Peppin John F, Pappagallo Marco
Center for Bioethics, Pain Management and Medicine, 1121 Four Wynds Trail, Lexington KT 40515, USA.
The New Medical Home for Pain Management and Medical Mentoring, New York, NY, USA.
Ther Adv Neurol Disord. 2014 Jan;7(1):22-32. doi: 10.1177/1756285613501576.
The treatment of neuropathic pain is difficult. Oral pharmaceuticals have significant side effects, and treatment efficacy tends to be modest. The use of topical analgesics reduces the potential for systemic side effects and allows direct application of medications to the area of pain. The natural spicy substance, capsaicin, has historically been known for its topical use. Capsaicin, once applied to the skin, causes a brief initial sensitization followed by a prolonged desensitization of the local pain nerves. This occurs through stimulation of the transient receptor potential vanilloid-1 (TRPV1) expressing pain nerve fibers. While low-dose capsaicin has not resulted in good efficacy, the larger dose 8% topical capsaicin has had some of the best data currently available in the treatment of post-herpetic neuralgia (PHN) and other neuropathic conditions. This paper discusses the data currently existing for capsaicin 8% in the treatment of PHN. It further reviews data for the low-dose capsaicin products and the current status in the development of other capsaicinoids, e.g. resiniferotoxin, and high-concentration liquid capsaicin.
神经性疼痛的治疗颇具难度。口服药物有显著的副作用，且治疗效果往往一般。局部用镇痛药的使用降低了全身副作用的可能性，并能将药物直接应用于疼痛区域。天然辛辣物质辣椒素一直以来都以局部用药而闻名。辣椒素一旦应用于皮肤，会引起短暂的初始致敏，随后使局部疼痛神经长期脱敏。这是通过刺激表达瞬时受体电位香草酸亚型1（TRPV1）的疼痛神经纤维实现的。虽然低剂量辣椒素并未产生良好疗效，但较大剂量的8%局部用辣椒素在治疗带状疱疹后神经痛（PHN）和其他神经性疾病方面拥有目前一些最佳数据。本文讨论了目前8%辣椒素治疗PHN的现有数据。还进一步回顾了低剂量辣椒素产品的数据以及其他辣椒素类物质（如树脂毒素）和高浓度液体辣椒素的研发现状。
