evaluation et de Traitement de la Douleur, Hôpital Cochin, Assistance Publique des Hôpitaux de Paris (AP-HP), Université Paris Descartes, Paris, France
| | - Michel Lantéri-Minet
- Département d'Evaluation et Traitement de la Douleur, Centre Hospitalier Universitaire (CHU) de Nice, Fédération Hospitalo-Universitaire InovPain, Université Côte d'Azur, Nice, France.,INSERM/UdA, U1107, Neuro-Dol, Université d'Auvergne, Clermont-Ferrand, France
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Lantéri-Minet M, Perrot S. QAPSA: post-marketing surveillance of capsaicin 8% patch for long-term use in patients with peripheral neuropathic pain in France. Curr Med Res Opin 2019; 35:417-426. [PMID: 30550354 DOI: 10.1080/03007995.2018.1558850] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To describe the characteristics of patients treated with the capsaicin 8% patch, prescribing conditions, long-term effects of repeat treatment on pain intensity and perception, quality of life, and impact on concomitant medication. METHODS A national, longitudinal, prospective, non-interventional, post-marketing open study was conducted in 50 French pain centers. Adult volunteer non-diabetic patients with peripheral neuropathic pain receiving capsaicin 8% patch treatment were consecutively enrolled. Treatment could be repeated over a 12-month period, with 6 months' follow-up after last application. RESULTS A total of 684 patients (age: 53.0 ± 14.9 years, mean ± standard deviation; post-traumatic/surgical peripheral neuropathic pain: 76.3%; pain intensity: 6.2 ± 1.7; pain duration: 3.0 years, median) were treated with 1 to 5 patches at 3/4 month intervals; 70.3% were naive to capsaicin 8% patch treatment at inclusion. Six months after last application, treatment was considered as successful for 21.8% (95% confidence interval: 17.5%-26.7%) of patients by a stringent criterion combining improvement according to the patient's global impression of change (PGIC) and at least 30% improvement on a numerical pain rating scale (NPRS). Clinically relevant improvement in health-related quality of life was observed at end-of-study. No unexpected safety concerns were observed with capsaicin 8% patch repeat treatment. CONCLUSIONS The data of this post-marketing study meets the request by the French authorities for additional data on conditions of use in everyday practice. They confirmed the tolerance and long-term effect of capsaicin 8% patch in patients with peripheral neuropathic pain in real-world conditions.
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Affiliation(s)
- Michel Lantéri-Minet
- a Département d'Evaluation et Traitement de la Douleur , Centre Hospitalier Universitaire (CHU) de Nice, Fédération Hospitalo-Universitaire InovPain, Université Côte d'Azur , France
- b INSERM/UdA, Neuro-Dol , Université d'Auvergne , France
| | - Serge Perrot
- c Centre d'Evaluation et de Traitement de la Douleur, Hôpital Cochin, Assistance Publique des Hôpitaux de Paris (AP-HP), Université Paris Descartes , Paris , France
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Aitken E, McColl G, Kingsmore D. The Role of Qutenza® (Topical Capsaicin 8%) in Treating Neuropathic Pain from Critical Ischemia in Patients with End-Stage Renal Disease: An Observational Cohort Study. PAIN MEDICINE 2018; 18:330-340. [PMID: 28204726 DOI: 10.1093/pm/pnw139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective Current treatment strategies for painful critical ischemia in patients with end-stage renal disease (ESRD) are suboptimal. A drug that is non-renally excreted has minimal systemic absorption and does not require dose adjustment in renal failure is attractive. The aim of this study was to evaluate the safety and efficacy of Qutenza® (topical capsaicin 8%) for chronic neuropathic pain from critical ischemia in patients with ESRD. Design and Setting A prospective cohort study was conducted in a single-center, university teaching hospital. Patients Twenty patients with ESRD were treated with Qutenza® for neuropathic pain from critical limb ischemia. Methods Patients were followed-up at 1, 6 and 12 weeks post-treatment. The primary end point was the difference in visual analog scale (VAS) between baseline and week 12. Secondary end points were Brief Pain Inventory questionnaire (BPI) scores, quality of life assessment (EQ-5D) and patient global impression of change (PGIC). Safety and tolerability data were also collected. The trial was prospectively registered with clinical trials databases (EudraCT: 2012-001586-32; NCT01704313). Results There was significant reduction in VAS from baseline to week 12 (-20+/-7%; P = 0.02). There was a significant reduction in all seven domains of the BPI. Quality of life also improved at 12 weeks following treatment in two of the EQ-5D domains (mobility and pain). Qutenza® was well tolerated with no significant side effects in this patient cohort, which included 20% diabetics. Conclusions In this small, observational study Qutenza® treatment has been shown to be effective and well-tolerated to treat neuropathic pain from critical ischemia in patients with ESRD.
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Affiliation(s)
- Emma Aitken
- Department of Renal Surgery, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
| | - Gillian McColl
- Department of Renal Surgery, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
| | - David Kingsmore
- Department of Renal Surgery, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
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Capsaicin 8% Patch Repeat Treatment in Nondiabetic Peripheral Neuropathic Pain: A 52-Week, Open-Label, Single-Arm, Safety Study. Clin J Pain 2018; 33:921-931. [PMID: 28872473 DOI: 10.1097/ajp.0000000000000473] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To investigate the long-term safety and tolerability of capsaicin 8% patch repeat treatment in nondiabetic patients with peripheral neuropathic pain. METHODS A prospective, open-label, observational study in patients with postherpetic neuralgia, posttraumatic or postsurgical nerve injury, HIV-associated distal sensory polyneuropathy, or other peripheral neuropathic pain, and average daily pain score ≥4, who received ≤6 capsaicin 8% patch treatments over 52 weeks according to clinical need (retreatment at 9 to 12 wk intervals). Sensory testing and analgesic effectiveness were assessed using "bedside tests" and Brief Pain Inventory (question 5). RESULTS Overall, 306 patients received treatment. Treatment-emergent adverse events (TEAEs) and drug-related TEAEs were reported by 252 (82.4%) and 207 (67.6%) patients. Application site pain was the most common drug-related TEAE (n=112, 36.6%); no drug-related serious TEAEs were reported. Sensory category shift analyses from baseline to end of study (EoS) in patients attending at least 2 sensory visits (n=278 for all tests except warm, n=277) found sensory deterioration/loss in at least 1 modality in 50.4% (n=140); deterioration/loss in 1, 2, 3, 4, or 5 modalities occurred in 26.6% (n=74), 14.0% (n=39), 5.8% (n=16), 2.5% (n=7), and 1.4% (n=4) cases. Newly emergent hyperesthesia or allodynia was apparent in 1.1% to 3.6% of the cases (depending on modality) by EoS. Between 25.2% and 32.0% of patients reported improvement in a sensory modality by EoS. Average daily pain was 6.6 and 4.7 at baseline and month 12. CONCLUSIONS Generally, capsaicin 8% patch repeat treatment over 52 weeks was well tolerated, with variable alteration in sensory function and minimal chance of complete sensory loss.
