Capsaicin topical cream (8%) for the treatment of myofascial pain syndrome / Creme tópico de capsaicina (8%) para o tratamento da síndrome da dor miofascial

Abstract Background: Myofascial pain syndrome is a common cause of musculoskeletal pain. The objective of this study was to evaluate the potential analgesic action of 8% capsaicin cream for topical use in patients with myofascial pain syndrome. Methods: Initially, cream formulations of PLA (Placebo) and CPS (Capsaicin 8%) were developed and approved according to the current requirements of the health authority agency. The 40 participating patients were randomly assigned to the PLA and CPS groups in a double-blind fashion. Before the creams were topically administered, according to the allocation group, the local anesthetic was used for a period of 50 minutes directly in the area of interest. The cream was applied to the area of the skin over the trigger point, represented by the area with pain at palpation, in an amount of 10 g for 30 minutes in a circular area of 24 mm diameter. Subsequently, the cream was removed and the skin tolerability parameters were evaluated. The pain was measured before and during the formulation application, as well as at 1 hour, 7 days, 30 days, and 60 days after the procedure, evaluated using a verbal numerical scale (from 0 to 10: with 0 = no pain and 10 = worst pain imaginable). Results: No patient in PLA Group had hyperemia or burning sensation at the site of application, while 85% of patients in CPS Group had hyperemia or burning sensation at 15 minutes. These complaints disappeared 24 hours after the cream was removed. The pain score in CPS Group decreased steadily up to the 60th day of evaluation (p < 0.0001). Conclusion: Application of the formulations did not cause macroscopic acute or chronic skin lesions in patients, and the 8% capsaicin formulation was beneficial and well tolerated.

Resumo Justificativa: A síndrome da dor miofascial é uma causa comum de dor musculoesquelética. O objetivo deste estudo foi avaliar a potencial ação analgésica de 8% do creme de capsaicina para uso tópico em pacientes com síndrome da dor miofascial. Métodos: Inicialmente, as formulações de creme de PLA (Placebo) e CPS (Capsaicina 8%) foram desenvolvidas e aprovadas de acordo com os requisitos atuais da agência de autoridade de saúde. Os 40 pacientes participantes foram distribuídos aleatoriamente e de forma duplo-cega para os grupos PLA e CPS. Antes dos cremes serem administrados topicamente, de acordo com o grupo de alocação, o anestésico local foi usado por um período de 50 minutos diretamente na área de interesse. A administração ocorreu na área da pele sobre o ponto-gatilho, o qual apresentou a área dolorida à palpação, em uma quantidade de 10 g por 30 minutos em área circular com diâmetro de 24 mm. Posteriormente, o creme foi removido e os parâmetros de tolerabilidade à pele foram avaliados. A dor foi medida antes e durante a aplicação da formulação, bem como 1 hora, 7 dias, 30 dias e 60 dias após o procedimento avaliado pela escala numérica verbal (0 a 10, com zero sem dor e dez a pior dor imaginável). Resultados: Nenhum paciente no grupo PLA experimentou hiperemia ou sensação de queimação no local de aplicação do creme, enquanto 85% dos que experimentaram no grupo CPS apresentaram hiperemia ou sensação de queimação 15 minutos. Essas queixas desapareceram 24 horas após a remoção do creme. O escore de dor no grupo CPS diminui de forma sustentada até o 60° dia de avaliação (p < 0,0001). Conclusão: A administração das formulações não causou lesões cutâneas agudas ou crônicas macroscópicas nos pacientes e a formulação de 8% de capsaicina foi benéfica e bem tolerada.

