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Wagamaga OP t1_jbykkl5 wrote

People living with diabetes can be at a higher risk of nerve damage in parts of their body, known as neuropathy. If nerves are damaged in the feet, ulcers can develop, which can lead to amputations if left unchecked.

While symptoms of neuropathy can be treated, at the moment there aren’t any treatments that can reverse or halt the nerve damage.

For some people, neuropathy can also cause debilitating pain, which can be very difficult to treat with over-the-counter painkillers. People tend to be offered antidepressants to manage their pain, but this isn’t always successful and can come with a risk of side effects.

A hot topic in pain relief Capsaicin is a molecule found in chillis, which gives them their fiery kick. It can also help to block pain signals from nerves when it’s applied to skin, making them less sensitive to pain. So capsaicin creams and skin patches – which stick to areas where nerves have been damaged – can be really helpful to reduce pain.

There’s also evidence that capsaicin can boost healing in some skin conditions like psoriasis. But we don’t yet know if capsaicin can help to treat the underlying cause of nerve pain, and how to reverse damage.

With our funding, a team of researchers at Imperial College London and Sheffield Teaching Hospitals recruited 75 people with diabetes and neuropathy. They investigated the effects of treating their feet with a patch containing 8% capsaicin (a licensed treatment for neuropathy called Qutenza), with one application for 30 minutes.

They wanted to figure out how the patch works to relieve pain, by looking at whether it could improve nerve damage over the course of three months.

50 of the participants had neuropathic pain, of which 32 were treated with the capsaicin patch and 18 received the current standard care for their pain. The other 25 participants didn’t have pain, but their neuropathy was still treated with the capsaicin patch.

During the study, participants were asked to keep a pain diary where they rated and described their pain, filled in questionnaires about their symptoms, and had their nerve sensitivity tested. They also gave samples of skin from their feet at the start and end of the study, and the researchers counted and analysed the nerves.

What the study found After three months, the team found that those who’d been treated with the capsaicin patch reported that their pain had reduced significantly, compared to those treated with standard care.

Excitingly, everyone who’d been treated with the capsaicin patch appeared to have more new nerves in their skin samples at the end of the study. This suggests that part of capsaicin’s role in lowering pain is by helping to heal the nerves and triggering them to grow back.

https://pubmed.ncbi.nlm.nih.gov/36388188/

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DisplayPorts t1_jbz5el5 wrote

Wait, I can apply cap to potentially address my psoriasis patches? Will have to try that.

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Betadzen t1_jbzbz9l wrote

Shows his own patches.

Trust me, this won't be painless. Also I strongly suppose that this research was conducted by a team of crocodiles that wanted humans under the hot sauce.

But, well, better than nothing.

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[deleted] t1_jbzfxt7 wrote

[deleted]

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ImpeachedPeach t1_jc0zfhn wrote

Here's a weird one, I'm not allergic to poison oak so I rubbed it on my psoriasis patches... no more psoriasis!

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Fixing_The_World t1_jc1iatw wrote

It's due to the antigen of poison oak distracting your immune system. These immune cells are distracted impeding the psoriasis.

If it works for you, it could be used in a medicinal way.

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[deleted] t1_jc1yoia wrote

[deleted]

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ImpeachedPeach t1_jc3x54n wrote

Nope, cured up all of my infection. Seems to take care of fungal infections too..

Ironically it's a wonderful plant for the few that aren't allergic.

Before you shower it off, rub dirt on the skin to take care of most of the oils.. this way it's not left any residue in the shower.

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[deleted] t1_jc46fi1 wrote

[deleted]

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ImpeachedPeach t1_jc5069s wrote

It just removed it.

I had it for years (and on my genitals..) as soon as I applied it, it vanished in a few weeks.

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Technical_Sir_9588 t1_jc0mgo4 wrote

The prior study that I read about used 8% patches so they had to anesthetize the area prior to application. The over the counter roll on from CVS is 0.15% and that burns hot enough.

