Topical Creams Any Good For Nerve Pain

Today's post from piedmontpmr.com (see link below) asks the question as to whether topical creams (creams applied to the skin at the area of most pain) are any good for neuropathy. It's an attractive prospect. We're so used to popping pills meant for other diseases and trying to live with the side effects, that the idea of a topical cream is tempting. However, as the article points out, it's often a question of 'suck it and see!' One of the proven analgesic creams for neuropathy is capsaicin (either as a cream or a patch) but you really have to watch out for burning side effects and depending on the strength of the cream, you may need expert help with its application. However, it's not the only one and some people even gain benefit by using sports creams meant for joint or muscle relief. Discuss it with your doctor first and then maybe try some out. You never know, you may find something that's just as effective as the strong pain killers you're normally prescribed.

Are Topical Creams Effective For Neuropathy?
Robert D. Schwartz MD 2016

You feel a tingling or slight burning sensation in your hands or feet and you know it’s a symptom of your neuropathy. These areas, especially your feet, tend to be targeted first because the nerves leading down to those extremities are the longest and the easiest to damage. But at the moment, you know its not a sign for major concern, you just want relief from the discomfort or pain as soon as possible.

Supplements are one way to treat these symptoms, but you don’t really know when they’ll start working and if there will be side effects. By taking any oral medication, you are prone to drowsiness, dizziness or simply lethargy. So what could you do to relieve the pain without all the other baggage? Well, there’s topical creams. They can be applied right onto the pained area usually without fuss and are usually better accepted by patients because they are painless.

It’s easy to be overwhelmed by all the products sitting on drug store counters for pain relief. They all claim to have the same end goal, but you’re not sure which one is right for you. Some are for muscle pain, joint back or back pain, but there are also plenty of non-prescription creams that you could use for neuropathy pain. What you should be looking out for are the two predominant components in topical over-the-counter creams/ointments: capsaicin and herbs. Several creams use a combination of these ingredients amongst others for effective pain relief.

Capsaicin

Capsaicin is a substance found in hot peppers, but interestingly, it also works as pain reliever for those with peripheral neuropathy symptoms. The slight burning sensation that is felt when capsaicin creams is applied counteracts the pain signals within your body, thus ceasing pain altogether temporarily. But capsaicin products aren’t for everyone. Some people can’t handle the initial pain sensation when it if first applied, despite proving to be an effective source for painful neuropathy.

Capsaicin products should not be applied on or near damaged, broken or irritated skin. It also needs to be applied several times a day and might take weeks for it to truly take effect.
Herbs

Another common non-prescription alternative is topical herbal products. Herbal products contain anti-inflammatory and analgesic (pain relief) properties. They essentially trick the brain into thinking your skin has changed temperature with a cooling sensation, relieving inflammation. They also widen blood vessels in the area so that blood flow is increased, allowing nutrients to be delivered more efficiently for quicker healing.

One of the most common herbal ingredients that uses these pain relief tactics is menthol. Menthol comes from peppermint plants — specifically extracted from wild mint or corn mint, and is used in a majority of pain relief ointments.

Herbs with these properties have been in use since ancient times. From North America to South East Asia, those around the world have turned to herbal medicine for effective pain relief. Other herbs that contain such properties include, balm of gilead, Calendula flowers and oil of clove. It’s hard to deny herbal effectiveness when it has stood against the test of time.

So now that you know a few ingredients in over-the-counter topical creams, what are some products that you can look out for?

Biofreeze
Capsin
Double Cap
Icy Hot Arthritis Therapy
Minagin
Rid-a-Pain
Sportsmed
Tiger balm
Trixaicin

You won’t really know which one works best for you until you try it. You can go online and do your research, but everyone’s condition is different, and everyone’s body will react differently to different medication.

If you find that over-the-counter products aren’t quite working for you, then maybe it’s time to turn to a prescription cream or ointment. Most likely, your doctor will prescribe a topical agent with either clonidine or lidocaine. Clonidine is used to treat high blood pressure, but those with nerve pain will also find relief in that department. And lidocaine has mainly been used for mouth numbing in a dentist’s chair, but has shown to be effective against neuropathy pain as well.

