Topical capsaicin treatment of chronic postherpetic neuralgia

Bernstein, Joel E.; Korman, Neil J.; Bickers, David R.; Dahl, Mark V.; Millikan, Lawrence E.

doi:10.1016/s0190-9622(89)70171-7

Cited by 263 publications

(112 citation statements)

References 20 publications

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“…Topical capsaicin produces benefit in postherpetic neuralgia (Bernstein et al, 1989;Watson et al, 1993), diabetic neuropathy (Capsaicin Study Group, 1992), postmastectomy pain syndrome (Watson and Evans, 1992;Dini et al, 1993), oral neuropathic pain, trigeminal neuralgia, and temperomandibular joint disorders (Epstein and Marcoe, 1994;Hersh et al, 1994), cluster headache (following intranasal application) (Marks et al, 1993), osteoarthritis (McCarthy and McCarthy, 1992), and dermatological and cutaneous conditions (Hautkappe et al, 1998). Whereas pain relief is widely observed in these studies, the degree of relief is usually modest, although some patients have a very good result.…”

Section: Capsaicinmentioning

confidence: 99%

Topical and Peripherally Acting Analgesics

2003

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Section: Capsaicinmentioning

confidence: 99%

Topical and Peripherally Acting Analgesics

2003

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“…In addition, CAP paradoxically induces desensitization of sensory neurons to various types of noxious stimuli, thus producing a long-lasting and naloxoneresistant analgesia (for review, see Holzer, 1991). Because of this analgesic action, CAP is often used for alleviating pain caused by diabetic or herpetic neuropathy or arthritis, and CAP analogs are being explored as potential analgesics (Watson et al, 1988;Bernstein et al, 1989;Donofrio et al, 1991;Szallasi and Blumberg, 1996).…”

Section: Abstract: Capsaicin Receptor; Vr1; Binding Domain; Da-5018;mentioning

confidence: 99%

Capsaicin Binds to the Intracellular Domain of the Capsaicin-Activated Ion Channel

et al. 1999

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Capsaicin (CAP) excites small sensory neurons, causing pain, neurogenic inflammation, and other visceral reflexes. These effects have been proposed to be the result of CAP activation of a nonselective cation current. It is generally assumed that CAP binds to an extracellular domain of the membrane receptor. However, the exact binding site is not known because of the lipophilic nature of CAP. To determine whether the binding domain is extracellular or intracellular, we tested the effect of a synthetic watersoluble CAP analog, DA-5018⅐HCl, on current activation. CAP activated the 45 pS (at Ϫ60 mV) nonselective cation channel from either side of the membrane. However, DA-5018⅐HCl, which had a greater potency and efficacy than CAP, activated the channels only from the cytosolic side of the patch membrane in a capsazepine, a CAP receptor antagonist, reversible manner. When applied extracellularly, DA-5018⅐HCl did not, but CAP did, activate whole-cell currents in sensory neurons, as well as in oocytes expressing vanilloid receptor 1, a recently cloned CAP receptor. Hydrogen ions, reported as a possible endogenous activator of cation current, failed to elicit any current when acidic medium (pH 5.0-6.0) was applied intracellularly, indicating that H ϩ does not mediate the CAP effect. These results indicate that CAP and its analog bind to the cytosolic domain of the CAP receptor and suggest that an endogenous CAP-like substance other than H ϩ may be present in the cell.

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“…Capsaicin is another topical agent that has shown efficacy in randomized clinical trials. 17,18 However, the burning sensation associated with the application of capsaicin often limits its clinical use. Patients should be advised that the burning sensation decreases with continued use of capsaicin.…”

Section: Topical Agentsmentioning

confidence: 99%

Herpes Zoster (Shingles) and Postherpetic Neuralgia

Sampathkumar

Drage

Martin

2009

Mayo Clinic Proceedings

337

202

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Herpes zoster (HZ), commonly called shingles, is a distinctive syndrome caused by reactivation of varicella zoster virus (VZV). This reactivation occurs when immunity to VZV declines because of aging or immunosuppression. Herpes zoster can occur at any age but most commonly affects the elderly population. Postherpetic neuralgia (PHN), defined as pain persisting more than 3 months after the rash has healed, is a debilitating and difficult to manage consequence of HZ. The diagnosis of HZ is usually made clinically on the basis of the characteristic appearance of the rash. Early recognition and treatment can reduce acute symptoms and may also reduce PHN. A live, attenuated vaccine aimed at boosting immunity to VZV and reducing the risk of HZ is now available and is recommended for adults older than 60 years. The vaccine has been shown to reduce significantly the incidence of both HZ and PHN. The vaccine is well tolerated, with minor local injection site reactions being the most common adverse event. This review focuses on the clinical manifestations and treatment of HZ and PHN, as well as the appropriate use of the HZ vaccine. © 2009 Mayo Foundation for Medical Education and ResearchOn completion of this article, you should be able to (1) recognize the common presentation of herpes zoster, (2) summarize appropriate treatment for acute herpes zoster and postherpetic neuralgia, and (3) select patients for whom herpes zoster vaccine is appropriate.H erpes zoster (HZ), commonly called shingles from the Latin cingulum, meaning belt, 1 is a distinctive syndrome caused by reactivation of varicella zoster virus (VZV). The risk of HZ increases with age; approximately half of all cases occur in persons older than 60 years. One of the most common and debilitating sequelae of HZ is postherpetic neuralgia (PHN), defined as pain persisting more than 3 months after the rash has healed. CLINICAL MANIFESTATIONS AND DIAGNOSISHerpes zoster is a painful, blistering skin eruption in a dermatomal distribution. After primary infection with varicella (ie, chicken pox), the virus persists asymptomatically in the ganglia of sensory cranial nerves and spinal dorsal root ganglia. As cellular immunity to VZV decreases with age or because of immunosuppression, the virus reactivates and travels along the sensory nerves to the skin, causing the distinctive prodromal pain followed by eruption of the rash. It is estimated that approximately 1 in 3 people will develop HZ during their lifetime, resulting in an estimated 1 million episodes in the United States annually. 2 Herpes zoster can occur at any age but is generally less severe in children and young adults, with the greatest morbidity and mortality seen in older adults and in immunocompromised patients. A recent population-based study in Olmsted County, Minnesota, found that the incidence of HZ was 3.6 per 1000 patientyears. 3 In that study, the incidence of HZ and the rate of HZassociated complications increased with age, with 68% of cases occurring in those aged 50 years and older. Prodromal...

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Topical capsaicin treatment of chronic postherpetic neuralgia

Cited by 263 publications

References 20 publications

Topical and Peripherally Acting Analgesics

Topical and Peripherally Acting Analgesics

Capsaicin Binds to the Intracellular Domain of the Capsaicin-Activated Ion Channel

Herpes Zoster (Shingles) and Postherpetic Neuralgia

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