Topical capsaicin for chronic neck pain. A pilot study.

Substance P is thought to be the principle neurotransmitter of nociceptive impulses in type C sensory neurons. Prolonged repeated applications of capsaicin cream depletes the sensory C-fibers of substance P. In an open-labeled prospective pilot study, 23 patients with chronic neck pain (greater than 3 mo) completed the study. Patients applied topical capsaicin (0.025%) cream four times a day to painful areas in the neck and shoulder girdle for a 5-wk treatment period. One patient dropped out because of intolerable burning. Statistically significant improvement was obtained in two primary outcome variables, the visual analog pain scale (P = 0.00013) and the pain relief scale (P = 0.002). Paired t tests failed to show a significant improvement in the McGill Pain Questionnaire. This study demonstrated that topically applied capsaicin cream may decrease subjective neck pain. A double-blind, placebo-controlled trial is needed to confirm this treatment effect.

Analysis of casualties referred to Army physical medicine services during the Persian Gulf conflict.

This study describes the casualties referred during the Persian Gulf War and underscores the valuable role of Army physical medicine and rehabilitation (PMR) services in evaluation and early rehabilitation of wartime casualties. Data regarding demographics, injury types, medical complications, complications of immobility and functional limitations were collected by military physiatrists at five Army Medical Centers with PMR services. Active duty soldiers injured in the Persian Gulf War who were referred totalled 222. Musculoskeletal injuries occurred in 57%, peripheral nerve injuries in 44%, penetrating wounds in 32%, fractures in 28%, brain injuries in 8%, amputations in 7%, burns in 6% and spinal cord injuries in 3%. The primary referral service was orthopedics (64%). Electrodiagnosis evaluations were performed for 41% of all referrals. Lower limb and upper limb contractures occurred in 10% and 9% of patients, respectively. Ambulatory impairments were seen in 48%. Nerve injuries were associated with penetrating wounds in 68%, with amputations in 67% and with fractures in 58%.