Neuropathic pain and Qutenza patches. Qutenza patches contain 8% capsaicin, the compound that gives chili peppers their heat. They are applied to the skin for 60 minutes to treat peripheral neuropathic pain conditions. Capsaicin binds to TRPV1 receptors on nerves, directly toxic to mitochondria, having a "haircut" effect to prune nerve endings and provide pain relief for months. Qutenza is recommended for localized neuropathic pain not adequately managed by other treatments, involving a single application every 3-4 months as needed.
Medical management of neuropathic painSudhir Kumar
This presentation looks at medical therapies for the treatment of neuropathic pain. Neuropathic pain is commonly caused by diabetes, herpes zoster, trigeminal neuralgia, cancer, vitamin B12 deficiency, vasculitis, etc.
Mc Gill pain scale, history , pathophysiology of labour pain , ideal labour analgesia, non pharmacological methods , birth philosophies , pharmacological methods ,systemic and inhalational agents , regional analgesia
What can be said about the importance of labor analgesia. I did not understand it in the beginning. Because the physiology of obstetrics not only changes but is dynamic. It keeps on changing depending upon the gestational month of the mother. Hence the difficulty faced by me are summarized in this presentation. It is very different and difficult but extremely rewarding.
Medical management of neuropathic painSudhir Kumar
This presentation looks at medical therapies for the treatment of neuropathic pain. Neuropathic pain is commonly caused by diabetes, herpes zoster, trigeminal neuralgia, cancer, vitamin B12 deficiency, vasculitis, etc.
Mc Gill pain scale, history , pathophysiology of labour pain , ideal labour analgesia, non pharmacological methods , birth philosophies , pharmacological methods ,systemic and inhalational agents , regional analgesia
What can be said about the importance of labor analgesia. I did not understand it in the beginning. Because the physiology of obstetrics not only changes but is dynamic. It keeps on changing depending upon the gestational month of the mother. Hence the difficulty faced by me are summarized in this presentation. It is very different and difficult but extremely rewarding.
Sedation in dentistry | Pediatric Sedation | Conscious SedationDr. Rajat Sachdeva
A phobic patient for their Dental treatment may suffer discomfort during the procedure.
Sedation to calm down the patient is quite necessary for proficient procedure.
Various sedation depending on phases of consciousness are mild, moderate, deep.All these sedation are non-assistant type or patient can breath by his or her own.
But under General anesthesia, patient bin completely unconscious and requires assistant in breathing.
However, to accomplish a procedure, patient should be calm and anxiety free.
Call us regarding Dental Treatment:-
Dr. Rajat Sachdeva
+919818894041,01142464041
drrajatsachdeva@gmail.com
Follow us here:-
• Google+ link: https://goo.gl/vqAmvr
• Facebook link: https://goo.gl/tui98A
• Youtube link: https://goo.gl/mk7jfm
• Linkedin link: https://goo.gl/PrPgpB
• Slideshare link : http://goo.gl/0HY6ep
• Twitter Page : https://goo.gl/tohkcI
• Instagram page : https://goo.gl/OOGVig
Learn more:-
• www.sachdevadentalcare.com
• www.dentalclinicindelhi.com
• www.dentalimplantindia.co.in
• www.dentalcoursesdelhi.com
• www.facialaestheticsdelhi.com
Right therapeutic approach for migraine Sudhir Kumar
Migraine is a common disease and about 15-20% of population suffers from it. Every physician needs to know the principles of migraine management. The current article describes the diagnostic criteria and treatment of migraine.
Neuropathic pain poses a challenge to effective rehabilitation. Best practice, considerations & the use of Action Potential Simulation therapy to effectively treat neuropathic pain, sharing our results from a 2 year research project in people with MS.
Palmitoylethanolamide in the Treatment of Neuropathic Pain Sudhir Kumar
Neuropathic pain is quite common. It is associated with severe disability and adversely affects the quality of life of sufferers. Current treatment options for neuropathic are not very effective. Moreover, they are associated with significant adverse effects. A new naturally occurring substance- PALMITOYLETHANOLAMIDE (PEA)- has been found to be effective and safe in treating neuropathic pain. The current presentation looks at the efficacy of PEA in neuropathic pain.