Tratamientos farmacológicos en pacientes con síndrome de boca urente: revisión sistemática / Pharmacologic treatment of burning mouth syndrome: a systematic review

El objetivo fue determinar mediante una revisión sistemática, cuáles tratamientos farmacológicos para el Síndrome de Boca Urente (SBU) logran una reducción de síntomas, según Escala Visual Análoga (EVA). Se realizó una búsqueda bibliográfica en la bases de datos PubMed y SciELO, Trip Database, Scopus Database, EBSCO host y LILACS entre el 2005 y 2015. De 72 artículos, se seleccionaron un total de 11. Los tratamientos sistémicos usados fueron, Hipericum perforatum, Catuama, Clonazepam, Ácido alfa lipoico y Lafutidina. Entre los tratamientos tópicos, Aceite de oliva virgen enriquecido con licopeno, Lisozima lactoperoxidasa, Clonazepam y Capsaicina. Los fármacos que obtuvieron mejores resultados para el tratamiento del SBU fueron Lafutidina, Catuama, Clonazepam tópico y sistémico, y en menor grado Capsaicina.

The aim of this study was to determine through a systematic review, which is the best drug treatment for burning mouth syndrome (SBU), measured on a Visual Analogue Scale. A scientific literature search was conducted in PubMed and SciELO, Trip Database, Database Scopus, EBSCO host and LILACS data between 2005 and 2015. Of a total of 72 articles, 11 were included for analysis. Systemic treatments were Lycopene-enriched virgin olive oil, Hypericum perforatum, Catuama, Clonazepam, Alpha lipoic acid; topical treatments were Lysozyme lactoperoxidase, Clonazepam, Capsaicin and Lafutidine. The best results obtained were with Lafutidine, Catuama, topical and systemic Clonazepam, and to a lesser degree Capsaicin.

Neuropathic truncal pain in patients with type 2 diabetes mellitus relieved by topical cream and nerve block

No abstract available.

Tissue distribution & elimination of capsaicin, piperine & curcumin following oral intake in rats.

Background & objectives: Curcumin, capsaicin and piperine - the bioactive compounds present in spices-turmeric (Curcuma longa), red pepper (Capsicum annuum) and black pepper (Piper nigrum) respectively, have a considerable portion of structural homology. Tissue distribution and elimination of these three structurally similar bioactive compounds was examined following their oral intake in rats. Methods: Separate sets of animals (150 - 160 g) were orally administered the three spice principles at dosages of 30 mg (capsaicin), 170 mg (piperine) and 500 mg (curcumin) / kg body weight. The tissue concentrations of administered spice compounds were determined by HPLC. Results: Maximum distribution of 24.4 per cent of administered capsaicin was seen at 1 h, while no intact capsaicin was detectable after 4 days. Absorption of capsaicin was about 94 per cent and very rapid relative to other two compounds. A maximum of 10.8 per cent of administered piperine was seen in tissues at 6 h. Absorption of the administered piperine was about 96 per cent. Curcumin concentration was maximum in the intestine at 1 h; maximum in blood at 6 h and remained at significantly higher level even at 24 h. About 63.5 per cent of the curcumin dose was absorbed. Only a small portion of the administered dose of capsaicin (< 0.1%) and curcumin (0.173 %) was excreted in urine, whereas piperine was not detectable in urine. Enhanced bioavailability of curcumin was evidenced when the same was orally administered concomitant with piperine. Intestinal absorption of curcumin was relatively higher when administered concomitantly with piperine, and it stayed significantly longer in the body tissues. Intact curcumin was detected in brain at 24, 48 and 96 h with a maximum at 48 h. Conclusions: Considerable difference exists in the bioavailability of the three test compounds. Curcumin could be traced in the brain following its administration. Bioavailability of curcumin can be improved by co-administration with piperine.

Pharmacokinetic and the effect of capsaicin in Capsicum frutescens on decreasing plasma glucose level.

