Anyway, he was kind of flustered and kept coming in and out of the room to talk, then find the right records since his secretary had printed the wrong ones, and then to let me change into a gown, and then to let me change back, etc. But the great thing about him is that no matter how off-schedule he is, Dr. A NEVER rushes and lets me have as much time with him as I need. I think he must get a ton of miserable, desperate patients in his office and knows they need that. So, it's nice to feel respected in that way.
On to the actual appointment—if you recall from last time, he was kind of stumped about why I was having pain despite everything looking pretty healed. He had predicted that the pain would ease off after a few months, but it's been about six with no real significant change. So he did another exam where he checked all the muscles and trigger points, and concluded that it is most likely neuropathic pain at this point—in other words, surface pain caused by the nervous system for no real physiological reason. I had been on drugs for this before (gabapentin and amitriptyline) but couldn't get up to a high enough dose for them to be effective due to side effects (dry eyes, tiredness, weight gain, etc.). So the new treatment is—wait for it—capsaicin cream. For those of you who don't know, capsaicin comes from chile peppers. In fact, it is the compound that makes chile peppers spicy. So as you can imagine, I am thrilled to be rubbing it on my skin.
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| It comes OTC, but mine's prescription because it's stronger and has a different base or something |
The idea is that it somehow deactivates nerves by depleting Substance P, which is a neuropeptide of some sort that you can research on your own because this is about where my understanding of the mechanism ends. Anyway, you rub the capsaicin cream into the skin wherever you have pain—for me, my lower back, space where my hipbones meet my legs, and someplace else that I don't want to write on the Internet. Over time, as the Substance P is depleted from the hyper-reactive areas, the nerves are desensitized and the pain decreases.
As you can probably imagine, the cream is supposed to burn like crazy when first applied. You rub it in, leave it on for 20 minutes, wash it off, and repeat nightly. I am supposed to do this for six weeks, and then call Dr. A back to let him know how I'm doing. I'm nervous as heck for it, but the success rate is supposed to be enormous. Apparently capsaicin is quite commonly used for diabetic neuropathy, various neuralgias, and arthritis. Which makes me feel a little better about rubbing fire cream onto my poor skin. A LITTLE. Still waiting for my script to come in the mail, so let's hope this thing works.
The theory behind it makes sense, and it's great that the success rate is so high! But it's a bummer that it'll be uncomfortable. I really hope it helps! Are you "allowed" to then put aloe, or something soothing like that on your skin after you wipe it off? I hope it works and that it isn't as uncomfortable as it sounds!
ReplyDeletethanks A—I've been using ice, which helps some. The cream definitely burns but it isn't unmanageable, and is supposed to decrease over time. I'm still figuring that 20 min a day is a smal price to pay if this stuff actually works!!
DeleteOhhh really interesting! I wonder if this works similarly to TENS units? I've used them for my spine probs before and found them helpful. Burns/hurts at first, but then pain relief for the whole day. How's it working?
ReplyDeleteisn't medicine weird?? I think it is the same idea as TENS—fire up the nerves and then shut them down, somehow. Although capsaicin is specifically for neuropathic pain, not sure about TENS - really glad it worked for you though. I barely even felt the cream the first time I used it, but then the second time it burned for sure. No real change yet, but I'll keep you posted!
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