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Capsaicin - Neuropathic pain: Playing with fire...

机译：辣椒素-神经性疼痛：玩火...

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? 5% Lidocaine medicated plasters are available for local treatment of neuropathic pain. Treatment is generally poorly effective but has few adverse effects, other than local erythema. ? Capsaicin is a natural chilli pepper extract that depletes sensory nerve endings of substance P, a pain neurotransmitter. It is authorised in the European Union for the treatment of non-diabetic neuropathic pain, in the form of cutaneous patches containing 8% capsaicin. ? Clinical evaluation of capsaicin patches does not include any trials versus lidocaine plasters. Eight double-blind trials have compared 8% capsaicin patches versus 0.04% capsaicin patches, 5 in postherpetic neuralgia, and 3 in HIV-related neuropathic pain. ? These trials are only vaguely described in the European Medicines Agency report. Taken separately, they yielded divergent results. It was only when some of the trials were pooled for analysis that any differences emerged between the two doses of capsaicin. The clinical implications are unclear, but efficacy is at best modest. ? Capsaicin is an irritant that frequently provokes pain and erythema at the site of patch application, and 3% of patients using the patches experienced transient arterial hypertension that the investigators attributed to this pain. ? Some pharmacological data suggest that repeated application of 8% capsaicin patches might provoke painful nerve damage in the long term. ? Patch application and removal by a third party is delicate, due to the strong irritant potential of capsaicin. ? In practice, when a patient with neuropathic pain requires local treatment, in the absence of a better alternative, it is better to use lidocaine plasters, which are better tolerated and with which we have more experience.
机译：？ 5％的利多卡因药膏可用于局部治疗神经性疼痛。除局部红斑外，治疗通常效果不佳，但几乎没有不良反应。 ？辣椒素是一种天然的辣椒提取物，能消耗物质P（一种疼痛性神经递质）的感觉神经末梢。它已获得欧盟的批准，可用于治疗非糖尿病性神经性疼痛，其形式为含有8％辣椒素的皮肤贴剂。 ？辣椒素贴剂的临床评估不包括利多卡因膏药的任何试验。八项双盲试验比较了8％的辣椒素贴片与0.04％的辣椒素贴片，疱疹后神经痛5例和HIV相关神经性疼痛3例。 ？这些试验仅在欧洲药品管理局的报告中模糊地描述。分开来看，它们产生了不同的结果。只有汇总了一些试验进行分析时，两次剂量的辣椒素之间才出现差异。临床意义尚不清楚，但疗效至多适中。 ？辣椒素是一种刺激物，经常在贴剂应用部位引起疼痛和红斑，使用贴剂的患者中有3％经历了短暂的动脉高压，研究人员将其归因于这种疼痛。 ？一些药理学数据表明，长期使用8％辣椒素贴剂可能会引起神经痛。 ？由于辣椒素具有很强的刺激性，因此由第三方进行的贴剂施用和清除非常困难。 ？在实践中，当神经性疼痛患者需要局部治疗时，在没有更好的选择的情况下，最好使用耐受性更好的利多卡因膏药，并且我们有更多的经验。

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