501576 501576 2013
TAN7110.1177/1756285613501576Therapeutic Advances in Neurological DisordersJF Peppin and M Pappagallo
Therapeutic Advances in Neurological Disorders
Capsaicinoids in the treatment of neuropathic pain: a review
Review
Ther Adv Neurol Disord (2014) 7(1) 22–32 DOI: 10.1177/ 1756285613501576 © The Author(s), 2013. Reprints and permissions: http://www.sagepub.co.uk/ journalsPermissions.nav
John F. Peppin and Marco Pappagallo
Abstract: The treatment of neuropathic pain is difficult. Oral pharmaceuticals have significant side effects, and treatment efficacy tends to be modest. The use of topical analgesics reduces the potential for systemic side effects and allows direct application of medications to the area of pain. The natural spicy substance, capsaicin, has historically been known for its topical use. Capsaicin, once applied to the skin, causes a brief initial sensitization followed by a prolonged desensitization of the local pain nerves. This occurs through stimulation of the transient receptor potential vanilloid-1 (TRPV1) expressing pain nerve fibers. While low-dose capsaicin has not resulted in good efficacy, the larger dose 8% topical capsaicin has had some of the best data currently available in the treatment of post-herpetic neuralgia (PHN) and other neuropathic conditions. This paper discusses the data currently existing for capsaicin 8% in the treatment of PHN. It further reviews data for the low-dose capsaicin products and the current status in the development of other capsaicinoids, e.g. resiniferotoxin, and high-concentration liquid capsaicin. Keywords: capsaicin, capsaicinoids, neuropathic pain, TRPV1
Introduction The treatment of chronic neuropathic pain has been a challenge to physicians for millennia. Despite the multiple approaches used, e.g. topical, pharmaceutical, behavioral and interventional, our current treatment methods still provide only modest efficacy in this difficult pain condition. In general, treatment is very complex and single agents are rarely adequately effective. Capsaicinoids, the hot spicy ingredients in chilies, were described in ancient writings and documents for topical analgesic use. The mechanism of action is unique. There has been renewed interest in the development of capsaicinoids for the treatment of neuropathic pain over the last few decades and new products are either on the market or in development. Low-concentration (LC), i.e.
TAN7110.1177/1756285613501576Therapeutic Advances in Neurological DisordersJF Peppin and M Pappagallo
Therapeutic Advances in Neurological Disorders
Capsaicinoids in the treatment of neuropathic pain: a review
Review
Ther Adv Neurol Disord (2014) 7(1) 22–32 DOI: 10.1177/ 1756285613501576 © The Author(s), 2013. Reprints and permissions: http://www.sagepub.co.uk/ journalsPermissions.nav
John F. Peppin and Marco Pappagallo
Abstract: The treatment of neuropathic pain is difficult. Oral pharmaceuticals have significant side effects, and treatment efficacy tends to be modest. The use of topical analgesics reduces the potential for systemic side effects and allows direct application of medications to the area of pain. The natural spicy substance, capsaicin, has historically been known for its topical use. Capsaicin, once applied to the skin, causes a brief initial sensitization followed by a prolonged desensitization of the local pain nerves. This occurs through stimulation of the transient receptor potential vanilloid-1 (TRPV1) expressing pain nerve fibers. While low-dose capsaicin has not resulted in good efficacy, the larger dose 8% topical capsaicin has had some of the best data currently available in the treatment of post-herpetic neuralgia (PHN) and other neuropathic conditions. This paper discusses the data currently existing for capsaicin 8% in the treatment of PHN. It further reviews data for the low-dose capsaicin products and the current status in the development of other capsaicinoids, e.g. resiniferotoxin, and high-concentration liquid capsaicin. Keywords: capsaicin, capsaicinoids, neuropathic pain, TRPV1
Introduction The treatment of chronic neuropathic pain has been a challenge to physicians for millennia. Despite the multiple approaches used, e.g. topical, pharmaceutical, behavioral and interventional, our current treatment methods still provide only modest efficacy in this difficult pain condition. In general, treatment is very complex and single agents are rarely adequately effective. Capsaicinoids, the hot spicy ingredients in chilies, were described in ancient writings and documents for topical analgesic use. The mechanism of action is unique. There has been renewed interest in the development of capsaicinoids for the treatment of neuropathic pain over the last few decades and new products are either on the market or in development. Low-concentration (LC), i.e.