BACKGROUND: The active substance found in Capsicum frutescens (capsicum) that gives hot and spicy flavor is capsaicin, and it seems to have many pharmacological effects. OBJECTIVE: The present research was conducted to study the effect of capsicum on plasma glucose level and to correlate its action with the pharmacokinetic properties of capsaicin in capsicum. MATERIAL AND METHOD: The crossover study was performed in 12 healthy volunteers by performing the OGTT while receiving placebo or 5 grams of capsicum. The insulin secretion and capsaicin level in plasma were measured using the HPLC method. RESULTS: The results of the OGTT showed that plasma glucose levels in volunteers who received capsicum were significantly lower than those in the placebo group at 30 and 45 minutes (p < 0.05). Furthermore, plasma insulin levels were significantly higher at 60, 75, 105, and 120 minutes (p < 0.05). When comparing before and after capsicum intake, the results showed the insulin levels were maintained The pharmacokinetic parameters of capsaicin shown as C(max), T(max), AUC(0-t), T1/2 are 2.47 +/- 0.13 ng/ml, 47.08 +/- 1.99 min, 103.6 +/- 11.3 ng x min/ml, and 24.87 +/- 4.97 min, respectively. CONCLUSION: In conclusion, the present study found that 5 grams of capsicum presented capsaicin levels that were associated with a decrease in plasma glucose levels and the maintenance of insulin levels. The present result might have clinical implications in the management of type 2 diabetes.

A role of intravesical capsaicin instillation in benign prostatic hyperplasia with overactive bladder symptoms: the first reported study in the literature.

OBJECTIVE: To study the treatment efficacy of capsaicin, in the cases of benign prostatic hyperplasia with overactive bladder symptoms. MATERIAL AND METHOD: A prospective study of 20 benign prostatic hyperplasia patients whose overactive bladder symptoms were not improved by alpha1 blockers. All of them underwent intravesical capsaicin instillation at the Faculty of Medicine Siriraj Hospital, Bangkok, between 2004 and 2006. Both clinical and urodynamic data were evaluated before and after treatment. RESULTS: Mean urgency decreased from 6.7 +/- 5.1 at baseline to 2.0 +/- 2.3 (p < 0.005), 1.4 +/- 2.4 (p < 0.005), and 1.3 +/- 2.2 (p < 0.005) at 1, 3, and 6 months. Mean urge incontinence decreaseD from 1.7 +/- 3.5 at baseline to 0.5 +/- 1.3 (p = 0.148), 0.4 +/- 1.2 (p = 0.114), and 0.3 +/- 1.1 (p = 0.085) at 1, 3, and 6 months. Mean urinary frequency decreased from 13.7 +/- 3.3 at baseline to 10.5 +/- 2.8 (p < 0.005), 9.6 +/- 2.0 (p < 0.005), and 9.5 +/- 2.6 (p < 0.005) at 1, 3, and 6 months. Mean nocturia decreased from 4.7 +/- 2.4 at baseline to 3.1 +/- 2.2 (p < 0.005), 2.7 +/- 1.2 (p < 0.005), and 2.9 +/- 1.6 (p < 0.005) at 1, 3, and 6 months. Mean first desire to void increased from 172.5 +/- 100.4 ml at baseline to 210.6 +/- 99.5 ml (p = 0.016) at 1 month. Mean maximal cystometric capacity increased from 350.3 +/- 165.9 ml at baseline to 397.4 +/- 165.7 ml (p = 0.012) at 1 month. Peak flow rate, detrusor pressure, and post void residual urine were not affected No serious adverse effect occurred in this study. CONCLUSION: Intravesical capsaicin instillation is an effective treatment for overactive bladder symptoms in benign prostatic hyperplasia patients.

A role of intravesical capsaicin instillation in benign prostatic hyperplasia with overactive bladder symptoms: the first reported study in the literature.

