scholarly journals The use of high dose topical capsaicin in the management of peripheral neuropathy: narrative review and local experience

2020 ◽  
Vol 14 (2) ◽  
pp. 133-140
Author(s):  
Sarah E Thomas ◽  
Helen Laycock
Keyword(s):  
Neuropathic Pain ◽  
Meta Analysis ◽  
Topical Therapy ◽  
High Dose ◽  
Pepper Plant ◽  
High Concentration ◽  
Chilli Pepper ◽  
Peripheral Diabetic Neuropathy ◽  
Analgesic Effects ◽  
Topical Capsaicin

Capsaicin, derived from the chilli pepper plant, is available in high concentration (8%) patches to provide topical therapy for neuropathic pain. Its analgesic effects relate to defunctionalisation and nerve terminal retraction of predominantly C fibres in the dermis and epidermis. Systematic reviews and meta-analysis support its use for the management of post-herpetic neuralgia and HIV neuropathy with some evidence for use in painful peripheral diabetic neuropathy. The article concludes with advice on the practicalities of running a topical 8% capsaicin clinic for peripheral neuropathic pain.

Does coffee, tea and caffeine consumption reduce the risk of incident breast cancer? A systematic review and network meta-analysis

2021 ◽  
pp. 1-13
Author(s):  
Shu Wang ◽  
Xiang Li ◽  
Yue Yang ◽  
Jingping Xie ◽  
Mingyue Liu ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Systematic Review ◽  
Postmenopausal Women ◽  
Meta Analysis ◽  
High Dose ◽  
Dependent Manner ◽  
Tea Consumption ◽  
Case Control Studies ◽  
High Concentration ◽  
Coffee Intake

Abstract Objective: We aimed to evaluate the association between coffee and/or tea consumption and breast cancer (BC) risk among premenopausal and postmenopausal women and to conduct a network meta-analysis. Design: Systematic review and network meta-analysis. Setting: We conducted a systematic review of electronic publications in the last 30 years to identify case–control studies or prospective cohort studies that evaluated the effects of coffee and tea intake. Results: Forty-five studies that included more than 3 323 288 participants were eligible for analysis. Network meta-analysis was performed to determine the effects of coffee and/or tea consumption on reducing BC risk in a dose-dependent manner and differences in coffee/tea type, menopause status, hormone receptor and the BMI in subgroup and meta-regression analyses. According to the first pairwise meta-analysis, low-dose coffee intake and high-dose tea intake may exhibit efficacy in preventing ER(estrogen receptor)− BC, particularly in postmenopausal women. Then, we performed another pairwise and network meta-analysis and determined that the recommended daily doses were 2–3 cups/d of coffee or ≥5 cups/d of tea, which contained a high concentration of caffeine, particularly in postmenopausal women. Conclusions: Coffee and tea consumption is not associated with a reduction in the overall BC risk in postmenopausal women and is associated with a potentially lower risk of ER− BC. And the highest recommended dose is 2–3 cups of coffee/d or ≥5 cups of tea/d. They are potentially useful dietary protectants for preventing BC.

scholarly journals Efficacy and Safety of 0.625% and 1.25% Capsaicin Patch in Peripheral Neuropathic Pain: Multi-Center, Randomized, and Semi-Double Blind Controlled Study

2017 ◽  
Vol 2 (20;2) ◽  
pp. 27-35
Author(s):  
PyungBok Lee
Keyword(s):  
Neuropathic Pain ◽  
Peripheral Neuropathy ◽  
College Teaching ◽  
Small Sample ◽  
Controlled Study ◽  
Efficacy And Safety ◽  
High Concentration ◽  
Double Blind ◽  
Peripheral Neuropathic Pain ◽  
Topical Capsaicin