So if you’re thinking about getting quick relief from topical creams, then it is definitely recommended. Creams can give your fast temporary relief if your pain is mild to moderate. If you’re dealing with a burden that’s a bit bigger, we advise you to talk to your doctor right away for the best route for relief. You might be given a prescription cream, taken daily for a period of time, or recommended toward other avenues altogether. Whatever your symptoms may be, ensure that your are taking care of your body and your health.

http://piedmontpmr.com/topical-creams-effective-neuropathy/

Can Topical Agents Help With Neuropathy

Today's post from diabeticconnect.com (see link below) talks about topical pain relief, which for many neuropathy patients, is a desirable alternative to pills, although it has to be said that the ingredients of topical creams are often the same as some pill alternatives. It all depends on your history of neuropathy really and where it affects you most on your body. What's worked and what's failed and whether your doctor will offer the option of topical creams or not. For some, the medications that are absorbed through the skin give more relief, if only because they avoid stomach problems; while for others they just feel better and give you the idea that your pain is being tackled at source so to speak. The point is that if we're guinea pigs anyway (as far as neuropathy medications go) and we're working through lists to find that one thing that works best for us, why not try topical creams. That said, medications such as capsaicin have to be applied very carefully and if you're forced to use stronger agents like fentanyl patches, you need to do it under supervision - just because it's a cream doesn't make it any less powerful. Apart from that, the possibility of side effects still exists with topical agents. Talk it over with your doctor and do your own research and then make a decision based on what works best for you.

Topical Pain Agents for Pain Relief  By Lana Barhum
  
Learn your topical treatment options to manage painful diabetic neuropathy.
 
Lana Barhum is a legal assistant, patient advocate, freelance writer, blogger, and single parent. She has lived with rheumatoid arthritis and fibromyalgia since 2008 and uses her experiences to share expert advice on living successfully with chronic illness.

When you’re experiencing pain in your joints and muscles, topical pain relievers are a good alternative for pain management. These medications are delivered through a variety of dosage forms, including patches, gels, lotions, creams, sprays, and ointments. Topical agents have been used for decades to help prevent and treat a wide variety of health conditions, including pain from arthritis, diabetes, and other chronic conditions.

Topical pain medications are absorbed through the skin and are best for relieving joint and muscle pain close to the skin's surface, including the hands, elbows, knees, and feet. If you are reluctant to take pills, you may opt for an over-the-counter cream or patch. You could also have your doctor prescribe a stronger topical medication.

So, what are your options? And will they work to manage your pain?

Non-steroidal anti-inflammatory agents

Diclofenac is a topical non-steroidal anti-inflammatory medication available for topical pain management. Diclofenac is available in both patch and solution/gel formulas. The patch (Flector Patch) was first approved by the FDA in 1998 and can be used for the treatment of sprains and strains, but the solution/gel (Voltaren Gel) was designed for arthritis pain. Diclofenac works by reducing substances that cause inflammation and pain in the body. It is only available as a prescription and carries the same risk as other non-steroidal anti-inflammatory drugs (NSAIDs). 

Topical anesthetics

Topical anesthetics are local anesthetics that are used to numb the surface of a body part. They are available in creams, ointments, lotions, and sprays. Transdermal patches that contain lidocaine can offer chronic pain relief but are only available with a prescription. The lidocaine transdermal patch (Lidoderm) works by stopping the nerves from sending pain signals to the brain. You should only use one patch a day. Using too many patches or wearing a patch for too long may result in overdose, in which too much lidocaine is absorbed into the blood. In case of an overdose, discontinue use and call 911. 

Counterirritants

Counterirritants contain substances that create a hot or cold sensation in one location to temporarily lessen pain and inflammation. Counterirritants are generally non-prescription and available for topical use to manage muscle pain. Counterirritants contain capsaicin, methyl salicylate, menthol, and/or camphor. Capasagel, Benjay, Icy Hot, Biofreeze, and Tiger Balm are all brand-name topical pain agents containing one or more of these ingredients, but there are other brands including generics. These products are intended for short-term use of mild pain. Use of heat with these products should be avoided.