OBJECTIVE: To study the efficacy of capsaicin in treating overactive bladder symptoms in benign prostatic hyperplasia patients. MATERIAL AND METHOD: A prospective study of 20 benign prostatic hyperplasia patients whose overactive bladder symptoms were not improved by alpha1 blocker Alpha1 blocker was taken about 22.9 +/- 17.2 months before and continued throughout 6 months duration of the present study. All of them had undergone intravesical capsaicin instillation at the Faculty of Medicine Siriraj Hospital, Bangkok, from 2004 to 2006. Both clinical and urodynamic data were evaluated before and after treatment. RESULTS: Mean urgency decreased from 6.7 +/- 5.1 at baseline to 2.0 +/- 2.3 (p < 0.005), 1.4 +/- 2.4 (p < 0.005), 1.3 +/- 2.2 (p < 0.005) at 1, 3 and 6 months. Mean urge incontinence decreased from 1.7 +/- 3.5 at baseline to 0.5 +/- 1.3 (p = 0.148), 0.4 +/- 1.2 (p = 0.114), 0.3 + 1.1 (p = 0.085) at 1, 3 and 6 months. Mean urinary frequency decreased from 13.7 +/- 3.3 at baseline to 10.5 +/- 2.8 (p < 0.005), 9.6 +/- 2.0 (p < 0.005), 9.5 +/- 2.6 (p < 0.005) at 1, 3 and 6 months. Mean nocturia decreased from 4.7 +/- 2.4 at baseline to 3.1 +/- 2.2 (p < 0.005), 2.7 +/- 1.2 (p < 0.005), 2.9 +/- 1.6 (p < 0.005) at 1, 3 and 6 months. Mean first desire to void increased from 172.5 +/- 100.4 ml at baseline to 210.6 +/- 99.5 ml (p = 0.016) at 1 month. Mean maximal cystometric capacity increased from 350.3 +/- 165.9 ml at baseline to 397.4 +/- 165.7 ml (p = 0.012) at 1 month. Peak flow rate, detrusor pressure, and postvoid residual urine were not affected. No serious adverse effect occurred in the present study. CONCLUSION: Intravesical capsaicin instillation is an effective treatment for overactive bladder symptoms in benign prostatic hyperplasia patients.

Aumento del umbral tusígeno en sujetos sanos con el uso de Levodropropizina / Increase of the cough threshold to capsaicin in healthy adults by administering Levodropropizine

A randomized, prospective, double blind and placebo controlled study was designed to evaluate in 20 non smoker healthy adult volunteers the reproducibility and modification of cough threshold (CT) induced by capsaicin after placebo and Levodropropizine (a new synthetic drug). Adult volonteers of both sexes, mean age 34.9 years old (range: 18-57 years), inhaled increasing concentrations of capsaicin to determine the basal CT: log concentration of capsaicin that induced at least two consecutive coughs. The basal CT was 2.240 µM (+/- 0.060 SE), without differences by sex or age (p: ns), In 11 out of 18 subjects the CT increased from 2.358 (+/- 0,044 SE) on placebo to 2.469 µM (+/- 0.057) after Levodropropizine (p = 0.01). Two subjects were excluded due to intercurrent disease, not related to the study. No significant adverse reactions were reported during the study. Conclusion: Capsaicin induced reproducible controlled cough in 20 healthy volunteers and Levodropropizine given orally increased the cough threshold.

Se diseñó un estudio aleatorio prospectivo, doble ciego cruzado contra placebo, para estudiar la reproducibilidad y las modificaciones del umbral tusígeno (UT) inducido por capsaicina, luego de administrar placebo y Levodropropizina (un nuevo antitusivo sintético). Se determinó el UT basal (logaritmo de la concentración de capsaicina que induce al menos dos toses consecutivas) en 20 voluntarios adultos sanos, no fumadores de ambos sexos con edad promedio de 34,9 años (rango: 18 a 57 años). El promedio del UT basal fue 2,240 µM (+ - 0,060 ES), sin haber diferencias significativas por sexo o edad (p: ns). En 11 de 18 sujetos el UT aumentó de 2,358 µM (+/ - 0,044 ES) con placebo a 2,469 µM (+/- 0,057 ES) con Levodropropizina (p = 0,01). Dos sujetos fueron excluidos por presentar una enfermedad intercurrente no relacionada con el estudio. No hubo efectos adversos significativos. Conclusión: La capsaicina indujo reproduciblemente el reflejo tusígeno en 20 voluntarios sanos, y la Levodropropizina administrada por vía oral aumentó el umbral tusígeno.