Background: Topical capsaicin therapy may be of benefit in providing pain relief in patients with peripheral neuropathy. Objectives: To investigate the efficacy and safety of 0.625% (50 µg/cm2 ) and 1.25% (100 µg/cm2 ) capsaicin patches (CPs) compared to conventional 0.075% capsaicin cream or placebo patches in patients suffering from peripheral neuropathy. Study Design: Early Phase II, multi-center, randomized, semi-double-blind, and placebocontrolled clinical trial. Setting: Two medical college teaching hospitals. Methods: Sixty patients were randomized to the 0.625% CP, 1.25% CP, placebo-controlled patch, or 0.075% capsaicin cream. The primary efficacy endpoint was the mean difference in the change of daily numerical rating scale (NRS) pain score. Secondary endpoints included values for the Daily Sleep Interference Scale, the percentage of patients achieving a ≥ 30% or ≥ 50% reduction in pain, and data for Global Impression Change (GIC) and EQ-5D. Results: Patients treated with the 0.625% CP and 0.075% capsaicin cream showed statistically significant improvements in pain after 6-weeks of test drug application. Daily sleep disorder scores were improved only for those patients applying the 0.075% capsaicin cream. For patient-derived GIC scores, the majority (11 of 12) of patients in the 0.625% CP group reported that their pain was improved. For the safety evaluation, 2 severe adverse events were reported for the 0.075% capsaicin cream group only. Repetitive patch application was related to minor skin problems such as a burning sensation, erythema, pruritus, and vesicles in 28 patients (46.67%). Limitations: The small sample size and relatively high dropout rates. Conclusion: Our data indicate that the 0.625% CP may prove to be an effective and safe alternative with which to treat patients with peripheral neuropathy and could replace the high concentration (8%) CP. Further studies are now needed to definitively establish efficacy. Key words: Capsaicin, patch, CP, topical capsaicin, neuropathic pain, peripheral neuropathic pain, PNP, high concentration CP

scholarly journals Topical capsaicin (high concentration) for chronic neuropathic pain in adults

2013 ◽  
Author(s):  
Sheena Derry ◽  
Andrew S C Rice ◽  
Peter Cole ◽  
Toni Tan ◽  
R Andrew Moore
Keyword(s):  
Neuropathic Pain ◽  
High Concentration ◽  
Chronic Neuropathic Pain ◽  
Topical Capsaicin

scholarly journals High Frequency Repetitive Transcranial Magnetic Stimulation Therapy For Chronic Neuropathic Pain: A Meta-analysis

2015 ◽  
Vol 6;18 (6;11) ◽  
pp. E1029-E1046 ◽  
Author(s):  
Qiwen Mu
Keyword(s):  
Neuropathic Pain ◽  
Transcranial Magnetic Stimulation ◽  
High Frequency ◽  
Analgesic Effect ◽  
Magnetic Stimulation ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Meta Analysis ◽  
Optimal Parameters ◽  
Analgesic Effects

Background: Increasing evidence supports an analgesic effect of repetitive transcranial magnetic stimulation (rTMS) for neuropathic pain (NP). However, the optimal parameters of rTMS (stimulation frequency and treatment sessions) for achieving long-term analgesic effects remain unknown. This study analyzed the current findings in the literature. Objective: The aim of this study was to assess the optimal parameters of rTMS for NP, including the rTMS sessions needed for inducing acute as well as long-term analgesic effects. Study Design: A meta-analysis of the analgesic effect of high frequency rTMS (HF- rTMS) for neuropathic patients. Setting: This meta-analysis examined all studies involving the analgesic efficacy of HF-rTMS for NP. Methods: PubMed, Embase, and the Cochrane library were searched for clinical studies of rTMS treatment on NP published before December 31, 2014. Crude standardized mean differences (SMD) with 95% confidence interval (CI) were calculated for pain intensity after different treatment sessions (from 1 to 10) and follow-up of one or 2 months after rTMS treatment using random effect models. Results: Twenty-five studies (including 32 trials and 589 patients) were selected for the metaanalysis according to the inclusion and exclusion criteria. All 3 HF-rTMS treatments (5, 10, and 20 Hz) produced pain reduction, while there were no differences between them, with the maximal pain reduction found after one and 5 sessions of rTMS treatment. Further, this significant analgesic effect remained forone month after 5 sessions of rTMS treatment. Limitations: There are limitations of this meta-analysis. For example, the long-term analgesic effects of different HF-rTMS and low frequency (LF) rTMS sessions, including the single session of rTMS on different NP of varying origins have yet not been evaluated; the full degree of pain relief is still unclear for many rTMS studies. Conclusions: HF-rTMS stimulation on primary motor cortex is effective in relieving pain in NP patients. Although 5 sessions of rTMS treatment produced a maximal analgesic effect and may be maintained for at least one month, further large-scale and well-controlled trials are needed to determine if this enhanced effect is specific to certain types of NP such as post-stroke related central NP. Key words: High frequency, repetitive transcranial magnetic stimulation, neuropathic pain, single stimulation, multiple stimulation, meta-analysis