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Bardo-Brouard P, Luizard C, Valeyrie-Allanore L, Goujon C, Do B, Colin A, Wolkenstein P, Paul M. High-concentration topical capsaicin in the management of refractory neuropathic pain in patients with neurofibromatosis type 1: a case series. Curr Med Res Opin 2018; 34:887-891. [PMID: 29368950 DOI: 10.1080/03007995.2018.1433142] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIM The aim of this case series was to report the use of 8% topical capsaicin patch (marketed under the trade name Qutenza®) a in the management of refractory neuropathic pain (NP) in adult patients with type 1 neurofibromatosis (NF1). METHODS Capsaicin has been suggested for NF1 patients suffering from refractory peripheral NP despite several years of analgesic treatments. The patch was applied for 60 minutes on the painful area, with tolerability control (blood pressure, intensity of pain and dermal reaction). The evaluation was done at the beginning of treatment and during the 2 months following the first treatment (phone calls at weeks 1, 2, 4 and 8). The primary efficacy criterion was the response rate: a patient was considered to be responding if he or she reported an average relief ≥30% at the time of the follow-up calls. The secondary criteria were: interference scores (QCD), Patient Global Impression of Change (PGIC) and overall treatment satisfaction, self-reported by the patient. RESULTS Eight patients (5 females/3 males, 41.8 ± 8.2 years of age) received a first treatment with capsaicin. Patients had pre-existing pain for 6.6 years (±6.0) and were currently receiving an average of 6.1 (±3.9) different analgesics. The response rate was 37.5%. The three responders felt globally improved and satisfied, with the improvement in overall condition as interference scores decreased. Apart from the expected local reactions, the treatment was not accompanied by systemic side effects. CONCLUSIONS As suggested in this case series, capsaicin provided pain relief in certain NF1 patients with resistant NP. The response rate is that expected in multi-line refractory NP. A significant benefit on the overall condition of some patients was observed. In addition, this topical treatment is administered every 3 months without systemic effects. This study is limited by the small number of patients, but was intended to describe a new and well tolerated alternative treatment.
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Affiliation(s)
- P Bardo-Brouard
- a Pharmacy Department , Henri Mondor University Hospital , Créteil , France
| | - C Luizard
- a Pharmacy Department , Henri Mondor University Hospital , Créteil , France
| | - L Valeyrie-Allanore
- b Dermatology Department , Neurofibromatosis Reference Center, Henri Mondor University Hospital , Créteil , France
| | - C Goujon
- c Neurosurgery Department , Henri Mondor University Hospital , Créteil , France
| | - B Do
- a Pharmacy Department , Henri Mondor University Hospital , Créteil , France
- d Université Paris Sud, UFR de Pharmacie , Châtenay-Malabry , France
| | - A Colin
- b Dermatology Department , Neurofibromatosis Reference Center, Henri Mondor University Hospital , Créteil , France
| | - P Wolkenstein
- b Dermatology Department , Neurofibromatosis Reference Center, Henri Mondor University Hospital , Créteil , France
| | - M Paul
- a Pharmacy Department , Henri Mondor University Hospital , Créteil , France
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Hansson P, Jensen TS, Kvarstein G, Strömberg M. Pain-relieving effectiveness, quality of life and tolerability of repeated capsaicin 8% patch treatment of peripheral neuropathic pain in Scandinavian clinical practice. Eur J Pain 2018; 22:941-950. [PMID: 29388284 PMCID: PMC5947653 DOI: 10.1002/ejp.1180] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2017] [Indexed: 11/15/2022]
Abstract
Context Clinical trials have demonstrated the efficacy and safety of the capsaicin 8% patch in patients with peripheral neuropathic pain (PNP); however, few studies have assessed this treatment in a clinical practice. Objective To determine whether treatment and re‐treatment with the capsaicin 8% patch reduce PNP intensity in clinical practice. Methods Three non‐interventional, observational studies were concurrently conducted in Denmark, Norway and Sweden. Patients with probable or definite PNP received one or two treatments with the capsaicin 8% patch according to usual clinical practice. All analyses were performed on combined data. Results Overall, 382 and 181 patients received treatment and re‐treatment, respectively, with the capsaicin 8% patch. At the group level, a significant reduction in mean level of ‘usual pain’ intensity (Numerical Pain Rating Scale) over the last 24 h’ score was observed from baseline to Weeks 2 through 8 [−1.05 (95% confidence interval: −1.27, 0.82); p < 0.001] with 28% and 31% of patients reporting a ≥30% reduction in pain after first treatment and re‐treatment, respectively. Improvements in health‐related quality of life (EQ‐5D‐3L index) and overall health status (Patient Global Impression of Change) were observed early (Week 1) and throughout the treatment periods. Most application site reactions subsided within a week after treatment. Following treatment and re‐treatment, 57% and 71% of patients, respectively, were willing to undergo further treatment with the capsaicin 8% patch. Conclusion In Scandinavian clinical practice, capsaicin 8% patch treatment was associated with significant reductions in pain intensity and was well tolerated with over half of patients willing to undergo re‐treatment.
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Affiliation(s)
- P Hansson
- Department of Molecular Medicine & Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Pain Research & Treatment, Division of Emergencies and Critical Care, Oslo University Hospital, Norway
| | - T S Jensen
- Department of Neurology and Danish Pain Research Center, Aarhus University Hospital, Denmark
| | - G Kvarstein
- Department of Pain Research & Treatment, Division of Emergencies and Critical Care, Oslo University Hospital, Norway.,UIT The Arctic University of Norway, Tromsø, Norway
| | - M Strömberg
- Astellas Pharma A/S Nordic Operations, Kastrup, Denmark
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Knezevic NN, Tverdohleb T, Nikibin F, Knezevic I, Candido KD. Management of chronic neuropathic pain with single and compounded topical analgesics. Pain Manag 2017; 7:537-558. [PMID: 29125423 DOI: 10.2217/pmt-2017-0020] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The goal of our review was to emphasize important aspects that physicians should take into consideration when prescribing topical analgesics as part of chronic neuropathic pain treatment. We discuss the dermatopharmacokinetics and microstructural components of the skin, differences between topical and transdermal drug delivery, and topical medication effects on peripheral neuropathy and central sensitization. Even though the US FDA approved topical analgesics are 8%-capsaicin and 5%-lidocaine patches for treating postherpetic neuralgia, there are many other studies conducted on the efficacy of topical ketamine cream, clonidine gel, topical gabapentin, topical baclofen and topical phenytoin for peripheral neuropathic pain, either alone or in combination with other formulations. Furthermore, we discuss new compounded topical analgesics that are becoming more popular and that are showing promising results in the management of chronic peripheral neuropathies. However, more studies are needed for elucidation of the role of topical analgesics and their effects, especially when combined with other treatments.