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Technical_Sir_9588 t1_jc0m60m wrote

The interesting thing is that I learned about this from a similar study probably about 6-7 years ago. Capsaicin damages the mitochondria in sensitized nerve cells (which are currently dysfunctional due to sending information to the brain that is incorrect). After the capsaicin application, the nerve cells first retract to some degree from the tissue they're inervating (such as the skin). Eventually those nerve cells regrow but apparently without dysfunctional signaling. I work in health care and I'm always looking for options to help my patients, especially those with chronic pain. I've never found a practitioner that utilized the capsaicin approach. If any, I would expect physiatrists to be the most open-minded to utilize this as a treatment option.

Edit.

This may be the study: https://openaccesspub.org/article/549/ijp-17-1581.pdf

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snappedscissors t1_jc1w1q2 wrote

You should check out the recent research on the receptors TRPV1 and TRPA1, among others. They are best known as external environment sensors, as receptors for heat and capsaicin. In the last decade or so work has shown them to be present in the central nervous system as well. Which begs the question: what is the effect of activating these receptors in neurons and nerve cells? Because the brain isn't getting much direct exposure to hot sauce right?

I read one paper recently looking at capsaicin as an agonist against TRPV1 in mouse neurons in a model for Alzheimer's disease. They showed rescue of a number of metabolic defects seen in neuronal cells during this disease, including increased mitochondrial metabolism. This might indicate a refresh of mitochondria, or a general increase in energy production.

A bunch of research groups are working on receptors like these now, trying to see where they are being activated and by what. They may have applications like this paper, or more!

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Technical_Sir_9588 t1_jc1xrfi wrote

What I understand from some other research is that when these peripheral nerves become sensitized they spontaneous sends afferent signaling to the spinal cord - > brain without any external stimuli. This sustained signaling drives central sensitization. The idea is that central nervous system plasticity allows the reversal from central sensitization to the norm if these external stimuli reinforcing the [pain/damage/harm] are removed, especially since no actual sustained damage to the tissues is present.

I also educate my patients on the benefits of prolonged fasting, with the potential "repair" of peripheral nerves, spinal cord, etc. via autophagy. There is definitely research out there using mouse subjects and I wish more research funds would go towards this end but fasting isn't sexy more is its profitable.

The combo of fasting and capsaicin seem to provide the best outcomes.

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BlueSkyToday t1_jc899wj wrote

I imagine that what you're saying is that just the multi-branched portion of the axion that's near the surface of the skin is what atrophies and then regenerates. Kind of like if I were to sever an axion and then regenerate from the stub.

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quantumgpt t1_jc13iqm wrote

I ..I ..... Might love you.

I've changed my entire life and improved my fitness. With one damn problem. I have nerve pain in my left foot. I'm in reasonable shape and even do barefoot running on the beach at times. But currently. I'm up tapping my foot trying to shake the pain away. I'll be making my own patches if I can't find any with a similar percentage. If this works..... It would be incredible. I've been trying to fight and hide this for a year and a half now. 80lbs down. Major improvements. But not on the damn foot.

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BlueSkyToday t1_jc8bywe wrote

I can't find the link right now but there was a very high quality study done a few years ago (IIRC it involved 20 hospitals and several thousand patients) using R-Alpha Lipoic Acid and L-Acetyl Carnitine.

Roughly 40% of the patients reported dramatic reduction in foot pain with a large fraction showing reinervation.

Both ALA and Carnitine have been used individually to teat diabetic neuropathy with mixed results. This study concluded that the trick was to combine them. IIRC they tried three different dosages and found a dose dependent response for the two lowest dosages and little/no benefit at the highest dosage (600mg R-ALA plus 1g L-Acetyl Carnitine, 3x a day).

It's important to use R-ALA. When ALA is synthesized, you get a mix of both isomers (R and S) but R is the only one that seems to be useful to the mitochondria. If you're buying ALA and it doesn't say R-ALA, you're buying a mix of both R-ALA and S-ALA.

https://geronova.com/consumers/different-forms-of-lipoic-acid/

FWIW, my experience (N=1) is that this eliminated my partner's unmanageable foot pain. She's seen all the various specialists at both Stanford and UCSF, done all the tests, and was told that the next (very painful) step was to the pain management clinic.

