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Skin Matters: A Review of Topical Treatments for Chronic Pain. Part One: Skin Physiology and Delivery Systems.

Peppin JF, Albrecht PJ, Argoff C, Gustorff B, Pappagallo M, Rice FL, Wallace MS - Pain Ther (2015)

Bottom Line: Achieving pain relief along with improved function and quality of life is the primary goal of pain clinicians; however, most patients and healthcare professionals consider 30% pain improvement to be clinically significant-a success level that would be unacceptable in other areas of medicine.However, topical analgesics have the advantage of local application with limited systemic levels of drug.Topical therapies benefit from reduced side effects, lower risk of drug-drug interactions, better patient acceptability/compliance, and improved tolerability.

View Article: PubMed Central - PubMed

Affiliation: Center for Bioethics Pain Management and Medicine, St. Louis, MO, USA, johnpeppin@msn.com.

ABSTRACT
Chronic pain is a complex disorder with multiple etiologies for which the pathologic mechanisms are still largely unknown, making effective treatment a difficult clinical task. Achieving pain relief along with improved function and quality of life is the primary goal of pain clinicians; however, most patients and healthcare professionals consider 30% pain improvement to be clinically significant-a success level that would be unacceptable in other areas of medicine. Furthermore, patients with chronic pain frequently have multiple comorbidities, including depression and sleep apnea, and most have seen several physicians prior to being seen by a pain specialist, have more than three specific pain generators, and are taking multiple medications. The addition of further oral medications to control pain increases the risk of drug-drug interactions and side effects. However, topical analgesics have the advantage of local application with limited systemic levels of drug. Topical therapies benefit from reduced side effects, lower risk of drug-drug interactions, better patient acceptability/compliance, and improved tolerability. This two-part paper is a review of topical analgesics and their potential role in the treatment of chronic pain.

No MeSH data available.


Related in: MedlinePlus

Capsaicin
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Related In: Results  -  Collection


getmorefigures.php?uid=PMC4470967&req=5

Fig2: Capsaicin

Mentions: Capsaicin, 8-methyl-N-vanillyl-6-nonenamide, is the active ingredient in chili peppers which provokes a burning sensation by binding to a heat-activated calcium channel, TRPV1. These channels normally open between 37 and 45 °C, but, when bound, the threshold decreases to less than 37 °C or the physiologic body temperature [47]. This stimulates the exocytosis of SP, leading to mast cell degranulation of histamine and serotonin release from platelets. A flare and weal response occurs rapidly while a poorly localized, protracted dull pain lingers from slow-conducting C nerve fibers. Mechanical and heat hyperalgesia ensue as pain thresholds decrease for central and peripheral nociceptors. An area of mechanical allodynia and secondary hyperalgesia occurs due to the activation of adjacent dermatomes. When capsaicin is given intradermally, acute pain is elicited by the activation of fast A fibers and as a direct effect of capsaicin. Elements of chronic neuropathic pain such as mechanothermal hyperalgesia and allodynia are mediated through activation of C fibers. These pain pathways are naturally activated by tissue abrasions, burns, and incisions. The chemical structure of capsaicin is shown in Fig. 2.Fig. 2


Skin Matters: A Review of Topical Treatments for Chronic Pain. Part One: Skin Physiology and Delivery Systems.

Peppin JF, Albrecht PJ, Argoff C, Gustorff B, Pappagallo M, Rice FL, Wallace MS - Pain Ther (2015)

Capsaicin
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4470967&req=5

Fig2: Capsaicin
Mentions: Capsaicin, 8-methyl-N-vanillyl-6-nonenamide, is the active ingredient in chili peppers which provokes a burning sensation by binding to a heat-activated calcium channel, TRPV1. These channels normally open between 37 and 45 °C, but, when bound, the threshold decreases to less than 37 °C or the physiologic body temperature [47]. This stimulates the exocytosis of SP, leading to mast cell degranulation of histamine and serotonin release from platelets. A flare and weal response occurs rapidly while a poorly localized, protracted dull pain lingers from slow-conducting C nerve fibers. Mechanical and heat hyperalgesia ensue as pain thresholds decrease for central and peripheral nociceptors. An area of mechanical allodynia and secondary hyperalgesia occurs due to the activation of adjacent dermatomes. When capsaicin is given intradermally, acute pain is elicited by the activation of fast A fibers and as a direct effect of capsaicin. Elements of chronic neuropathic pain such as mechanothermal hyperalgesia and allodynia are mediated through activation of C fibers. These pain pathways are naturally activated by tissue abrasions, burns, and incisions. The chemical structure of capsaicin is shown in Fig. 2.Fig. 2

Bottom Line: Achieving pain relief along with improved function and quality of life is the primary goal of pain clinicians; however, most patients and healthcare professionals consider 30% pain improvement to be clinically significant-a success level that would be unacceptable in other areas of medicine.However, topical analgesics have the advantage of local application with limited systemic levels of drug.Topical therapies benefit from reduced side effects, lower risk of drug-drug interactions, better patient acceptability/compliance, and improved tolerability.

View Article: PubMed Central - PubMed

Affiliation: Center for Bioethics Pain Management and Medicine, St. Louis, MO, USA, johnpeppin@msn.com.

ABSTRACT
Chronic pain is a complex disorder with multiple etiologies for which the pathologic mechanisms are still largely unknown, making effective treatment a difficult clinical task. Achieving pain relief along with improved function and quality of life is the primary goal of pain clinicians; however, most patients and healthcare professionals consider 30% pain improvement to be clinically significant-a success level that would be unacceptable in other areas of medicine. Furthermore, patients with chronic pain frequently have multiple comorbidities, including depression and sleep apnea, and most have seen several physicians prior to being seen by a pain specialist, have more than three specific pain generators, and are taking multiple medications. The addition of further oral medications to control pain increases the risk of drug-drug interactions and side effects. However, topical analgesics have the advantage of local application with limited systemic levels of drug. Topical therapies benefit from reduced side effects, lower risk of drug-drug interactions, better patient acceptability/compliance, and improved tolerability. This two-part paper is a review of topical analgesics and their potential role in the treatment of chronic pain.

No MeSH data available.


Related in: MedlinePlus