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Affiliation(s)
- Nebojsa Nick Knezevic
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL 60657, USA.,Department of Anesthesiology, University of Illinois, Chicago, IL 60612, USA.,Department of Surgery, University of Illinois, Chicago, IL 60612, USA
| | - Tatiana Tverdohleb
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL 60657, USA
| | - Farid Nikibin
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL 60657, USA
| | - Ivana Knezevic
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL 60657, USA
| | - Kenneth D Candido
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL 60657, USA.,Department of Anesthesiology, University of Illinois, Chicago, IL 60612, USA.,Department of Surgery, University of Illinois, Chicago, IL 60612, USA
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Baron R, Treede RD, Birklein F, Cegla T, Freynhagen R, Heskamp ML, Kern KU, Maier C, Rolke R, Seddigh S, Sommer C, Ständer S, Maihöfner C. Treatment of painful radiculopathies with capsaicin 8% cutaneous patch. Curr Med Res Opin 2017; 33:1401-1411. [PMID: 28436279 DOI: 10.1080/03007995.2017.1322569] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND OBJECTIVE The treatment of neuropathic pain due to low-back (lumbosacral) radiculopathies, a common source of neuropathic pain, is challenging and often requires a multimodal therapeutic approach. The capsaicin 8% patch is the first topical analgesic licensed for peripheral neuropathic pain. To evaluate this treatment, a subset of patients with painful radiculopathy (lumbar and cervical, including ventral and dorsal rami) enrolled into the multicenter, non-interventional QUEPP study (Qutenza 2 - safety and effectiveness in peripheral neuropathic pain) was analyzed. METHODS Of the 1044 study participants, 50 were diagnosed with painful radiculopathy as only peripheral neuropathic pain syndrome and were eligible for evaluation. Patients received a single treatment (visit 1) with follow-up visits 2-5 at weeks 1-2, 4, 8 and 12. Parameters assessed at all visits included pain intensity, neuropathy symptoms and side effects. Quality of life (SF-12) and painDETECT 1 questionnaires were completed at baseline and final visit. Data was analyzed by patch application site and duration of pain. RESULTS Topical treatment led to a significant decrease of pain intensity between weeks 1/2 and week 12 versus baseline at the application sites representing dermatomes of ventral (N = 26) and dorsal rami (N = 13) of spinal nerves. A significant decline (p ≤ .001) of numeric pain rating scale scores was observed between weeks 1/2 following patch application and the end of observation (week 12) in the overall radiculopathy group (N = 50), and the groups with either 3 months to 2 years (N = 14) or >2 years (N = 23) duration of pain. Pain relief of at least 30% was observed in 50.0%, 71.4% and 39.1% of patients in the respective groups. Four patients experienced in total seven adverse drug reactions (application site pain or pruritus). CONCLUSION Effective neuropathic pain relief was observed after patch application within the innervation territories of both dorsal and ventral branches of the spinal nerve. Further controlled randomized trials are indicated.
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Affiliation(s)
- R Baron
- a Division of Neurological Pain Research and Therapy, Department of Neurology , Universitätsklinikum Schleswig-Holstein , Campus Kiel , Germany
| | - R D Treede
- b Chair of Neurophysiology, Medical Faculty Mannheim , Heidelberg University , Germany
| | - F Birklein
- c Department of Neurology , University of Mainz , Germany
| | - T Cegla
- d Department of Anesthesiology and Pain therapy , St. Josef Hospital , Wuppertal , Germany
| | - R Freynhagen
- e Department of Anaesthesiology , Benedictus Hospital Tutzing and Technische Universität München , Germany
| | - M L Heskamp
- f Medical Department , Astellas Pharma GmbH , Germany
| | - K U Kern
- g Institute of Pain Medicine/Pain Practice , Wiesbaden , Germany
| | - C Maier
- h Department of Pain Medicine , BG University Hospital Bergmannsheil GmbH, Ruhr-University Bochum , Germany
| | - R Rolke
- i Department of Palliative Medicine , Medical Faculty RWTH Aachen University , Germany
| | - S Seddigh
- j Department of Neurology , BG-Klinikum Duisburg , Germany
| | - C Sommer
- k Department of Neurology , University of Würzburg , Germany
| | - S Ständer
- l Competence Center Chronic Pruritus, Department of Dermatology , University Hospital of Münster , Germany
| | - C Maihöfner
- m Department of Neurology , General Hospital Fürth , Fürth , Germany
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Privitera R, Birch R, Sinisi M, Mihaylov IR, Leech R, Anand P. Capsaicin 8% patch treatment for amputation stump and phantom limb pain: a clinical and functional MRI study. J Pain Res 2017; 10:1623-1634. [PMID: 28761369 PMCID: PMC5516883 DOI: 10.2147/jpr.s140925] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Purpose The aim of this study was to measure the efficacy of a single 60 min application of capsaicin 8% patch in reducing chronic amputation stump and phantom limb pain, associated hypersensitivity with quantitative sensory testing, and changes in brain cortical maps using functional MRI (fMRI) scans. Methods A capsaicin 8% patch (Qutenza) treatment study was conducted on 14 patients with single limb amputation, who reported pain intensity on the Numerical Pain Rating Scale ≥4/10 for chronic stump or phantom limb pain. Pain assessments, quantitative sensory testing, and fMRI (for the lip pursing task) were performed at baseline and 4 weeks after application of capsaicin 8% patch to the amputation stump. The shift into the hand representation area of the cerebral cortex with the lip pursing task has been correlated with phantom limb pain intensity in previous studies, and was the fMRI clinical model for cortical plasticity used in this study. Results The mean reduction in spontaneous amputation stump pain, phantom limb pain, and evoked stump pain were −1.007 (p=0.028), −1.414 (p=0.018), and −2.029 (p=0.007), respectively. The areas of brush allodynia and pinprick hypersensitivity in the amputation stump showed marked decreases: −165 cm2, −80% (p=0.001) and −132 cm2, −72% (p=0.001), respectively. fMRI analyses provided objective evidence of the restoration of the brain map, that is, reversal of the shift into the hand representation of the cerebral cortex with the lip pursing task (p<0.05). Conclusion The results show that capsaicin 8% patch treatment leads to significant reduction in chronic pain and, particularly, in the area of stump hypersensitivity, which may enable patients to wear prostheses, thereby improving mobility and rehabilitation. Phantom limb pain (“central” pain) and associated brain plasticity may be modulated by peripheral inputs, as they can be ameliorated by the peripherally restricted effect of the capsaicin 8% patch.