The efficacy of Thai capsaicin in management of overactive bladder and hypersensitive bladder.

This paper has been generated to provide information on the effectiveness of capsaicin treatment among patients with overactive or hypersensitive bladder. The evaluation process required approximately 14 (overactive bladder) and 11 (hypersensitive bladder and primary detrusor instability) participants who received capsaicin intravesically. The solution consisted of capsaicin (concentration = 1 mM/L) diluted in 30 per cent ethanol solution 100 ml. All participants went through at least 1 urodynamic test 1 month before and after receiving capsaicin intravesical instillation. The capsaicin treatment for overactive and hypersensitive bladders was very effective. On the average, (overactive bladder) participants' voiding needs decreased from 16.5 +/- 4.8 times/day to 8.6 +/- 2.5 times/day, leakage from 9.7 +/- 8.1 times/day to 2.4 +/- 4.3 times/day, bladder capacity from 160.1 +/- 123.3 ml to 236.9 +/- 146.1 ml, and detrusor contraction from 71.1 +/- 29.2 cm/H2O to 57.3 +/- 27.2 cm/H2O. On average, (hypersensitive bladder and primary detrusor instability) participants' voiding needs decreased from (Day time) 19.45 +/- 17.99 times to 12.00 +/- 8.91 times/day, (Night time) 7.09 +/- 6.03 times to 4.09 +/- 3.8 times, bladder capacity from 197.40 +/- 156.06 ml to 323.45 +/- 129.46 ml, and detrusor contraction from 32.64 +/- 22.77 cm/H2O to 36.64 +/- 19.22 cm/H2O. Capsaicin efficiency was rated very high for both overactive and hypersensitive bladder and primary detrusor instability. In Thailand, it has been possible to produce capsaicin using local chili supplies, thus the price of the drug itself is very economical. When considering the efficiency and the inexpensive cost of capsaicin, this treatment would be another great alternative for overactive and hypersensitive bladder cure.

Cough Sensitivity and Extrathoracic Airway Responsiveness to Inhaled Capsaicin in Chronic Cough Patients

Enhanced cough response has been frequently observed in chronic cough. Recently, extrathoracic airway constriction to inhaled histamine was demonstrated in some chronic cough patients. However, relation between extrathoracic airway hyperresponsiveness (EAHR) and cough sensitivity determined by capsaicin inhalation is unclear in each etiological entity of chronic cough. Seventy-seven patients, with dry cough persisting for 3 or more weeks, normal spirometry and chest radiography, and 15 controls, underwent methacholine bronchial provocation test and capsaicin cough provocation test. Elicited cough number and flow-volume curve was examined after inhalation of capsaicin to evaluate cough sensitivity and EAHR. Thirty-three patients, with postnasal drip, showed normal extrathoracic airway responsiveness, and 27 of them showed normal cough sensitivity to capsaicin. Cough sensitivity was enhanced in 14 patients with cough variant asthma (CVA) who showed bronchial hyperresponsiveness; EAHR to inhaled capsaicin was present in 12 of them. The remaining 30 patients were tentatively diagnosed as idiopathic chronic cough (ICC). Eleven ICC patients showed enhanced cough sensitivity and EAHR to inhaled capsaicin while 19 patients showed normal values. These results indicate that cough sensitivity is closely related with extrathoracic airway responsiveness during capsaicin provocation in some chronic cough patients. EAHR and enhanced cough sensitivity to inhaled capsaicin may be a part of mechanism developing chronic cough.