Recently approved by FDA:

A transdermal patch containing 8% capsaicin (NGX-4010, Qutenza) showed tolerable safety in long-term use for post-herpetic neuralgia and HIV-related neuropathy, researchers said here.

http://www.qutenza.com/about/whyQutenza.php

The patch also seemed safe and effective in a short-term study in painful diabetic neuropathy, according to research presented at the American Academy of Pain Medicine meeting.

The 8% capsaicin patch was applied for 60 to 90 minutes in the open-label studies reported here, following a preparatory application of lidocaine cream or other topical anesthetic. A single treatment was used in the 12-week diabetic neuropathy study.

Just under half of patients had at least a 30% reduction from baseline in pain scores, and one-third had a reduction of at least 50%.

Maximal pain reductions in most patients were achieved over a two-week period after patch application, and were maintained through week 10, with a slight uptick seen in mean scores at week 12.

Evaluations at the second and sixth weeks after treatment showed 48% and 47% of patients, respectively, reporting "much" or "very much" improvement.

http://www.medpagetoday.com/MeetingCoverage/AAPM/12720

This looks promising for PN and I asked my pharmacist to get the product, so I could try it...

In the meantime, late this afternoon I have tried applying 5% Lidocaine cream one top of one foot and Topricin cream to the other: both products are working well enough, so far, making the pain bearable for now...

This morning I took 2 Curamin tablets, a product that claims a synergistic multiplication of Curcumin benefits by a factor of 20: it worked well enough for my PN foot pain for about 3 hours...

http://www.curamin.com/ingredients/

As usual, the testimonials are glowing and fall barely short of reviving week old corpses...

http://www.prescriptiondrug-info.com...008170&ad=true

In 1997, a research team led by David Julius of UCSF showed that capsaicin selectively binds to a protein known as TRPV1 that resides on the membranes of pain and heat sensing neurons.[28] TRPV1 is a heat activated calcium channel, which opens between 37 and 45 °C. When capsaicin binds to TRPV1, it causes the channel to open below 37 °C (normal human body temperature), which is why capsaicin is linked to the sensation of heat.

Prolonged activation of these neurons by capsaicin depletes presynaptic substance P, one of the body's neurotransmitters for pain and heat. Neurons that do not contain TRPV1 are unaffected.

The result appears to be that the chemical mimics a burning sensation, the nerves are overwhelmed by the influx, and are unable to report pain for an extended period of time. With chronic exposure to capsaicin, neurons are depleted of neurotransmitters, leading to reduction in sensation of pain and blockade of neurogenic inflammation. If capsaicin is removed, the neurons recover.

Capsaicin is being explored as a possible prophylaxis for Type 1 diabetes by researchers in Toronto, Canada; capsaicin was injected subcutaneously affecting pancreatic sensory nerves of mice with Type 1 diabetes because of a suspected link between the nerves and diabetes.[29]

In addition, Capsicum kills cancer cells efficiently...

The American Association for Cancer Research reports studies suggesting capsaicin is able to kill prostate cancer cells by causing them to undergo apoptosis.[30][31] The studies were performed on tumors formed by human prostate cancer cell cultures grown in mouse models, and showed tumors treated with capsaicin were about one-fifth the size of the untreated tumors. There have been several clinical studies conducted in Japan and China that showed natural capsaicin directly inhibits the growth of leukemic cells.[32]

Another study carried out at the University of Nottingham suggests capsaicin is able to trigger apoptosis in human lung cancer cells as well.[33]

Capsaicin is also the key ingredient in the experimental drug Adlea, which is in Phase 2 trials as a long-acting analgesic to treat post-surgical and osteoarthritis pain for weeks to months after a single injection to the site of pain.[34] More over, it reduces pain resulted rheumatoid arthritis [35] as well as joint or muscle pain from fibromyalgia or other causes.

The patch is still HUSH-HUSH and a cruel $675.00/pc...

It's only distributed to doctors or hospitals in the US for controlled application and costs $675.00 a piece, which is slated to provide relief for a 12 weeks period...