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Affiliation(s)
- Rosario Privitera
- Peripheral Neuropathy Unit, Centre for Clinical Translation, Hammersmith Hospital, Imperial College London, London, UK
| | - Rolfe Birch
- Peripheral Neuropathy Unit, Centre for Clinical Translation, Hammersmith Hospital, Imperial College London, London, UK
| | - Marco Sinisi
- Peripheral Nerve Injury Unit, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - Iordan R Mihaylov
- Department of Pain Medicine, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | - Robert Leech
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - Praveen Anand
- Peripheral Neuropathy Unit, Centre for Clinical Translation, Hammersmith Hospital, Imperial College London, London, UK
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Mankowski C, Poole CD, Ernault E, Thomas R, Berni E, Currie CJ, Treadwell C, Calvo JI, Plastira C, Zafeiropoulou E, Odeyemi I. Effectiveness of the capsaicin 8% patch in the management of peripheral neuropathic pain in European clinical practice: the ASCEND study. BMC Neurol 2017; 17:80. [PMID: 28431564 PMCID: PMC5399813 DOI: 10.1186/s12883-017-0836-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 03/13/2017] [Indexed: 12/22/2022] Open
Abstract
Background In randomised studies, the capsaicin 8% patch has demonstrated effective pain relief in patients with peripheral neuropathic pain (PNP) arising from different aetiologies. Methods ASCEND was an open-label, non-interventional study of patients with non-diabetes-related PNP who received capsaicin 8% patch treatment, according to usual clinical practice, and were followed for ≤52 weeks. Co-primary endpoints were percentage change in the mean numeric pain rating scale (NPRS) ‘average daily pain’ score from baseline to the average of Weeks 2 and 8 following first treatment; and median time from first to second treatment. The primary analysis was intended to assess analgesic equivalence between post-herpetic neuralgia (PHN) and other PNP aetiologies. Health-related quality of life (HRQoL, using EQ-5D), Patient Global Impression of Change (PGIC) and tolerability were also assessed. Results Following first application, patients experienced a 26.6% (95% CI: 23.6, 29.62; n = 412) reduction in mean NPRS score from baseline to Weeks 2 and 8. Equivalence was demonstrated between PHN and the neuropathic back pain, post-operative and post-traumatic neuropathic pain and ‘other’ PNP aetiology subgroups. The median time from first to second treatment was 191 days (95% CI: 147, 235; n = 181). Forty-four percent of all patients were responders (≥30% reduction in NPRS score from baseline to Weeks 2 and 8) following first treatment, and 86.9% (n = 159/183) remained so at Week 12. A sustained pain response was observed until Week 52, with a 37.0% (95% CI: 31.3, 42.7; n = 176) reduction in mean NPRS score from baseline. Patients with the shortest duration of pain (0–0.72 years) experienced the highest pain response from baseline to Weeks 2 and 8. Mean EQ-5D index score improved by 0.199 utils (responders: 0.292 utils) from baseline to Week 2 and was maintained until Week 52. Most patients reported improvements in PGIC at Week 2 and at all follow-up assessments regardless of number of treatments received. Adverse events were primarily mild or moderate reversible application site reactions. Conclusion In European clinical practice, the capsaicin 8% patch provided effective and sustained pain relief, substantially improved HRQoL, improved overall health status and was generally well tolerated in a heterogeneous PNP population. Trial registration NCT01737294 Date of registration - October 22, 2012.
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Affiliation(s)
- Colette Mankowski
- Astellas Pharma Europe Ltd, 2000 Hillswood Drive, Chertsey, KT16 0PS, UK
| | - Chris D Poole
- Astellas Pharma Europe Ltd, 2000 Hillswood Drive, Chertsey, KT16 0PS, UK
| | | | | | | | | | - Cecil Treadwell
- Astellas Pharma Europe Ltd, 2000 Hillswood Drive, Chertsey, KT16 0PS, UK
| | - José I Calvo
- Complejo Hospitalario de Navarra, Pamplona, Spain
| | | | | | - Isaac Odeyemi
- Astellas Pharma Europe Ltd, 2000 Hillswood Drive, Chertsey, KT16 0PS, UK
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Sommer C, Cruccu G. Topical Treatment of Peripheral Neuropathic Pain: Applying the Evidence. J Pain Symptom Manage 2017; 53:614-629. [PMID: 28042075 DOI: 10.1016/j.jpainsymman.2016.09.015] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 09/13/2016] [Accepted: 09/25/2016] [Indexed: 12/26/2022]
Abstract
CONTEXT Patients with peripheral neuropathic pain (NP) may only achieve partial pain relief with currently recommended first-line oral treatments, which are also associated with systemic adverse events. Topical treatments are currently considered second- or third-line options, but a recent pharmacologic treatment algorithm has called for broader first-line use of these agents. This has highlighted a need to communicate the benefits associated with topical agents, in particular around the efficacy, targeted local action, and limited systemic availability resulting in minimal systemic adverse events and drug-drug interactions. OBJECTIVES This review aims to evaluate the evidence base for topical therapies currently used to treat peripheral NP, discuss the evidence comparing these treatments head-to-head with oral standard of care, and evaluate how they fit into treatment regimens in the "real world." METHODS This is a narrative review. RESULTS Two topical treatments are currently licensed: lidocaine 5% medicated plaster (post-herpetic neuralgia) and the capsaicin 8% patch (peripheral NP). When compared head to head with the oral standard of care (pregabalin), the lidocaine 5% medicated plaster provided similar relief of pain associated with post-herpetic neuralgia but did not meet the primary predefined criteria for noninferiority. The capsaicin 8% patch, however, demonstrated noninferior efficacy when compared head-to-head with pregabalin across a wide range of peripheral NP etiologies. Importantly, both treatments demonstrated effective pain relief without the systemic adverse events associated with oral therapies. CONCLUSION First-line use of topical agents may be of particular benefit in patients where the safety and tolerability of oral therapy is a concern.
