Treatment of painful diabetic peripheral neuropathy

Abstract

Painful diabetic peripheral neuropathy impairs quality of life and can be difficult to treat. Many treatment options have adjuvant benefits or side effects which should be considered prior to initiating therapy. Often, a combination of treatment modalities with various mechanisms of action is required for adequate pain control.

What role for capsaicin in diabetic peripheral neuropathy?

“…The pain relief provided by the treatments is often poor, although a modest decrease in pain can be clinically meaningful 6. Oral treatments commonly cause unwanted effects, which may be intolerable 7,8.…”

“…Agonist action at the receptor probably accounts for the initial burning experienced with topical capsaicin. Prolonged activation of the receptor results in depletion of neurotransmitters, particularly substance P, and reduces the ability of neurons to transmit pain signals 6. This desensitisation is thought to underlie capsaicin's analgesic effect 11.…”

“…It needs to be applied three or four times daily (not more than every 4 hours) for several weeks before a significant analgesic effect is achieved 6. The summary of product characteristics (SPC) advises that the product should only be continued for longer than 8 weeks after a full clinical assessment of the patient's condition, with regular re-evaluation by the supervising consultant thereafter; this is because clinical trial data did not go beyond 8 weeks 12…”

“…Skin irritation is the most common unwanted effect of capsaicin and some patients do not tolerate the therapy 6. Application of capsaicin cream is usually associated with local erythema and treatment-associated discomfort, including pain 6.…”

“…Application of capsaicin cream is usually associated with local erythema and treatment-associated discomfort, including pain 6. The SPC for the cream states that burning occurs more often when the cream is used less frequently than recommended.…”