Narcotic analgesics

The FDA has only approved two narcotic analgesics for chronic pain. Fentanyl patches have been around since the 1990s and buprenorphine patches were approved in 2010. Both of these medications carry a high risk for abuse and misuse. The Fentanyl patch is usually prescribed to patients who are dependent on opioids (medications that reduce the intensity of pain signals to the brain) and require continuous opioid treatment. Buprenorphine patches are usually given to those who require long-term chronic pain management.
Treatment considerations

Topical medications are available in a variety of dosage formulas and more are being researched to improve pain management. Not everyone will experience good pain relief from using topical pain agents.

Here is what you can do to get the greatest effect from using these medications:

• Follow usage instructions carefully.

• Wash your hands before applying them.

• Do not apply patches, creams, gels, sprays, or lotions to damaged skin.

• Never use topical pain agents with heating pads or tight bandages.

• Do not use non-prescription topical pain agents for more than seven days.

• Monitor yourself for signs of toxicity (tinnitus, nausea, vomiting). Products containing methyl salicylate can absorb into the bloodstream.

• If you are allergic to aspirin or take blood-thinning medicines, check with your doctor before taking topical pain agents containing methyl salicylate.

http://www.diabeticconnect.com/diabetes-information-articles/general/1883-topical-pain-agents-for-pain-relief

New Topical Salve For Neuropathic Pain

Today's post from painresearchforum.org (see link below) takes a look at another interesting development involving using a topical salve to restore nerve function. The ever-suffering lab-mice have been the recipients of the trials thus far and it seems years away from  something that might be given to human patients on prescription but it's an interesting story. Basically it involves applying a non-peptide GDNF receptor agonist (XIB4035) to for instance, the feet. How it works is tricky to understand and may even seem illogical to most people but every new finding is worth reading about and keeping in mind for the future. The best treatments have often emerged from such seemingly improbable sources.

Topical Compound Boosts Trophic Factor Actions to Stem Neuropathy
Drug restores thermal nociception in two mouse models of small fiber neuropathy
By Stephani Sutherland on 19 Feb 2014

The term small fiber neuropathy (SFN) encompasses a mixed bag of conditions with a unifying element: damage or malfunction in unmyelinated peripheral nerves. In new work from Gabriel Corfas and colleagues at Harvard Medical School, Boston, US, a salve containing a compound that increases glial-derived neurotrophic factor (GDNF) activity restored lost pain sensation in two mouse models of SFN and prevented loss of nerve endings in one of them.

The work was published January 21 in the Proceedings of the National Academy of Sciences (PNAS).

The symptoms of SFN seem paradoxical: Many people experience both pain and numbness. Nerve damage can arise from diabetes, injury, autoimmune attack, or cancer (or its treatment), but many cases of SFN have mysterious origins.

“There is a desperate need in the field to develop pathogenesis-based specific treatments to treat painful symptoms in patients with peripheral neuropathies,” wrote Ahmet Höke of Johns Hopkins School of Medicine, Baltimore, US, in a commentary on the work published January 28 in PNAS (Höke, 2014).

While the current work did not look at painful symptoms of neuropathy—the experimenters measured loss of sensation to painful heat—it does hold out the possibility that a topical, small molecule treatment might be capable of rescuing lost innervation to the skin.

Derek Molliver, a neuroscientist at the University of Pittsburgh, US, says the potential is tremendous. “If you could apply something topically to restore nerve function, that would be phenomenal. Obviously, this would be worlds better than intrathecal injections.”

Co-first authors Kristian Hedstrom and Joshua Murtie used a mouse model of SFN the group had previously developed called line-D (Chen et al., 2003). The transgenic mice express non-functional receptors for the epidermal growth factor receptor ErbB specifically on non-myelinating Schwann cells, a type of glial cell that supports the peripheral axons of C-fiber neurons. When their support cells fail, C-fiber endings retract, and the sensory neurons eventually die. By a few weeks of age, the mice display deficits in the ability to sense painful heat.

In line-D mice, peripheral nerves are deficient in GDNF, and the new study shows that genetically augmenting GDNF production in the skin reversed the deficits in thermal nociception. Molliver pointed out that, like other models of peripheral neuropathy in which nerves lose contact with their target tissue, the line-D mouse actually models loss of trophic support, so the improvement with replacement of GDNF is perhaps not surprising.