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Affiliation(s)
- Claudia Sommer
- Neurologische Klinik, Universitätsklinikum Würzburg, Würzburg, Germany.
| | - Giorgio Cruccu
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
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Quantitative Thermal Testing Profiles as a Predictor of Treatment Response to Topical Capsaicin in Patients with Localized Neuropathic Pain. PAIN RESEARCH AND TREATMENT 2017; 2017:7425907. [PMID: 28321335 PMCID: PMC5339491 DOI: 10.1155/2017/7425907] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 01/15/2017] [Accepted: 01/30/2017] [Indexed: 01/17/2023]
Abstract
There are no reliable predictors of response to treatment with capsaicin. Given that capsaicin application causes heat sensation, differences in quantitative thermal testing (QTT) profiles may predict treatment response. The aim of this study was to determine whether different QTT profiles could predict treatment outcomes in patients with localized peripheral neuropathic pain (PeLNP). We obtained from medical records QTT results and treatment outcomes of 55 patients treated between 2010 and 2013. Warm sensation threshold (WST) and heat pain threshold (HPT) values were assessed at baseline at the treatment site and in the asymptomatic, contralateral area. Responders were defined as those who achieved a > 30% decrease in pain lasting > 30 days. Two distinct groups were identified based on differences in QTT profiles. Most patients (27/31; 87.1%) with a homogenous profile were nonresponders. By contrast, more than half of the patients (13/24, 54.2%) with a nonhomogenous profile were responders (p = 0.0028). A nonhomogenous QTT profile appears to be predictive of response to capsaicin. We hypothesize patients with a partial loss of cutaneous nerve fibers or receptors are more likely to respond. By contrast, when severe nerve damage or normal cutaneous sensations are present, the pain is likely due to central sensitization and thus not responsive to capsaicin. Prospective studies with larger patient samples are needed to confirm this hypothesis.
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Feasibility of Topical Applications of Natural High-Concentration Capsaicinoid Solutions in Patients with Peripheral Neuropathic Pain: A Retrospective Analysis. Pain Res Manag 2016; 2016:9703036. [PMID: 28115879 PMCID: PMC5223041 DOI: 10.1155/2016/9703036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 11/23/2016] [Accepted: 12/08/2016] [Indexed: 11/17/2022]
Abstract
Background. Capsaicin, one of several capsaicinoid compounds, is a potent TRPV1 agonist. Topical application at high concentration (high concentration, >1%) induces a reversible disappearance of epidermal free nerve endings and is used to treat peripheral neuropathic pain (PNP). While the benefit of low-concentration capsaicin remains controversial, the 8%-capsaicin patch (Qutenza®, 2010, Astellas, Netherlands) has shown its effectiveness. This patch is, however, costly and natural high-concentration capsaicinoid solutions may represent a cheaper alternative to pure capsaicin. Methods. In this retrospective study, 149 patients were screened, 132 were included with a diagnosis of neuropathic pain, and eighty-four were retained in the final analyses (median age: 57.5 years [IQR25–75: 44.7–67.1], male/female: 30/54) with PNP who were treated with topical applications of natural high-concentration capsaicinoid solutions (total number of applications: 137). Indications were postsurgical PNP (85.7%) and nonsurgical PNP (14.3%) (posttraumatic, HIV-related, postherpetic, and radicular PNP). Objectives. To assess the feasibility of topical applications of natural high-concentration capsaicinoid solutions for the treatment of PNP. Results. The median treated area was 250 cm2 [IQR25–75: 144–531]. The median amount of capsaicinoids was 55.1 mg [IQR25–75: 28.7–76.5] per plaster and the median concentration was 172.3 μg/cm2 [IQR25–75: 127.6–255.2]. Most patients had local adverse effects on the day of treatment, such as mild to moderate burning pain and erythema. 13.6–19.4% of the patients experienced severe pain or erythema. Following treatment, 62.5% of patients reported a lower pain intensity or a smaller pain surface, and 35% reported a sustained pain relief lasting for at least 4 weeks. Conclusion. Analgesic topical treatment with natural high-concentration capsaicinoid is feasible and may represent a low cost alternative to alleviate PNP in clinical practice.
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Recent Advances in the Pharmacological Management of Neuropathic Pain. CURRENT ANESTHESIOLOGY REPORTS 2016. [DOI: 10.1007/s40140-016-0186-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Campbell BK, Fillingim RB, Lee S, Brao R, Price DD, Neubert JK. Effects of High-Dose Capsaicin on TMD Subjects: A Randomized Clinical Study. JDR Clin Trans Res 2016; 2:58-65. [PMID: 28879245 DOI: 10.1177/2380084416675837] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Temporomandibular joint disorder (TMD) is a complex musculoskeletal disorder that presents with pain, limited jaw opening, and abnormal noises in the temporomandibular joint. Despite the significant impact that TMD has in terms of suffering and financial burden, relatively few new treatments have emerged; therefore, development of novel treatments to treat TMD pain remains a high priority. The rationale of this study was to use a double-blind, vehicle-controlled clinical trial to evaluate the effects of a high-concentration (8%) capsaicin cream on TMD. This is based on the hypothesis that targeting TRP vanilloid subfamily member 1 (TRPV1) for pain control may provide a novel method for pain relief in TMD patients. TRPV1 is primarily expressed on a population of nociceptive-specific neurons and provides a candidate target for the development of pain treatments. Capsaicin is the primary agonist for TRPV1 and has been used previously in relatively low doses (0.025% to 0.075%) as a therapeutic for a variety of pain disorders, including postherpetic neuralgia and osteoarthritis; however, analgesic efficacy remains equivocal. TMD and healthy control subjects were assigned to either an active capsaicin or vehicle control group. The treatments were applied for 2 h and then removed. Quantitative sensory testing (QST) was completed prior to drug application (baseline), 2 h after drug application, and 1 wk later. Perceived pain intensity was measured using a visual analog scale (VAS) following capsaicin or vehicle cream application. Significantly lower pain was reported in the week after application in the capsaicin-treated TMD subjects. For QST measures, there was a decreased thermal pain threshold 2 h after capsaicin application for both the control and TMD groups, but this resolved within a week. Capsaicin had no effect on pressure pain threshold or mechanical sensitivity in both TMD and healthy individuals. This study demonstrates that 8% topical capsaicin therapy is a relatively safe, simple, and effective treatment for patients with TMD. Knowledge Transfer Statement: This study evaluated a novel topical capsaicin therapy for reducing orofacial pain. The results of this study can be used to provide another treatment option for patients with TMD.