She told them what she was doing in later follow-ups with Stanford and UCSF Neurologists. They all said, 'Yeah, we use ALA for diabetic neuropathy'.

So, this isn't a guarantee, but it's got about a 40% success rate.

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quantumgpt t1_jc8fdbu wrote

Well this is oddly something I should consider. I take carnitine already for another reason. 1-3g per day.

Ala is probably one of the few things I seriously do not get enough of.

So I do have one other hope here. I noticed the study was with 8%. All of the OTC patches are .025. But some say they burn. Study didn't mention a burn. The study also appears to be branded. Is that the same capsaicin? I have located oils and extracts but still even pure extracts seem under 1%.

So is the study the same stuff?

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BlueSkyToday t1_jc8lzxx wrote

I can't imagine that there's any chemical difference between the capsaicin in the patches and the capsaicin in OTC products.

Here's a link to a paper discussing the 8% patches,

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3755533/

In relation to pain from the patch, this part might be what people are looking for,

> Patients were prepared for the patch with 4% lidocaine cream that was applied for 1 h prior to treatment. The capsaicin 8% patch (NGX-4010) was applied for 60 min to a maximum area of 1000 cm2. In the dose-ranging study, it was applied for 30, 60 and 90 min [Webster et al. 2010]. Treatment-related pain was dealt with by local cooling methods and oral oxycodone (1 mg/ml). In the first week after treatment, hydrocodone bitartrate/acetaminophen (5 mg/500 mg) was allowed as rescue medication up to day 5 only.

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quantumgpt t1_jc8rv0y wrote

I will be ordering an extract and cutting it with coconut oil until it's at my tolerance level and then include (R)ALA in my diet, as well as continue my carnitine. I mean I will to to do what it takes and I don't mind the discomfort during the day. It's when it's 3am and I'm bouncing my foot and tying knots around my toe to help with the pain just to sleep. It's rather annoying.

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BlueSkyToday t1_jc8v67f wrote

I don't know that you'll be able to get anywhere close to 1.8g of R-ALA without supplementing.

I don't remember the three dosage levels that they tested but it was probably factors of two. If that's true, then the lowest dosage was 450mg a day, divided into three doses. And that wasn't as successful as higher doses.

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quantumgpt t1_jc8wefu wrote

I'll definitely supplement. I just meant adding. Since I titrate a few things already. I found a process on how to extract the oil already. I would assume the oil is close to 100% after extraction. But to confirm how does one test something like that? Any idea?

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john_1182 t1_jc1i9hx wrote

As someone with a rare genetic nerve pain condition (14th in the world) i find this very interesting. Thanks for all the information.

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DriftingMemes t1_jc20bhb wrote

The neuropathy in my feet is so bad, of I didn't have my pregabalin, I'd have to end my life. It's just not livable. I keep hoping that there will be some breakthrough to fix the problem, rather than just treating a small part of the symptoms. Even with the highest dose of Pregabalin I can take, my feet feeling like they are being burned with a lighter 24/7.

Would it be worth my time to try over the counter capsaicin creams? Or does this need something far stronger to be of any help?

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Man_Bear_Beaver t1_jbznhc9 wrote

I use capsaicin cream for my knees, it’s the best thing I’ve ever found for them

I once rubbed my eyes after applying it, not very fun.

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Maudesquad t1_jc0kst6 wrote

Omg why are your knees sore??? I have arthritis and am on tons of meds this would be awesome if it would help with arthritis

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BafangFan t1_jc10qqc wrote

Going on the carnivore diet has helped my aches and pains more than anything I could have imagined.

I've been eating crap food again lately, and it feels like I've aged 10 years in the span of 1 month

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onyerbikedude t1_jc1y9fh wrote

Yeah. I'm middle aged now and find myself craving meat (whereas I spent year as a varsity student in a vegetarian flat with no pain incurred whatsoever). I eat meat, fruit, nuts, vegetables and sometimes carbohydrates and occasionally chocolate. I always cook my own food. I feel healthier than I have in decades.

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elderrage t1_jc84hwg wrote

Have you tried a diet reducing or eliminating foods that may aggravate it? My arthritis almost disappears when I go on a keto diet or just stop sugar, bread and pasta. Best of luck!