...So, I tried the next best thing AND, so far, it's working beyond expectations, as long as application is done anew on a daily basis: here is a full report...

http://www0.epinions.com/review/Capz...t_514039975556

Here are additional opinions by sufferers of Peripheral Neuropathy on the use of 0.075% Capsicin "Neuropathy Cream for diabetic foot pain relieving" made by Zostrix...

http://www.amazon.com/Zostrix-Neurop...f=pd_sbs_hpc_9

I like this one best...

4.0 out of 5 stars RELIEF!, August 18, 2008 By L. Granigan (KIngs Mountain, NC) -

This review is from: Zostrix Neuropathy Cream, 2-Ounce Boxes (Health and Beauty)

I have neuropathy in my feet. The pain, burn, tingling and numbness is extremely bad. I have tried electrical stimulation, with some relief, but nothing compared to the relief that I have gotten with the Zostrix Cream. I found it at local drugstore, for much more than amazon is selling it for. I love it! I put it on about 3-4 times a day. There is still some pain, but NOTHING compared to before. Thank you to the makers of Zostrix!

Capsaicin is not a new product. It has been available for about a decade. It never caught on in a major way for shingles pain.

Zostrix was the first product aside from herbal suppliers. It was detailed to doctors, who prescribed it. But I can tell you personally that the product, even when on the shelf where customers can buy it easily is not really popular.

The reason is that it takes 2 or more weeks to start working, if it works at all. Most people cannot stand the severe burning it causes for those 2 weeks.

I am not surprised that Qutenza is highly restricted. Misuse of this ultra strong version could do substantial damage to tissue.
It is 100 times stronger than any topical product available today. Also one patch= $675 !! Better make sure it goes on the correct spot!

You know many products have pepper extract in them. And the makers know that people will not buy it if it is listed clearly in the ingredients! They use the Latin name for it to conceal its real identity, hoping people will buy it out of desperation as another potential useful remedy!
It can appear in ingredient lists as C. chinense, or C. annuum for example. Capsicum is a nightshade vegetable, and many people are intolerant of nightshades. They may create a serious allergic reaction.

http://www.helium.com/items/303428-a...u-need-to-know

I hope you can derive some benefit from capsicum products, but be very vigilant for adverse effects over time. There are many more people who cannot stand this treatment, than like it.

The Qutenza patch, which started my research on the benefits of Capsicin is new, but not very practical or reasonable in price, hence the review of the other OTC Capsicin products available...

What is also interesting is that, besides arthritis pain, Zostrix is now targeting sufferers of Peripheral Neuropathy and these are now providing interesting testimonials...

Having read most of the opinions available on the Internet on the use of Capsicin, I have come to the conclusions that:

Many people do not pay attention to the instructions and are surprised by the intensity of the burning: unless they have an allergy, it's usually their mistake and/or their pain level just doesn't warrant using Capsicin...

However, Capsicin as a nerve de-sensitizer will be really helpful - as far as I can tell from my own experience - if the following conditions are met:

- Serious ongoing neuropathic pain that would normally require taking some debilitating pain relievers, such as Lyrica, opioids, etc...

- Intelligent use of the various strengths of product, starting with the lower concentration of Capsicin of 0.025% and working up through 0.075, to 0.1%...

- Repeated applications at least twice a day until the 'P' substance facilitating neuro-transmission has been mostly depleted and the burning sensation is mostly gone...

- Scrupulous observance of a few basic rules: apply with gloves, do not cover/wrap the area, do not subject to heat or get wet, do not spread accidentally to other areas of the body, etc...

To dismiss Capsicin summarily because one had a bad experience or an allergic reaction may deprive those who could benefit from its careful use from a very useful tool, once it modus operandi is understood...

In conclusion, I should add that Capsicin is going to be BIG BUSINESS, as the rights for Europe to Qutenza have been bought by Astellas for a cool $42 million, plus royalties in the double digits on net sales:

Astellas will commercialize Qutenza in the above-mentioned territories and perform certain development of Qutenza including post-marketing commitments, to support Qutenza in the EU market. NeurogesX will receive EUR 30 million (approximately $42 million) for Qutenza commercialization rights, and EUR 5 million (approximately $7 million) for a license option of NGX-1998, the next-generation liquid formulation which uses the same active ingredient as Qutenza.

http://ngsx.client.shareholder.com/r...leaseID=391009

No Pharmaceutical company will pay this sort of money, unless it's confident the product has an excellent future!...