Moving to a more pharmacological approach, the researchers asked whether topical application of a non-peptide GDNF receptor agonist (XIB4035) might have the same effect. They applied a cream containing XIB4035 to the hind paws of the mice beginning at three weeks of age and tested thermal nociception every seven days. While vehicle-treated line-D mice showed progressive loss of thermal nociception, line-D mice treated with XIB4035 showed no sensory loss. Line-D mice left untreated until four weeks already showed severe neuropathy symptoms that improved with XIB4035, but symptoms returned if treatment was halted, suggesting an ongoing need for the drug. Wild-type mice displayed normal sensation regardless of treatment.

The treatment also prevented the decrease in epidermal C-fiber density seen in the mutant mice, suggesting that treatment stabilized sensory nerves and prevented retraction. “Because XIB4035 was able to restore epidermal nerve fiber density in line-D, I am hopeful that it can have a positive effect as a regenerative therapy in peripheral neuropathies in people,” Höke told PRF in an email.




Image: Treatment with XIB4035 starting at postnatal day 28 increases labeling for isolectin-B4 (IB4), a marker for nonpeptidergic fibers, in the dorsal spinal cord. Left: Vehicle-treated wild-type mice display normal appearance of IB4+ (green) and TRPV1+ (red) nerve terminals. Center: Vehicle-treated line-D mice display complete absence of IB4 labeling. Right: XIB4035-treated line-D mice show presence of IB4+ fibers. No differences were observed in TRPV1 labeling between wild-type and line-D mice. Credit: From Hedstrom, Murtie, et al., 2014, © the authors.

To test a more clinically relevant mouse model of SFN, the team looked at streptozotocin-induced diabetic neuropathy. The diabetic mice showed a loss of thermal nociceptive sensation by the age of eight weeks. Mice treated with topical XIB4035 cream starting at the onset of diabetes displayed thermal sensitivity midway between that of healthy and untreated diabetic mice, which lasted throughout treatment. Interestingly, unlike in the line-D mice, XIB4035 treatment did not rescue intraepidermal nerve fiber density in the diabetic mice, suggesting that treatment improved sensation differently in the two models. “We were surprised by that finding,” said Corfas. More work needs to be done in order to understand how sensation was restored without regrowth of the missing fibers, he added.

Almost as an afterthought, Corfas told PRF, the team tested XIB4035 in a human neuroblastoma cell line to confirm the compound’s effects on human GDNF receptors. XIB4035 had previously been described as a competitive agonist at GDNF receptor α1 (GFRα1; Tokugawa et al., 2003), but unexpectedly—and unlike GFRα agonists—XIB4035 by itself had no effect on the receptor. Rather, the drug potentiated the effects of GDNF or artemin, another GFRα agonist. Further experiments confirmed that the drug bolstered activation of three different GFRα receptors by respective agonists, but had no effect on signaling by a different trophic factor, nerve growth factor (NGF), and its receptor TrkA, which are found on a different population of sensory neurons than GDNF-family receptors.

That last experiment could turn out to be the big boon that would give XIB4035 an advantage over an agonist as a therapeutic drug. “This finding led us to understand that this was a positive modulator,” Corfas told PRF. “As a modulator, its activity is restricted to the place where you have both ligands and receptors,” he said. “The drug gives a subtle but effective boost in signaling by endogenous molecules, rather than saturating the system in artificial ways.”

Previous reports had shown that GDNF and related trophic factors injected into the paw led to thermal hypersensitivity in healthy mice (Malin et al., 2006; Elitt et al., 2006). Importantly, the GDNF-augmenting treatment did not change mechanical or thermal sensitivity in healthy mice.

The effects the drug would have in animal models or patients with painful neuropathy remain to be seen. In any case, as Höke wrote, the enhancement of trophic factor signaling with this small molecule offers the hope of targeting the pathology of SFN itself.

Stephani Sutherland, PhD, is a neuroscientist, yogi, and freelance writer in Southern California, US.

http://www.painresearchforum.org/news/37375-topical-compound-boosts-trophic-factor-actions-stem-neuropathy