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onyerbikedude t1_jc1xy62 wrote

You can use milk if you do that. It neutralises the chili immediately

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Salt_Cantaloupe_1766 t1_jc25t11 wrote

Not enough people know this! Dunk whatever body part you just accidentally touched in milk for a few minutes, you'll be fine

Also, drinking it works the same; so does eating sugar (although IME milk works better)

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VoldemortsBallsack t1_jbyu1ap wrote

I can personally attest to how well this works for a foot injury. I smashed a dolly for a boat hull onto the back of my Achilles tendon, I couldn't even put pressure on the foot or walk after hurting it. I put a capsaicin patch on it overnight and I woke up and had absolutely zero pain, like I was never hurt. Never tested it for back pain or other injuries but it definitely helps and worth a shot.

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5tyhnmik t1_jbyufz7 wrote

Did you just have a capsaicin patch lying around or how did you think to do this in the first place? I am not familiar with these patches.

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kinda_alone t1_jbyy04h wrote

Someone recommended it to me. I had a bout of nerve pain following an accident myself. I was seeing some specialist who kept prescribing various nerve pain medicines. Nothing was working. Eventually she recommended I try a capsaicin cream, which did the trick for me. Not sure if it was a placebo or if there’s something actually to it, but god damn it was a life send

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Justtryme90 t1_jbyz5aq wrote

Capsaisin is an irritant. Constant exposure to it, leads to a depletion of neurotransmitters in nearby pain sensing nerves. I don't think it's placebo. So long as you keep using it, it should help.

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Papancasudani t1_jbzrb72 wrote

Tangential to what you said, it actually san't be placebo tested because there's no burning inactive placebo. If something doesn't burn then it can be distinguished from the actual treatment, which makes it useless as a placebo. If it burns, it's probably activating the same channels as capsaicin does, in which case it's not inactive.

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VoldemortsBallsack t1_jbz0375 wrote

I've seen commercials for them and had someone go buy some as I was desperate to end the pain and was willing to try anything. I was surprised it actually works, it's hot on the skin and your body reacts by releasing endorphins and such.

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mouthbabies t1_jbyvsxh wrote

I've used them for my back and at least in my case they work very well. I feel a warming effect on my muscles even eight hours later with the same patch.

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Harpsist t1_jbyzmo1 wrote

As I read it I saw 'we funded' and was like. Great, a click bait website funded study...

Then I read what the site was. Now I'm impressed.

I learned the hard way if you put capsaicin on your body - and it gets to intense - (I put a shirt on and then drove an hour)

If you need to STOP the heat. Vinegar does the trick. Almost instantly.

Works great on skin. Dunno how it would work if it was somewhere sensitive - like your eyes or private parts.

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Doct0rStabby t1_jbz6jek wrote

>Dunno how it would work if it was somewhere sensitive - like your eyes or private parts.

It works excellently if your goal is searing intense pain. Capsicum on mucus membranes is not a good idea if you aren't into that kind of thing, though.

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IRYIRA t1_jc0izu1 wrote

I think you should try putting vinegar in your eye and on your private parts. I heard somewhere that acid is the best thing you can put on extremely sensitive areas! Be sure to setup a camera first though because you know sctience requires collection of data. Be sure to post your data so that it can be peer reviewed as well!

NOTE: I am being very sarcastic, PLEASE FOR THE LOVE OF EVERYTHING HOLY, DO NOT PUT VINEGAR IN YOUR EYE!!!

2nd NOTE: If you do decide to put vinegar in your eye or on your private parts, do still record it and post it though. Stience is awesome!

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wielkiepolskiejaja t1_jbzfw6c wrote

People been using tigerbalm for years

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suikoarke t1_jc0h183 wrote

Yeah, used it since I was a child. That stuff burns but it really works.

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wielkiepolskiejaja t1_jc7wp5a wrote

Tell me about it, forgot to wash my hands one time after using it and I went to the bathroom.

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Grouchy-Cod-5908 t1_jbyyi60 wrote

What about carpal tunnel?

