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Effect of Topical Analgesia on Desensitization Following 8% Topical Capsaicin Application

  • Janne D. Christensen
    Affiliations
    Laboratory for Experimental Cutaneous Pain and Itch Research, SMI, Center for Neuroplasticity and Pain, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Denmark
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  • Silvia Lo Vecchio
    Correspondence
    Address reprint requests to Silvia Lo Vecchio, PhD, MSc, Center for Neuroplasticity and Pain, Faculty of Medicine, Aalborg University, Fredrik Bajers Vej 7D, D3-217, 9220 Aalborg East, Denmark.
    Affiliations
    Laboratory for Experimental Cutaneous Pain and Itch Research, SMI, Center for Neuroplasticity and Pain, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Denmark
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  • Hjalte H. Andersen
    Affiliations
    Laboratory for Experimental Cutaneous Pain and Itch Research, SMI, Center for Neuroplasticity and Pain, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Denmark
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  • Jesper Elberling
    Affiliations
    The Allergy Clinic, Department of Dermato-Allergology, Copenhagen University Hospital, Gentofte, Copenhagen, Denmark
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  • Lars Arendt-Nielsen
    Affiliations
    Laboratory for Experimental Cutaneous Pain and Itch Research, SMI, Center for Neuroplasticity and Pain, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Denmark
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Published:January 29, 2021DOI:https://doi.org/10.1016/j.jpain.2021.01.005

      Highlights

      • EMLA caused significant reductions in capsaicin-induced pain compared with placebo.
      • EMLA enhanced capsaicin-induced superficial blood perfusion.
      • Capsaicin reduced the neurogenic flare induced by histamine compared with EMLA.
      • Topical analgesic pretreatment does not interfere with capsaicin desensitization.

      Abstract

      To prevent pain associated with 8% capsaicin application, pretreatment with local anesthetics, such as EMLA (eutectic mixture of lidocaine 2.5% and prilocaine 2.5%), is considered an option. However, there is contradicting evidence regarding the effects of local analgesia on capsaicin-induced desensitization. In session 1, 2 skin areas in each forearm of 24 healthy volunteers were randomized to 2-hour pretreatment with EMLA/placebo cream. After pretreatment, 8% capsaicin patches were applied for 3 hours in 1 placebo and 1 EMLA pretreated area, obtaining the following four areas: Capsaicin + EMLA, Capsaicin + Placebo, EMLA alone, and Placebo. Pain intensity scores were assessed during the 3-hour application of capsaicin. Warmth detection, heat pain sensitivity, and microvascular reactivity were measured after the removal of capsaicin. After 24 hours, in session 2, all tests were repeated followed by histamine application in each area to examine itch intensity and neurogenic flare.
      Overall, EMLA caused significant reductions in capsaicin-induced pain compared with placebo (P= .007) and enhanced the capsaicin-induced increase in superficial blood perfusion immediately after the 3-hour capsaicin application (P< .01). Regardless of pretreatment, capsaicin induced heat hyperalgesia immediately after the application (P< .001). Twenty-four hours post application, heat pain sensitivity was normalized. However, WDT increased significantly (P< .001). Capsaicin tended to reduce the itch intensity and significantly reduced the neurogenic flare (P< .05) induced by histamine compared with EMLA alone. The findings suggest that pretreatment with topical analgesic cream reduces application site pain without interfering with the 8% topical capsaicin-induced desensitization.

      Perspective

      Pretreatment with local anesthetic EMLA cream might be considered a good therapeutic option to reduce the pain associated with 8% capsaicin application currently used for treatment of neuropathic pain syndromes. This study also suggests the existence of a synergistic effect of capsaicin and EMLA on the process of neurogenic inflammation.

      Key Words

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