I tried the cream on my feet. My husband brought extra strength by accident. I didn't think my feet could burn any worse then they already do but the burn was completely unbearable. It took a few days to wear off.
I am not saying it can't work for others, definitely not for me. I have a friend who has RA and swears by it for her feet.
hopeful

42 million is nothing in the drug world. One reason it is so expensive is that the expectation of sales is low. The smaller the pool of potential patients the higher the price. While patches are costly to make, they are not that costly, and there is no expensive drug in it.
The cost is to cover the smaller user base and the control of dispensing etc.

I used to sell these products, so I know how many left the shelves each week. And each week is a huge exaggeration...they actually sat around until they expired for the most part and we'd have to send them back. When people got the cream on RX they never came back for refills.

Since this thread is so complex with alot of information on it, I'm going to request it be moved to the subforum above, where the informational posts are.

So look for it there in the near future.

Zostrix was put out there specifically for neuropathy caused by Shingles. Even tho it is OTC we used to keep it behind the counter at first, and use it only on RX --because it was only detailed to doctors. But it soon was moved to the BenGay section when advertisments started appearing in magazines for the general public. It was pretty expensive at first.. back then over $25 a tube. Now it is less. This link to Amazon for Zostrix HP ($15) has a very negative but typical review/response:
http://www.amazon.com/Zostrix-Potenc.../dp/B000F5IEK8

I had a tube by another company, here, my son used for hand pain from his overusing his video gaming controller... he liked it and it didn't burn for him. But he didn't use it for very long either. I just couldn't stand it. It was the weaker strength.
In all the years (over 10+) I have been on this board and its predecessor only a handful have ever reported success with it.
That is just the way it is.

There have over the years been other drugs in various pipelines to block Substance P. Merck had one it was going to sell as an antidepressant. But studies didn't pan out for it. It then went RX for nausea from chemo. Emend.
I recall some others now in the pipeline for pain, and only time will tell if they withstand the 3 tiers of clinical trials. It would be nice to have something really effective, so I am ever hopeful. But it might be a long time in coming.

Typically the press releases you can find on the net are very glowing.
They imply great success always, so that perhaps people will invest.

This location is actually the nitty gritty of the Pharm industry, and this is the link to Astellas:
http://www.cafepharma.com/boards/forumdisplay.php?f=68
So far there is only one brief mention of the "pain patch" coming out in Europe in Dec '10. But when Qutenza comes out, the reps will have alot to say about it. (from their perspective). Cafepharma is usually unpleasant IMO, but sometimes interesting data can be had from it.

With all due respect, Mrs. D, one negative review out of a single review is hardly informative...

Here are some 30 odd reviews, evenly divided between those who hate it because they can't see further than "it burns like hell!", have not used the product according to the instructions, are allergic or only suffer mild pain in the first place... AND those who think Capsaicin is nothing short of a miracle...

http://www0.epinions.com/reviews/Capzasin_HP

Also, let's remember that 'Capzaicin HP' is the highest potency available for OTC Capsaicin at 0.1% and that users are well advised to begin with a much lower concentration, such as 0.025%...

Since Qutenza will likely be a low volume product, as you remarked, the $42 million distribution rights paid by Astellas is all the more interesting...

Even more interesting is that there was little to chose in a recent failed clinical test pitting Qutenza for HIV Neuropathy and a .4% Capsaicin patch used as a placebo, both providing around 30% pain improvement over one hour...

http://www.pslgroup.com/dg/24704e.htm

A 30% improvement is nothing to be sneezed at and may well make some type of pain bearable: not having found the 0.04% patch yet, I have ordered the 0.025% Salonpas patches, which I intend to test later on with the view of reporting the results here...

Further discussion of Capsaicin is continuing at this thread location:

http://neurotalk.psychcentral.com/thread124004.html