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futureshocked2050 t1_jbz1obv wrote

I'd love to see a response to this as well. I've seen some improvement in my own carpal tunnel through hemp spray, sleeping with a cast and drinking less. Would be nice if capsaicin was a one-stop though.

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Grouchy-Cod-5908 t1_jbz3rth wrote

I have some capsaicin cream, I'm going to use it this week. I will update on my progress. I work as a chef so I really need this to work

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tofutti_kleineinein t1_jc1fg8r wrote

Stinging nettles work when my tendons get all inflamed. Wonder if it’s the same principle as capsaicin.

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ChadlyThe3rd t1_jc208iv wrote

Like the fresh plant or some product derived from them

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tofutti_kleineinein t1_jc20k9q wrote

The fresh plant. Rub on the site of your pain. You get a rash from it but the relief is real.

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lorrie_101 t1_jbzcga2 wrote

WOW!! First time I'm learning about this!! I don't have diabetes, but have arthritis in both feet (for the last +/- 15 years)...I'm relatively young, & have never understood how this happened (tho I used to run 5 - 7 miles/day, 7 days/week, & figured that's why.) It literally feels like the bones in my feet are broken shards of glass walking on metal ballbearings. I can't wait to try this! Pain has def increased since being on chemo for Leukemia. Are these patches available at local drugstores? Do you need a prescription, or are they over-the-counter (in USA)? I will def discuss w my Hematologist/Oncologist. Thank you, all, for taking the time to post, comment, & for your contributions.

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gadget850 t1_jbzt27p wrote

I've been looking. The patches in the article are 8% and prescription. Every patch and cream I have found OTC is 0.025%.

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lolamongolia t1_jbzu0xu wrote

I'm not sure about the patches, but capsaicin cream is available over the counter. It's worth a shot. Just be aware that it will cause a burning sensation that can get intense. Worth it, though, if it helps with the primary source of pain.

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redrightreturning t1_jc0ubqc wrote

Nurse here… Chemo can cause nerve pain. Talk to the provider who is ordering your chemo and get a prescription for capsaicin patches. I think they are certainly worth a try, and very low risk.

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lorrie_101 t1_jc12vsp wrote

Wow! Thank you, so very much, for your response.

I do have pain all over - joints, tendons, muscles, & large bones - feet are the worst. I received my Leukemia (CML) diagnosis 5 yrs ago...My Hem-Onc specialist @ UCSF told me at diagnosis I'd had it for the prior 10~12 years (so 15~17 years, since age 38~40.) I'm on my 4th regimen; it's new. Despite the pain, I'm thankful to be alive, especially for my kids...20 years ago, I'd have been dead 2 months after diagnosis.

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Maudesquad t1_jc0l4c7 wrote

You should definitely look into treating your arthritis. I have rheumatoid arthritis for a long time and untreated inflammation fucks your body up

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Raudskeggr t1_jbz1n6f wrote

Interesting when scientific data actually backs up old folk remedies like this.

I wonder if you see similar for other types of pain, or if it’s exclusive to peripheral neuropathy?

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STATmelatonin t1_jbzvnfj wrote

It’s specifically for nerve pain because it’s not really absorbed. It basically blasts the nerves on your skin overstimulating them at first which reduces that nerve receptor’s expression which relieves pain

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Skaindire t1_jbz474p wrote

I didn't need a reason to eat chilies in excess, but now I'm glad I found one.

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jdippey t1_jbzmy2h wrote

Capsaicin patches (topical administration) were used in this study. Consuming peppers has not been shown to reduce peripheral neuropathy.

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Skaindire t1_jbzolm3 wrote

Has not been tested for either. They specifically tested the patch and nothing else. It's

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jdippey t1_jbzp38y wrote

Not in this study, but I’m sure you can find other studies which tested different administration methods and found equivocal results.

Eating capsaicin just isn’t the best method to get the desired reductions in neuropathic pain. Eating more hot peppers will not help diabetics with such symptoms.

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astern126349 t1_jbzrw2s wrote

This may sound dumb…can you use the patches on your feet for neuropathy? I would think the cream would work better.

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jdippey t1_jbzug0j wrote

Yes. They used patches on patients’ feet in the linked study.

