Summary
In order to evaluate the efficacy, time-course of action and predictors of response to topical capsaicin, 39 patients with chronic post-herpetic neuralgia (PHN), median duration 24 months, were treated with 0.025% capsaicin cream for 8 weeks. During therapy the patients rated their pain on a visual analogue scale (VAS) and a verbal outcome scale. A follow-up investigation was performed 10–12 months after study onset on the patients who had improved. Nineteen patients (48.7%) substantially improved after the 8-week trial; 5 (12.8%) discontinued therapy due to side-effects such as intolerable capsaicin-induced burning sensations (4) or mastitis (1); 15 (38.5%) reported no benefit. The decrease in VAS ratings was significant after 2 weeks of continuous application. Of the responders 72.2% were still improved at the follow-up; only one-third of them had continued application irregularly. Treatment effect was not dependent on patient's age, duration or localization of PHN (trigeminal involvement was excluded), sensory disturbance or pain character. Treatment response was not correlated with the incidence, time-course or severity of capsaicin-induced burning. If confirmed in controlled trials, the long-term results of this open, non-randomized study might indicate that the analgesic effect of capsaicin in PHN is mediated by both interference with neuropeptide metabolism and morphological changes (perhaps degeneration) of nociceptive afferents.
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References
Bernstein JE, Swift RM, Soltani K, Lorincz AL (1981) Inhibition of axon reflex vasodilatation by topically applied capsaicin. J Invest Dermatol 76:394–395
Bernstein JE, Bickers DR, Dahl MV, Roshal JY (1987) Treatment of chronic postherpetic neuralgia with topical capsaicin. J Am Acad Dermatol 17:93–96
Bernstein JE, Korman NJ, Bickers DR, Dahl MV, Millikan LE (1989) Topical capsaicin treatment of chronic postherpetic neuralgia. J Am Acad Dermatol 21:265–270
Bucci FA, Gabriels CF, Krohel GB (1988) Successful treatment of postherpetic neuralgia with capsaicin. Am J Ophthalmol 106:758–759
Buck SH, Burks TF (1986) The neuropharmacology of capsaicin: review of some recent observations. Pharmacol Rev 38:179–226
Carpenter SE, Lynn B (1981) Vascular and sensory responses of human skin to mild injury after topical treatment with capsaicin. Br J Pharmacol 73:755–758
Drake HF, Harries AJ, Gamester RE, Justins D (1990) Randomised double-blind study of topical capsaicin for treatment of post-herpetic neuralgia. Pain 5 [Suppl]:S58
Ebert MH (1949) Histologic changes in sensory nerves of the skin in herpes zoster. Arch Dermatol 60:641–648
Fitzgerald M (1983) Capsaicin and sensory neurones — a review. Pain 15:109–130
Gamse R, Holzer P, Lembeck F (1980) Decrease of substance P in primary afferent neurones and impairment of neurogenic plasma extravasation by capsaicin. Br J Pharmacol 68:207–213
Gamse R, Leeman SE, Holzer P, Lembeck F (1981) Differential effects of capsaicin on the content of somatostatin, substance P and neurotensin in the nervous system of the rat. Naunyn Schmiedebergs Arch Pharmacol 317:140–148
Gamse R, Petsche U, Lembeck F, Jancso G (1982) Capsaicin applied to peripheral nerve inhibits axoplasmatic transport of substance P and somatostatin. Brain Res 239:447–462
Hawk RJ, Millikan LE (1988) Treatment of oral postherpetic neuralgia with topical capsaicin. Int J Dermatol 27:336
Jancso G, Kiraly E, Jancso-Gabor A (1977) Pharmacologically induced selective degeneration of chemosensitive primary sensory neurons. Nature 270:741–743
Jansco G, Hökfelt T, Lundberg JM, Kiraly E, Halasz N, Nilsson G, Terenius L, Rehfeld J, Steinbusch H, Verhofstad A, Elde R, Said S, Brown M (1981) Immunohistochemical studies on the effect of capsaicin on spinal cord and medullary peptide and monoamine neurons using antisera to substance P, gastrin/CCK, somatostatin, VIP, enkephalin, neurotensin and 5-hydroxytryptamin. J Neurocytol 10:963–980
Jansco G, Kiraly E, Joo F, Such G, Nagy A (1985) Selective degeneration by capsaicin of a subpopulation of primary sensory neurons in the adult rat. Neurosci Lett 59:209–214
Jessell TM, Iversen LL, Cuello AC (1978) Capsaicin-induced depletion of substance P from primary sensory neurones. Brain Res 152:183–188
Lynn B (1986) The immediate and long-term effects of applying capsaicin to cutaneous nerves. Acta Physiol Hung 69:287–294
Lynn B (1990) Capsaicin: actions on nociceptive C-fibres and therapeutic potential. Pain 41:61–69
Loeser JD (1986) Herpes zoster and postherpetic neuralgia. Pain 25:149–164
Marsh SJ, Stansfeld CE, Brown DA, Davey R, McCarthy D (1987) The mechanism of action of capsaicin on sensory C-type neurons and their axons in vitro. Neuroscience 23:275–289
Muller SA, Winkelmann RK (1969) Cutaneous nerve changes in zoster. J Invest Dermatol 52:71–77
Nagy JI, Iversen LL, Goedert M, Chapman D, Hunt SP (1983) Dose-dependent effects of capsaicin on primary sensory neurons in the neonatal rat. J Neurosci 3:399–406
Noordenbos W (1968) Physiological correlates of clinical pain syndromes. In: Soulairac A, Cahn J, Charpentier J (eds) Pain. Academic Press, New York, pp 465–476
Pini A, Baranowski R, Lynn B (1990) Long-term reduction in the number of C-fibre nociceptors following capsaicin treatment of a cutaneous nerve in adult rats. Eur J Neurosci 2:89–97
Portenoy RK, Duma C, Foley KM (1986) Acute herpetic and postherpetic neuralgia: clinical review and current management. Ann Neurol 20:651–664
Russell LC, Burchiel KJ (1984) Neurophysiological effects of capsaicin. Brain Res Rev 8:165–176
Straus SE (1988) Varicella-zoster virus infections. Ann Intern Med 108:221–237
Szolcsanyi J (1977) A pharmacological approach to elucidation of the role of different nerve fibres and receptor endings in mediation of pain. J Physiol (Paris) 73:251–259
Szolcsanyi J, Jansco-Gabor A, Joo F (1975) Functional and fine structural characteristics of the sensory neuron blocking effect of capsaicin. Naunyn Schmiedebergs Arch Pharmacol 287:157–169
Wall PD (1988) Editor's note. Pain 33:340
Watson CP (1989) Postherpetic neuralgia. Neurol Clin 7:231–248.
Watson CPN, Evans RJ, Watt VR (1988) Post-herpetic neuralgia and topical capsaicin. Pain 33:333–340
Watson CPN, Evans RJ, Watt VR, Birkett N (1988) Post-herpetic neuralgia: 208 cases. Pain 35:289–297
Watson CPN, Morshead C, Van der Kooy D, Deck J, Evans RJ (1988) Post-herpetic neuralgia: post-mortem analysis of a case. Pain 34:129–138
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Peikert, A., Hentrich, M. & Ochs, G. Topical 0.025% capsaicin in chronic post-herpetic neuralgia: efficacy, predictors of response and long-term course. J Neurol 238, 452–456 (1991). https://doi.org/10.1007/BF00314653
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DOI: https://doi.org/10.1007/BF00314653