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Único Y Eficaz La Glucosamina,Condroitina Orihiro Glucosamina La glucosamina es un tipo de aminoácido que combina aminoácido y azúcar,. Y está.
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Acortar URL. Boro como citrato, glicinato y aspartato de boro. Osteoarthritis is the most common joint disorder worldwide.

IN THIS EPISODE

The predominant symptom, pain, is usually treated with acetaminophen or oral non-steroidal anti-inflammatory drugs, although they are associated with a significant risk of side effects. Topical capsaicin may represent an effective and safe alternative.. The aim of this review is to examine the evidence for the efficacy and safety profile of topical capsaicin in the management of pain caused by osteoarthritis. When compared to placebo, it was found that topical capsaicin has a good safety profile and efficacy in reducing osteoarthritis pain of the hand, knee, hip or shoulder.

However, the studies have significant limitations, the most important the difficulty of blinding. It is attributed to this review the strength of recommendation B.. Sin embargo, los estudios tienen limitaciones significativas, principalmente la dificultad de cegamiento. Osteoarthritis OA is the most common joint disorder worldwide.

Topical capsaicin for pain in osteoarthritis: A literature review | Reumatología Clínica

The management of OA ranges from non-pharmacologic interventions and drugs to surgical approach. Topical agents, such as NSAIDs and capsaicin are valuable choices when systemic side effects of some drugs are not acceptable. The purpose of this article was to review the evidence regarding the efficacy and safety profile of topical capsaicin in the treatment of pain from OA.. Guidelines, meta-analysis, systematic reviews and randomized controlled trials RCTs , published between January and January , in Portuguese, English or Spanish, were searched.

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We included articles whose population have been diagnosed with OA, not undergoing arthroplasty. Any form of topical capsaicin gel, cream, ointment, solution , used alone and compared with a control placebo or no treatment at all was included. The measured outcome was the reduction of pain.

Secondary outcome included any adverse reaction.. Exclusion criteria were: disagreement with the goal of review; duplicate publication; opinion manuscripts and consensus guidelines; classical review papers and summaries of websites; clinical trials included in recent systematic reviews; and systematic reviews with the same total RCTs as the latest review articles..

Two investigators independently assessed the titles of the articles found and excluded duplicates and those clearly irrelevant.

Abstracts of the selected articles were examined independently by the two reviewers who applied the selection criteria. If the information in the abstracts was not enough, full papers were analyzed to make a decision. Where disagreements of selections arose, these were discussed until consensus was reached.. Data were extracted from each eligible study by a single reviewer and checked by the second reviewer.

The data items extracted were: number of trials included; number of persons recruited to the trials; type of intervention and control; length of follow-up; evaluated endpoint; results achieved in efficacy and safety; final recommendations.. A total of studies were found, and, from these, were excluded and 6 fulfilled the inclusion criteria: three systematic reviews and three guidelines.. Excluded studies were mainly duplicates, studies on diseases other than OA, study designs other than guidelines, meta-analysis, systematic reviews and RCTs, studies of other drugs or of complementary medicines such as acupuncture, studies whose control was active, systematic reviews with the same total RCTs as the latest review articles and studies on animals.

All studies included are summarized in Tables 1 and Process of selection of relevant articles. RCTs — randomized controlled trials.. OA: osteoarthritis; RCTs: randomized controlled trials.. The systematic review of Cameron et al. All studies assessed pain four of them by visual analogue scale — VAS , with similar and consistent results among themselves after three to four weeks of treatment. Absolute VAS pain scores after three to four weeks were in favour of capsaicin as well. Thus, topical capsaicin, applied four times daily over three to four weeks reduced the OA pain and was superior to placebo..

Although the placebo cream appear indistinguishable from the capsaicin, placebo validity and blinding was compromised by the local burning sensation associated with topical capsaicin. Despite adequate sample size and consistent results for all studies, the level of evidence attributed to this review was two limited-quality patient-oriented evidence , 17 since the allocation concealment was unclear in each of the studies and the blinding was problematic.. In the systematic review of De Silva et al. A median Jadad score 19 of four was attributed by the authors.

The sample sizes ranged from fourteen to two hundred patients and the duration of the studies between four and twelve weeks. In all RCTs it was found that topical capsaicin was significantly more effective than placebo in improving OA pain.

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The main limitations of this study were the small number of trials, the small number of patients in some RCTs and the possibility of publication bias submission of studies with unfavourable results less likely. The double-blinding method was not assessed in this study. Comparing with the systematic review of Cameron et al. Although there is consistent evidence that capsaicin gel is effective in the management of OA, the primary data is of low quality.

As such, the level of evidence two was attributed to this review. The systematic review of Laslett et al. The sample sizes ranged from fourteen to hundred patients. Most studies applied VAS to assess pain after four to twelve weeks of treatment. It was found that topical capsaicin had a moderate efficacy in reducing pain intensity after four to twelve weeks of treatment, compared to placebo. Indeed, over four weeks of treatment the change in VAS pain score was moderate standardized mean difference 0. These results were consistent across trials, suggesting no differences between different doses of capsaicin and between different application sites.

It was also reported that continuing use of capsaicin beyond four weeks was beneficial.

Descripción

One study, in a long-term open label extension, reported that differences between groups increase over time, even up to 20 weeks. However, four weeks is probably sufficient to support a therapeutic trial.. It was also reported a greater mean application discomfort score at baseline in the capsaicin group 2. However, burning decreased with continued use.

As such, topical capsaicin was considered safe, with no reports of systemic toxicity. Besides, the burning sensation was not associated with clinical response.. The main limitations mentioned in this review were the difficulty of treatment blinding due to the burning sensation associated with capsaicin, the short duration of RCTs and the limited data of capsaicin efficacy in patients with OA at other sites than hand or knee specially non-superficial joints such as the hip..

Overall, this study suggests that capsaicin should be used for superficial joints like the hand or knee over twelve weeks and possibly longer. The level of evidence two was attributed to this review. The guideline from the Royal College of Physicians 2 Table 2 developed its recommendations using studies with high or very high levels of evidence. Four RCTs were found on topical capsaicin given four times daily in OA patients, compared with placebo. These trials evaluated the impact of treatment on pain and morning stiffness, functional capacity and quality of life, with samples of variable size 59— patients and a short study duration four to twelve weeks.

They also differed in terms of osteoarthritis site: knee and shoulder osteoarthritis were evaluated in a RCT; knee osteoarthritis in the second RCT; knee, hip, shoulder and hand osteoarthritis in the third RCT; and hand osteoarthritis in the fourth RCT. It was found that topical capsaicin was superior to placebo in reducing pain intensity assessed by VAS and articular tenderness, the difference being statistically significant in most of the variables..