Neuropathic pain poses a challenge to effective rehabilitation. Best practice, considerations & the use of Action Potential Simulation therapy to effectively treat neuropathic pain, sharing our results from a 2 year research project in people with MS.
Sedation in dentistry | Pediatric Sedation | Conscious SedationDr. Rajat Sachdeva
A phobic patient for their Dental treatment may suffer discomfort during the procedure.
Sedation to calm down the patient is quite necessary for proficient procedure.
Various sedation depending on phases of consciousness are mild, moderate, deep.All these sedation are non-assistant type or patient can breath by his or her own.
But under General anesthesia, patient bin completely unconscious and requires assistant in breathing.
However, to accomplish a procedure, patient should be calm and anxiety free.
Call us regarding Dental Treatment:-
Dr. Rajat Sachdeva
+919818894041,01142464041
drrajatsachdeva@gmail.com
Follow us here:-
• Google+ link: https://goo.gl/vqAmvr
• Facebook link: https://goo.gl/tui98A
• Youtube link: https://goo.gl/mk7jfm
• Linkedin link: https://goo.gl/PrPgpB
• Slideshare link : http://goo.gl/0HY6ep
• Twitter Page : https://goo.gl/tohkcI
• Instagram page : https://goo.gl/OOGVig
Learn more:-
• www.sachdevadentalcare.com
• www.dentalclinicindelhi.com
• www.dentalimplantindia.co.in
• www.dentalcoursesdelhi.com
• www.facialaestheticsdelhi.com
Right therapeutic approach for migraine Sudhir Kumar
Migraine is a common disease and about 15-20% of population suffers from it. Every physician needs to know the principles of migraine management. The current article describes the diagnostic criteria and treatment of migraine.
Neuropathic pain poses a challenge to effective rehabilitation. Best practice, considerations & the use of Action Potential Simulation therapy to effectively treat neuropathic pain, sharing our results from a 2 year research project in people with MS.
Palmitoylethanolamide in the Treatment of Neuropathic Pain Sudhir Kumar
Neuropathic pain is quite common. It is associated with severe disability and adversely affects the quality of life of sufferers. Current treatment options for neuropathic are not very effective. Moreover, they are associated with significant adverse effects. A new naturally occurring substance- PALMITOYLETHANOLAMIDE (PEA)- has been found to be effective and safe in treating neuropathic pain. The current presentation looks at the efficacy of PEA in neuropathic pain.
Neuropathic pain poses a challenge to effective rehabilitation. Best practice, considerations & the use of Action Potential Simulation therapy to effectively treat neuropathic pain, sharing our results from a 2 year research project in people with MS.
Interventional pain management by dr rajeev harsheRajeev Harshe
This is a brief presentation on how pain can be managed in a better way. Dr Rajeev Harshe is senior pain management consultant in western India. He is attached to Apollo Hospitals and has his private consulting room as well.Email: dr.harshe@gmail.com. If you are anaesthesiologist and if you wish to learn pain management,contact him.
The key to a successful Acute Pain Service is not so much the use of sophisticated drugs and high technology equipment, but an excellent organisational structure and well trained medical and nursing personnel.
Acute neuropathic pain - Stephan Schug - SSAI2017scanFOAM
A talk by Stephan Schug at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All of the conference content can be found here: https://scanfoam.org/ssai2017/
Developed in collaboration between scanFOAM, SSAI and SFAI.
Similar to S Humble Neuropathic pain July 2015 (20)
1. Neuropathic pain and Qutenza
Dr Stephen Humble
Consultant in Pain Management & Anaesthesia
Charing Cross Hospital
Dorset Naga
~1,000,000 SHU
2. IASP Definition:
An unpleasant sensory and emotional experience associated with actual or
potential tissue damage, or described in terms of such damage.
Pain is always subjective.
What is Pain?
3. Rene Descartes
Pathology → nerve ending → neural impulse → brain → pain
Pain has underlying pathological cause
If no cause found: ‘malingering or crazy’
How do we feel pain?