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Affiliation(s)
| | - R B Fillingim
- Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL, USA
| | - S Lee
- Department of Orthodontics, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Korea
| | - R Brao
- Department of Orthodontics, College of Dentistry, University of Florida, Gainesville, FL, USA
| | - D D Price
- Department of Oral Surgery and Diagnostic Sciences, College of Dentistry, University of Florida, Gainesville, FL, USA
| | - J K Neubert
- Department of Orthodontics, College of Dentistry, University of Florida, Gainesville, FL, USA
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Abstract
The capsaicin 8 % patch (QUTENZA®) is an adhesive patch containing a high concentration (8 % w/w) of synthetic capsaicin, a selective agonist of transient receptor potential vanilloid 1 channel. It is approved for treatment of peripheral neuropathic pain in adults either alone or in combination with other medicinal products for pain in the EU; it is only approved to treat postherpetic neuralgia (PHN) in the USA. In patients with painful diabetic peripheral neuropathy (PDPN), a single 30-min application of the capsaicin 8 % patch significantly improved pain relief and sleep quality compared with placebo in a 12-week double-blind trial. In a 52-week, randomized trial, up to seven consecutive 30-min treatments with the capsaicin 8 % patch (≤7 treatments each at least 8 weeks apart) plus standard of care therapy was associated with sustained pain relief and no negative neurological safety consequences compared with standard of care. In two randomized trials, a single 60-min application of the capsaicin 8 % patch reduced pain scores significantly more than a low-concentration (0.04 %) capsaicin control patch in patients with PHN. Capsaicin 8 % patch treatment was noninferior to pregabalin (optimized dosage) in a randomized trial in patients with nondiabetic peripheral neuropathic pain. Results in two trials in patients with HIV-AN were equivocal, with a significant improvement in pain intensity observed in one trial, but not in the other. The capsaicin 8 % patch was associated with expected, transient, capsaicin-related application-site adverse events such as erythema and pain.
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Affiliation(s)
- Celeste B Burness
- Springer, Private Bag 65901, Mairangi Bay, 0754, Auckland, New Zealand.
| | - Paul L McCormack
- Springer, Private Bag 65901, Mairangi Bay, 0754, Auckland, New Zealand
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Barbero GF, de Aguiar AC, Carrera C, Olachea Á, Ferreiro-González M, Martínez J, Palma M, Barroso CG. Evolution of Capsaicinoids in Peter Pepper (Capsicum annuumvar.annuum) During Fruit Ripening. Chem Biodivers 2016; 13:1068-75. [DOI: 10.1002/cbdv.201500503] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 02/23/2016] [Indexed: 02/02/2023]
Affiliation(s)
- Gerardo F. Barbero
- Department of Analytical Chemistry; Faculty of Sciences; Agrifood Campus of International Excellence (ceiA3); University of Cádiz; P.O. Box 40 ES-11510 Puerto Real, Cádiz
| | - Ana C. de Aguiar
- Department of Food Engineering; College of Food Engineering; University of Campinas, DEA/FEA/UNICAMP; 13083-862 Campinas SP Brazil
| | - Ceferino Carrera
- Andalusian Center for Wine Research; Agrifood Campus of International Excellence (ceiA3); University of Cadiz, Campus de Puerto Real; ES-11510 Puerto Real, Cádiz
| | - Ángel Olachea
- Department of Analytical Chemistry; Faculty of Sciences; Agrifood Campus of International Excellence (ceiA3); University of Cádiz; P.O. Box 40 ES-11510 Puerto Real, Cádiz
| | - Marta Ferreiro-González
- Department of Analytical Chemistry; Faculty of Sciences; Agrifood Campus of International Excellence (ceiA3); University of Cádiz; P.O. Box 40 ES-11510 Puerto Real, Cádiz
| | - Julian Martínez
- Department of Food Engineering; College of Food Engineering; University of Campinas, DEA/FEA/UNICAMP; 13083-862 Campinas SP Brazil
| | - Miguel Palma
- Department of Analytical Chemistry; Faculty of Sciences; Agrifood Campus of International Excellence (ceiA3); University of Cádiz; P.O. Box 40 ES-11510 Puerto Real, Cádiz
| | - Carmelo G. Barroso
- Department of Analytical Chemistry; Faculty of Sciences; Agrifood Campus of International Excellence (ceiA3); University of Cádiz; P.O. Box 40 ES-11510 Puerto Real, Cádiz
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Capsaicin, Nociception and Pain. Molecules 2016; 21:molecules21060797. [PMID: 27322240 PMCID: PMC6273518 DOI: 10.3390/molecules21060797] [Citation(s) in RCA: 124] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 06/06/2016] [Accepted: 06/14/2016] [Indexed: 12/13/2022] Open
Abstract
Capsaicin, the pungent ingredient of the hot chili pepper, is known to act on the transient receptor potential cation channel vanilloid subfamily member 1 (TRPV1). TRPV1 is involved in somatic and visceral peripheral inflammation, in the modulation of nociceptive inputs to spinal cord and brain stem centers, as well as the integration of diverse painful stimuli. In this review, we first describe the chemical and pharmacological properties of capsaicin and its derivatives in relation to their analgesic properties. We then consider the biochemical and functional characteristics of TRPV1, focusing on its distribution and biological effects within the somatosensory and viscerosensory nociceptive systems. Finally, we discuss the use of capsaicin as an agonist of TRPV1 to model acute inflammation in slices and other ex vivo preparations.
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Abstract
PURPOSE OF REVIEW The purpose of this review is to provide an update on the diagnosis, treatment, and prevention of neuropathic pain. RECENT FINDINGS Neuropathic pain can be debilitating, leading to poor quality of life and functional status. Neuropathic pain results from numerous mechanisms of nerve injury including infectious diseases, complication of medical diseases, and mechanical damage. As a result of the lack of class I evidence for the treatment of numerous neuropathic pain conditions, those diseases without such evidence are often managed, as though neuropathic pain is a singular condition. In diseases such as diabetes, HIV, and herpes infections, the resultant neuropathic pain is often modifiable with prevention strategies. In one of the more prevalent neuropathic pain conditions, radiculopathy, the commonly used treatments lack sufficient evidence to explain their widespread use. SUMMARY The literature reveals that neuropathic pain is underdiagnosed and often undertreated or treated with ineffective or untested modalities. Evolving definitions of neuropathic pain has broadened the range of therapeutic approaches and brought current treatment paradigms under increased scrutiny. The lack of a mechanism-based approach to treatment may be responsible for the lackluster responses seen in most neuropathic pain conditions.
