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Doc: Capsaicin a reliable topical pain-relief option

December 19, 2018

Dear Dr. Roach: I am writing to you on behalf of my cousin, an 83-year-old female, 5 feet tall, weighing 100 pounds. She takes only vitamin D. Her blood pressure, cholesterol, etc., all are within the normal ranges. However, she has osteoarthritis in her knees and lower back. Ibuprofen sometimes helps a bit, but she would like more relief during the day.

She was considering a topical medication called PainBloc24, but the side effects seem scary. Should she try this over-the-counter remedy?

M.A.C.

Dear M.A.C.: PainBloc24, like other over-the-counter creams such as Capzasin and Zostrix, contains capsaicin, the active ingredient in hot peppers. It is thought to work by decreasing the activity of pain fibers.

Most people notice a burning sensation when it is applied, which should decrease over time. Afterward, pain is decreased. One study estimated a 33 percent reduction in pain, while another found that 80 percent of people had improvement in pain.

Anyone who has put hot peppers near eyes, mucous membranes or other sensitive skin areas knows that the pain can be exquisite, so stay away from those areas. Further, skin absorption is higher after a hot shower, so capsaicin cream can REALLY burn if applied then — that’s not recommended. Finally, if your cousin decides to try it, she should start with the low 0.025 percent strength, not the higher-potency strength. Fortunately, it does not seem to have side effects outside of the local irritation and burning.

Dear Dr. Roach: I just read your advice to H.S. concerning excessive sweating. I, too, suffered from hyperhidrosis in both my hands. They literally dripped sweat constantly. It affected my everyday life. This began around age 13.

I noticed that you did not recommend surgery as one of the options. I had a sympathectomy performed by a neurologist when I was 18 years old.

The surgery worked beautifully. I would highly recommend it and would not hesitate to do it again. I understand that you may not want to recommend this for a 71-year-old woman, but others who suffer as I did might want to know that this may be an option for them.

M.P.

Dear M.P.: Thank you, M.P., for writing with a treatment for hyperhidrosis that I didn’t mention.

One of the signals for us to sweat normally is the information carried by the sympathetic nerves. The sympathetic nervous system is the “fight or flight” mode of the autonomic nervous system, the part that is not under conscious control.

In the case of H.S., the sweating was mostly on the torso; sympathectomy is effective for people whose excess sweating is on the hands (as in the case of M.P.) or feet. It is particularly recommended for people who, like M.P., had onset before age 16 and who are under 25 at the time of evaluation and who are generally healthy. Ninety-five percent of people are satisfied with the results, but symptoms can recur over time.

A new treatment is expected to become available (and may be available by the time this column is published). A topical medication called glycopyrronium tosylate has been shown to reduce sweating, both by self-report and by measuring sweat production.

I expect this will be a useful addition to the treatment possibilities, especially for people with axillary (armpit) sweating who have not had good response to over-the-counter or prescription antiperspirants. Side effects seem to be mild and include dry mouth. The medication sometimes is used orally, but then side effects are much more likely.

Many people wrote me to tell me just how much this condition has affected their life. I found more information at sweathelp.org.

Email questions to ToYourGoodHealth@med.cornell.edu.

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