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gratusin t1_jbzqxix wrote

I eat some form of chile pretty much everyday. I have never had foot pain, but if I go overboard… boy does another part of my body feel it.

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terrycaus t1_jc0pbjd wrote

Err, you have to rub them on. Not eat them.

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AoedeSong t1_jc0qwcr wrote

Capsaicin drops became my go to for sore throat treatment, it has helped me tremendously… after Covid the sore throat caused this ongoing involuntary coughing spasms long after the original Covid infection had resolved. But it would trigger with a laugh or just talking or breathing too hard and it was so painful from the constant irritation - I remembered how capsaicin drops had helped my throat in the past and I still had a bottle, I was so surprised how it also stopped the coughing spasms and helped my throat heal up. Seemed so counter intuitive that capsaicin would help sore throat & throat irritation but here we are.

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woowooman t1_jbz5gr5 wrote

Capsaicin isn’t standard care in the UK? At least in my area in the US, it has been since I was in school several years ago.

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tracer2211 t1_jc0jinj wrote

I have inherited peripheral neuropathy. The nerves in my limbs have slowly continued being stripped of their myelin for years. About a decade ago, my foot pain was at its worst, and my doctor suggested capsaicin cream. It hurt like hell! And despite numerous washings, the cream kept causing pain for about three days. I have a high pain tolerance, but I don't think I could try it again.

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ICumInThee t1_jc0ma5q wrote

capsain patch... ok.. how much hot sauce is that?

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Bambiitaru t1_jc0sedd wrote

I wonder if this would help heal areas where you have lost sensation due to damage?

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Garthak_92 t1_jbz4ryv wrote

Instead of a heat rub, I used to apply lotion and rub chilies to sore areas. The lotion would open up the skin and allow more of the heat through.

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maucat29 t1_jc1cgyn wrote

I have severe neuropathy in my legs/feet and a bit in my arm/hands due to spinal injuries and some other stuff. Unfortunately capsaicin did absolutely nothing for me :/

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BlueSkyToday t1_jc8ndnl wrote

Does an 8% patch hurt?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3755533/

> Patients were prepared for the patch with 4% lidocaine cream that was applied for 1 h prior to treatment. The capsaicin 8% patch (NGX-4010) was applied for 60 min to a maximum area of 1000 cm2. In the dose-ranging study, it was applied for 30, 60 and 90 min [Webster et al. 2010]. Treatment-related pain was dealt with by local cooling methods and oral oxycodone (1 mg/ml). In the first week after treatment, hydrocodone bitartrate/acetaminophen (5 mg/500 mg) was allowed as rescue medication up to day 5 only.

If you're not familiar with analgesics, stacking hydrocodone with acetaminophen is a common practice.

Is 5mg of hydrocodone a lot? Let me put it this way, 10 mg every 12 hours is for 'severe pain',

https://www.mayoclinic.org/drugs-supplements/hydrocodone-oral-route/proper-use/drg-20084881

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KittenDust t1_jc192yf wrote

Can I just put chillies in my shoes?

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Xu_Lin t1_jc1lxwd wrote

laughs in mango habanero hot wings

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Geawiel t1_jc2fm6k wrote

Does it burn? Do I have to shave myself to wear the body suit that will treat my body wide SFN.

Seriously, I'm well over recommended dosage of horizant, and I'm on another med, plus hydro. The pain is still intense, and only getting worse. Affects my entire skin from the neck line down. I want this now. Neurologist have no idea what to do with me and just started up a referral to the Mayo Clinic. This would be life changing!

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FujiNikon t1_jc377t0 wrote

8% capsaicin is wild. The maximum strength I've seen OTC is 0.25%, and it's a pretty intense burn. I wonder how 8% feels.

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LawTider t1_jc1dsod wrote

Spicy food makes all other pain not go away, just less in comparison.

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Feisty-Summer9331 t1_jbz06u4 wrote

I always wondered why my feet don’t hurt, now my mind is at peace!

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Tazz_Sym t1_jc0cxsq wrote

Major Payne: "want me to show you a little trick to get the pain off that foot?"

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