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Hylands-White N, Duarte RV, Raphael JH. An overview of treatment approaches for chronic pain management. Rheumatol Int 2016; 37:29-42. [PMID: 27107994 DOI: 10.1007/s00296-016-3481-8] [Citation(s) in RCA: 185] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 04/15/2016] [Indexed: 02/08/2023]
Abstract
Pain which persists after healing is expected to have taken place, or which exists in the absence of tissue damage, is termed chronic pain. By definition chronic pain cannot be treated and cured in the conventional biomedical sense; rather, the patient who is suffering from the pain must be given the tools with which their long-term pain can be managed to an acceptable level. This article will provide an overview of treatment approaches available for the management of persistent non-malignant pain. As well as attempting to provide relief from the physical aspects of pain through the judicious use of analgesics, interventions, stimulations, and irritations, it is important to pay equal attention to the psychosocial complaints which almost always accompany long-term pain. The pain clinic offers a biopsychosocial approach to treatment with the multidisciplinary pain management programme; encouraging patients to take control of their pain problem and lead a fulfilling life in spite of the pain.
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Affiliation(s)
- Nicholas Hylands-White
- Faculty of Health Education and Life Sciences, Birmingham City University, Birmingham, UK. .,, 80 Knightsfield, Welwyn Garden City, Hertfordshire, AL8 7HB, UK.
| | - Rui V Duarte
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jon H Raphael
- Faculty of Health Education and Life Sciences, Birmingham City University, Birmingham, UK.,Department of Pain Management, Russells Hall Hospital, Dudley, UK
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Baron R, Binder A, Attal N, Casale R, Dickenson AH, Treede RD. Neuropathic low back pain in clinical practice. Eur J Pain 2016; 20:861-73. [PMID: 26935254 PMCID: PMC5069616 DOI: 10.1002/ejp.838] [Citation(s) in RCA: 142] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background and objective Low back pain (LBP) is one of the most common chronic pain conditions. This paper reviews the available literature on the role of neuropathic mechanisms in chronic LBP and discusses implications for its clinical management, with a particular focus on pharmacological treatments. Databases and data treatment Literature searches were performed in PubMed, key pain congresses and ProQuest Dialog to identify published evidence on neuropathic back pain and its management. All titles were assessed for relevant literature. Results Chronic LBP comprises both nociceptive and neuropathic components, however, the neuropathic component appears under‐recognized and undertreated. Neuropathic pain (NP) is challenging to manage. Many patients with chronic LBP have pain that is refractory to existing treatments. Typically, less than half of patients experience clinically meaningful analgesia with oral pharmacotherapies; these are also associated with risks of adverse effects. Paracetamol and NSAIDs, although widely used for LBP, are unlikely to ameliorate the neuropathic component and data on the use of NP medications such as antidepressants and gabapentin/pregabalin are limited. While there is an unmet need for improved treatment options, recent data have shown tapentadol to have efficacy in the neuropathic component of LBP, and studies suggest that the capsaicin 8% patch and lidocaine 5% medicated plaster, topical analgesics available for the treatment of peripheral NP, may be a valuable additional approach for the management of neuropathic LBP. Conclusions Chronic LBP often has an under‐recognized neuropathic component, which can be challenging to manage, and requires improved understanding and better diagnosis and treatment. What does this review add? Increased recognition and improved understanding of the neuropathic component of low back pain raises the potential for the development of mechanism‐based therapies. Open and retrospective studies suggest that agents like tapentadol and topical analgesics — such as the capsaicin 8% patch and the lidocaine 5% medicated plaster — may be effective options for the treatment of neuropathic low back pain in defined patient groups.
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Affiliation(s)
- R Baron
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - A Binder
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - N Attal
- INSERM U 987 and Centre d'Evaluation et de Traitement De La Douleur, APHP, Boulogne-Billancourt, France
| | - R Casale
- Habilita Care & Research Hospitals, 24040, Zingonia di Ciserano, Italy
| | - A H Dickenson
- Department of Neuroscience, Physiology and Pharmacology, University College London, UK
| | - R-D Treede
- Centre of Biomedicine and Medical Technology Mannheim, Heidelberg University, Mannheim, Germany
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Mainka T, Malewicz N, Baron R, Enax-Krumova E, Treede RD, Maier C. Presence of hyperalgesia predicts analgesic efficacy of topically applied capsaicin 8% in patients with peripheral neuropathic pain. Eur J Pain 2016; 20:116-129. [DOI: 10.1002/ejp.703] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- T. Mainka
- Department of Pain Medicine; Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH; Ruhr-University Bochum; Germany
- Department of Neurology; University Medical Center Hamburg-Eppendorf; Germany
| | - N.M. Malewicz
- Department of Pain Medicine; Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH; Ruhr-University Bochum; Germany
| | - R. Baron
- Sektion Neurologische Schmerzforschung und Therapie; Klinik für Neurologie; Universitätsklinikum Schleswig-Holstein; Kiel Germany
| | - E.K. Enax-Krumova
- Department of Neurology; Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH; Ruhr-University Bochum; Germany
| | - R.-D. Treede
- Center for Biomedicine and Medical Technology Mannheim; Heidelberg University; Germany
| | - C. Maier
- Department of Pain Medicine; Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH; Ruhr-University Bochum; Germany
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Fernandes ES, Cerqueira ARA, Soares AG, Costa SKP. Capsaicin and Its Role in Chronic Diseases. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 929:91-125. [PMID: 27771922 DOI: 10.1007/978-3-319-41342-6_5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A significant number of experimental and clinical studies published in peer-reviewed journals have demonstrated promising pharmacological properties of capsaicin in relieving signs and symptoms of non-communicable diseases (chronic diseases). This chapter provides an overview made from basic and clinical research studies of the potential therapeutic effects of capsaicin, loaded in different application forms, such as solution and cream, on chronic diseases (e.g. arthritis, chronic pain, functional gastrointestinal disorders and cancer). In addition to the anti-inflammatory and analgesic properties of capsaicin largely recognized via, mainly, interaction with the TRPV1, the effects of capsaicin on different cell signalling pathways will be further discussed here. The analgesic, anti-inflammatory or apoptotic effects of capsaicin show promising results in arthritis, neuropathic pain, gastrointestinal disorders or cancer, since evidence demonstrates that the oral or local application of capsaicin reduce inflammation and pain in rheumatoid arthritis, promotes gastric protection against ulcer and induces apoptosis of the tumour cells. Sadly, these results have been paralleled by conflicting studies, which indicate that high concentrations of capsaicin are likely to evoke deleterious effects, thus suggesting that capsaicin activates different pathways at different concentrations in both human and rodent tissues. Thus, to establish effective capsaicin doses for chronic conditions, which can be benefited from capsaicin therapeutic effects, is a real challenge that must be pursued.