4. Nociceptive stimulation of A Delta & C nerve fibres (e.g. by
inflammation)
1st
order neuron to spinal cord
2nd
order neuron via spinothalamic tract
3rd
order neuron from thalamus to cortex
Rx: Paracetamol, NSAIDs, Opioids
Nociceptive Pain Pathway
6. Phantom limb pain
Complex Regional Pain Syndrome
Post Herpetic Neuralgia
Central Post Stroke Pain
Chronic scar hypersensitivity
How can these be an evolutionary defence?
But what about Neuropathic pain?
7. Pain in an area of neurological dysfunction
Sharp, burning, electric shocks, squeezing
Poor response to usual analgesics
Can last after area has healed completely
Neuropathic pain
8. Conditions:
PHN, Chronic post surgical pain, diabetes, HIV, chemotherapy
Prevalence:
>1%
Features:
Hyperalgesia - an increased response to a painful stimulus
Allodynia - pain due to a non-noxious stimulus
Prognosis:
No known cure
Often minimally response to analgesic medication
Peripheral neuropathic pain
10. What are Qutenza patches?
Naga Viper
~1,300,000 SHU
Dorset Naga
~1,000,000 SHU
Carolina Reaper
~2,000,000 SHU
Jalapeno
~4000 SHU
Bird’s eye
~200,000 SHU
Capsaicin
~16,000,000 SHU
Medicated patches impregnated with 8% Capsaicin
Capsaicin is the compound that give chilli peppers their kick
Applied to skin for a single 60-minute application (in hospital)
Can be repeated after 3-4 months
11. 0.075% Capsaicin cream effective but poor compliance
Excellent compliance with patches & very minimal side effects
Multiple RCTs showing benefit for peripheral NP
Can work in patients where nothing else works
Rule of thirds
Can get long benefit from single treatment i.e. disease modification
Rationale for Capsaicin 8% patches
Carolina Reaper
~2,000,000 SHU
12. Capsaicin binds TRPV1 receptor on nerve endings
Capsaicin previously thought to only desensitise the receptor directly
However, also has direct toxicity to mitochondria
‘Haircut’ or ‘pruning’ mechanism
How do Capsaicin 8% patches work?
Anand & Bley, BJA 2011Anand & Bley, BJA 2011
14. Inclusion criteria Exclusion criteria
Well localised Peripheral neuropathic pain for > 3 months
e.g. PHN, post-surgical pain, scar hypersensitivity, HIV, painful
chemotherapy neuropathy
Pain score > 4/10
Neuropathic character to pain i.e. burning, sharp, shooting, electric
shocks, dysaesthesia
Patient fully aware of procedure including duration of benefit and
potential side effects
Patient is prepared to put up with burning sensation of the patch
Standard medications for neuropathic pain have already been tried at
appropriate dosages & durations
Patient uncertain if they want to go ahead
Area is on face or head
Presence of broken skin (e.g. in diabetic neuropathy)
Genuine allergy to chilli or other ingredient
Area is too large
Uncontrolled hypertension or unstable angina
Uncontrolled severe respiratory disease
Significant mental illness including severe anxiety/phobia of treatment
Acute physical illness e.g. chest infection
Very high opioid tolerance or drug abuse
Patient unable to be supervised by responsible adult after patch applied
Patient does not have the cognitive capacity to look after the area of
exposed skin safely
Numbness is the problem rather than pain
Fibromyalgia/CWPS
Pregnancy & children (no safety data available)
15. Neuropathic pain is
-a dysfunction of the nervous system
-often under-recognised
-difficult to manage
There is a growing number of pharmacological options
Capsaicin 8% patches
-are an alternative option
-can work for long periods in some cases where nothing else works
Summary
16. Thank you!
The Telegraph:
Scottish nine-year-old boy eats the
world's spiciest chilli and posts reaction
on YouTube
“the first few chews were very hot but
just about manageable.
Then, the volcano erupted.”
Carolina Reaper
~2,000,000 Sc