Pharmacological Treatment of Neuropathic Pain

2018 ◽  
pp. 45-52
Author(s):  
Randall P. Brewer ◽  
Rinoo V. Shah ◽  
Elizabeth Casserly
Keyword(s):  
Neuropathic Pain ◽  
Sleep Disturbances ◽  
Meta Analysis ◽  
Disease Process ◽  
Analgesic Efficacy ◽  
Randomized Control Trials ◽  
Topical Lidocaine ◽  
Noradrenaline Reuptake ◽  
Randomized Control ◽  
Topical Capsaicin

Neuropathic pain is a result of a somatosensory lesion or disease process, either centrally or peripherally. Prevalence is estimated to be in the millions and high as 8% in the general population. Neuropathic pain is often associated with depression, sleep disturbances, compromised physical and emotional functionality, and reduced productivity. Pharmacotherapy is a key component of a multidisciplinary approach to the management of neuropathic pain and is a treatment limited by analgesic efficacy and dose-related side effects. First-line medications for neuropathic pain include tricyclic antidepressants (TCAs), serotonin-noradrenaline reuptake inhibitors (SNRIs), calcium channel alpha2delta-1 ligands (gabapentin and pregabalin), topical lidocaine (lidocaine patch 5%), and topical capsaicin (capsaicin 8% patch). Tramadol is generally considered second-line medication. Sources for this chapter have come from randomized control trials, systematic reviews, meta-analysis, and the IASP NeuPSIG guidelines for the treatment of neuropathic pain.

Clinical Efficacy of Aconitum-Containing Traditional Chinese Medicine for Diabetic Peripheral Neuropathic Pain

2014 ◽  
Vol 42 (01) ◽  
pp. 109-117 ◽  
Author(s):  
Ling Feng ◽  
Wen-Ke Liu ◽  
Lan Deng ◽  
Jia-Xing Tian ◽  
Xiao-Lin Tong
Keyword(s):  
Neuropathic Pain ◽  
Chinese Medicine ◽  
Traditional Chinese Medicine ◽  
Adverse Reactions ◽  
Nerve Repair ◽  
Well Being ◽  
High Dose ◽  
Peripheral Neuropathic Pain ◽  
Analgesic Effects ◽  
Relieve Pain

Diabetic peripheral neuropathy is a common chronic complication of diabetes. Routine clinical management uses analgesics to relieve pain in combination with drugs for nerve repair. The drugs are often not effective for the severe pain cases, and these western medications also have side effects. We report a more effective treatment of diabetic peripheral neuropathic pain using a high dose of a traditional Chinese medicine, aconitum (including both Radix aconite preparata and Radix aconite kusnezoffii), in combination with Huangqi Guizhi Wuwu Tang (i.e., astragalus, cassia twig, white peony root, and spatholobi). In order to achieve stronger analgesic effects, we increased the clinical dosage of aconitum from 15 to 120 g. The aconitum was boiled for 6–8 hours, and licorice was also used to reduce potential toxicities of aconitum. In the four reported cases, the patients' neuropathic pain was remarkably reduced and the EMG profile was also improved with this treatment regimen. Adverse reactions were not observed during the therapy. Thus, aconitum represents a promising and safe treatment for the well-being of patients and their diabetic peripheral neuropathic pain. Future controlled clinical trials using traditional Chinese medicines containing aconitum in treating the neuropathic pain are warranted.

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