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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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