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Affiliation(s)
- E S Fernandes
- Programa de Pós-Graduação, Universidade Ceuma, São Luís-MA, Brazil.,Vascular Biology Section, Cardiovascular Division, King's College London, London, UK
| | - A R A Cerqueira
- Department of Pharmacology, Institute of Biomedical Sciences (ICB), University of São Paulo (USP), Av. Prof. Lineu Prestes, 1524 - Room 326, Butantan, São Paulo, 05508-900, Sao Paulo, Brazil
| | - A G Soares
- Department of Pharmacology, Institute of Biomedical Sciences (ICB), University of São Paulo (USP), Av. Prof. Lineu Prestes, 1524 - Room 326, Butantan, São Paulo, 05508-900, Sao Paulo, Brazil
| | - Soraia K P Costa
- Department of Pharmacology, Institute of Biomedical Sciences (ICB), University of São Paulo (USP), Av. Prof. Lineu Prestes, 1524 - Room 326, Butantan, São Paulo, 05508-900, Sao Paulo, Brazil.
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Capsaicin 8% Patch for Central and Peripheral Neuropathic Pain of Persons with Incomplete Spinal Cord Injury: Two Case Reports. Am J Phys Med Rehabil 2015; 94:e66-72. [PMID: 26035723 DOI: 10.1097/phm.0000000000000301] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Neuropathic pain after spinal cord injury is common and often refractory to standard treatments. The capsaicin 8% patch is a Food and Drug Administration-approved treatment of neuropathic pain in postherpetic neuralgia and has demonstrated significant efficacy in human immunodeficiency virus-autonomic neuropathy. The patch defunctionalizes transient receptor potential vanilloid 1 receptors, impairing cutaneous nociceptors for a prolonged period (i.e., 8-12 wks) with no systemic side effects. A retrospective review was conducted on the effects of the patch in two patients with spinal cord injury and neuropathic pain refractory to standard treatments. Two weeks after application, both patients reported complete pain relief. Average onset of relief of 4 days and average duration of relief of 197 days, requiring only one to four applications per year, paralleled findings reported in postherpetic neuralgia and human immunodeficiency virus-autonomic neuropathy trials. Upregulation of capsaicin-sensitive transient receptor potential vanilloid 1 receptors after spinal cord injury has been reported. The capsaicin 8% patch is a promising therapeutic agent for neuropathic pain in spinal cord injury.
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Liu Z, Zhu P, Tao Y, Shen C, Wang S, Zhao L, Wu H, Fan F, Lin C, Chen C, Zhu Z, Wei Z, Sun L, Liu Y, Wang A, Lu Y. Cancer-promoting effect of capsaicin on DMBA/TPA-induced skin tumorigenesis by modulating inflammation, Erk and p38 in mice. Food Chem Toxicol 2015; 81:1-8. [DOI: 10.1016/j.fct.2015.04.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Revised: 03/10/2015] [Accepted: 04/01/2015] [Indexed: 12/20/2022]
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Schweitzer M, Caillet JB, Paillet C, Baude C, Fagnoni P, Aulagner G, Armoiry X. [Capsaicin Cutaneous Patch: a Cost-consequences Study in a French University Hospital]. Therapie 2015; 70:359-68. [PMID: 25899819 DOI: 10.2515/therapie/2015022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 12/04/2014] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The capsaïcine 8% cutaneous patch (Qutenza®) was recently approved for the management of patients with peripheral neuropathic pain (PNP). Considering its limited clinical efficacy data, its improvement of medical benefit was determined to be 5 which was insufficient to support its reimbursement in addition to diagnosis related groups'tarifs. Nevertheless its commercialization was associated with a marked interest considering the unmet therapeutic needs for patients with PNP. OBJECTIVES Our objectives were to assess the effectiveness, the safety, and the economic impact of Qutenza® in real-life conditions. METHODS An observational cost-consequences study was launched under the aegis of the Drug Committee of our hospital. Medical charts and prescriptions of all patients who received at least one patch application were analyzed. Effectiveness and safety were assessed after 12-week and 24-week of follow-up. The economic impact was measured within the Hospital and Health Insurance perspective and with limitation to direct costs. RESULTS From March 2012 to October 2013, 91 patients (54.3 ± 14.1 years; 52.7% of male) received at least one application. The average follow- up duration was 188.3 ± 86.4 days. The PNP etiologies were mainly post-surgery (42.9%) and post-traumatology (20.8%). A therapeutic response (decrease of ENS score of least 30%) after 12 weeks and 24 weeks was observed in 27.9% and 37.1% of patients respectively. The SF-36 mental score was significantly improved. The safety profile was good. The application of the patch resulted in incremental costs of 154 euros per hospital stay without impact on outpatient-prescription drug expenditures. CONCLUSION This study confirms the interest of Qutenza® for heavily pretreated, refractory patients with PNP. The clinical profile of responders has to be further investigated in large observational studies.
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Affiliation(s)
- Maud Schweitzer
- Hospices Civils de Lyon, Groupement Hospitalier Est, Service Pharmaceutique, Lyon, France
| | - Jean-Bernard Caillet
- Hospices Civils de Lyon, Groupement Hospitalier Est, Centre d'Évaluation et de Traitement de la Douleur, Lyon, France
| | - Carole Paillet
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service Pharmaceutique, Lyon, France - Hospices Civils de Lyon, Comité de Lutte contre la Douleur, Lyon, France
| | - Christian Baude
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Consultation et Traitement de la Douleur, Lyon, France
| | - Philippe Fagnoni
- Centre Hospitalier Universitaire de Dijon, Service Pharmacie, Dijon, France
| | - Gilles Aulagner
- Hospices Civils de Lyon, Groupement Hospitalier Est, Service Pharmaceutique, Lyon, France
| | - Xavier Armoiry
- Hospices Civils de Lyon, Délégation à la Recherche Clinique et à l'Innovation, Cellule Innovation/UMR-CNRS 5510/MATEIS, Lyon, France
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