Papers of the Week

To prevent pain associated with 8% capsaicin application, pretreatment with local anesthetics, such as EMLA (eutectic mixture of lidocaine 2.5% and prilocaine 2.5%), is considered an option. However, there is contradicting evidence regarding the effects of local analgesia on capsaicin-induced desensitization. In session 1, two skin areas in each forearm of 24 healthy volunteers were randomized to 2-hour pretreatment with EMLA/placebo cream. After pretreatment, 8% capsaicin patches were applied for 3 hours in one placebo and one EMLA pretreated area, obtaining the following four areas: Capsaicin+EMLA, Capsaicin+Placebo, EMLA alone, and Placebo. Pain intensity scores were assessed during the 3-h application of capsaicin. Warmth detection, heat pain sensitivity, and micro-vascular reactivity were measured after the removal of capsaicin. After 24 hours, in session 2, all tests were repeated followed by histamine application in each area to examine itch intensity and neurogenic flare. Overall, EMLA caused significant reductions in capsaicin-induced pain compared with placebo (p=0.007) and enhanced the capsaicin-induced increase in superficial blood perfusion immediately after the 3-hour capsaicin application (p<0.01). Regardless of pretreatment, capsaicin induced heat hyperalgesia immediately after the application (p<0.001). 24 h post application, heat pain sensitivity was normalized. However, WDT increased significantly (p<0.001). Capsaicin tended to reduce the itch intensity and significantly reduced the neurogenic flare (p<0.05) induced by histamine compared with EMLA alone. The findings suggest that pre-treatment with topical analgesic cream reduces application site pain without interfering with the 8% topical capsaicin-induced desensitization. Perspective: Pretreatment with local anesthetic EMLA cream might be considered a good therapeutic option to reduce the pain associated with 8% capsaicin application currently used for treatment of neuropathic pain syndromes. This study also suggests the existence of a synergistic effect of capsaicin and EMLA on the process of neurogenic inflammation.