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STEWART B: 'Vitamin D: A Champion of Pain Relief, Pain Treatment Topics', [Online] June 2008, Retrieved from the Internet:
STEWART B: 'Vitamin D for Chronic Pain' PRACTICAL PAIN MANAGEMENT vol. 8, no. 6, July 2008, pages 24 - 42
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See also references of EP 2387407A1
1. The use of vitamin D3 for the manufacture of a medicament for the transdermal treatment of neurogenic inflammation and neuropathic pain.
2. The use as claimed in claim 1 , wherein the medicament includes a carrier medium suitable for transdermal application, in which vitamin D3 is dispersed or dissolved.
3. The use as claimed in claim 2, wherein the carrier medium is selected from the group consisting of:- aqueous-based cream, massaging oil, gel base, ointment, patches, impregnated sheet material, pessaries, suppositories.
4. The use as claimed in any one of the preceding claims wherein the vitamin D3 is present in a concentration in the range of 5000 IU/gram to 100,000 IU/gram.
5. The use as claimed in claim 4 wherein the vitamin D3 is present in a concentration of 40,000 IU/gram.
6. The use as claimed in any one of the preceding claims wherein the vitamin D3 is in the form of a powder.
7. The use as claimed in any one of claims 1 - 5 wherein the vitamin D3 is dissolved in a plant oil.
8. A method for the relief of neurogenic inflammation and neuropathic pain by the transdermal application of a medicament including vitamin D3.
9. The method as claimed in claim 8, wherein the medical and includes a carrier medium suitable for transdermal application, in which vitamin D3 is dispersed or dissolved.
10. The method as claimed in claim 9 wherein the carrier medium is selected from the group consisting of:- aqueous-based cream, massaging oil, gel base, ointment, patches, impregnated sheet material, pessaries, suppositories.
1. The method as claimed in any one of claims 8 - 10 wherein the vitamin D3 is present in a concentration in the range of 5000 lU/gram to 100,000 IU/gram.
Field of the Invention
The present invention relates to a medicament for the relief of pain and inflammation, in particular neurogenic inflammation and neuropathic pain. The medicament of the present invention has been found to be especially effective in the relief of peripheral neuropathic pain.
Background of the Invention
Neurogenic inflammation is inflammation of the nerves which is actually caused by the nerves, in the sense that it is caused by the pro-inflammatory neuropeptides released by the nerves when the nerves are irritated, damaged, or injured. The neurogenic inflammation causes the neuropathic pain. Peripheral neuropathic pain is neuropathic pain experienced in the distribution of the peripheral nervous system, i.e. outside the central nervous system (brain and spinal cord). Typical sites for peripheral neuropathic pain are the heels/hands/feet/elbows/knees.
Neurogenic inflammation, and the resulting neuropathic pain, typically are difficult to treat and often respond poorly to standard pain treatments. Treatments typically used for neurogenic inflammation and neuropathic pain (including peripheral neuropathic pain) include non-steroidal anti-inflammatory drugs, painkillers, anticonvulsant drugs, antidepressant drugs, electrical nerve stimulation, and corticosteroid/local anaesthetic injections; however, none of these treatments reliably reduces the pain in a majority of cases, and in addition may have undesirable side-effects.
Disclosure of the Invention
An object of the present invention is the provision of a medicament capable of providing a convenient, safe and effective relief for neurogenic inflammation and neuropathic pain (including peripheral neuropathic pain), with minimal risk of undesirable side-effects. The present invention provides the use of vitamin D3 for the manufacture of a medicament for the transdermal treatment of neurogenic inflammation and neuropathic pain (including peripheral neuropathic pain).
The present invention further provides a method for the relief of neurogenic inflammation and neuropathic pain (including peripheral neuropathic pain) by the transdermal application of a medicament including vitamin D3.
Preferably, the medicament of the present invention includes a carrier medium suitable for transdermal application, in which vitamin D3 is dispersed or dissolved. It should be noted that vitamin D3 is fat soluble. Vitamin D3 is commercially available either as a powder or dissolved in a plant oil; in either form it can be mixed into the carrier medium. It is envisaged that suitable carrier mediums for transdermal application would include aqueous-based creams, massage oils, ointments, gels, pessaries/suppositories, patches, and impregnated bandages or other sheet material, e.g. insoles for footwear.
It should be noted that, as used herein, the term "vitamin D3" means cholecalciferol, (i.e. the pro-hormone form of vitamin D3) as opposed to the metabolically active form, calcitriol.
The preferred range of concentration of the vitamin D3 in the medicament is in the range 5000 IU/gram to 100,000 lU/gram; a concentration of 40,000 IU/gram has been found particularly effective. (IU is an abbreviation of "International Unit").
Vitamin D3 is of course known as a vitamin necessary for bone health, although the recommended daily intake of vitamin D3 is currently a matter of debate.
Over the last 10 years, studies carried out in USA and UK have indicated that people suffering from persistent, non-specific musculoskeletal pain syndromes resistant to normal forms of treatment tend to have a deficiency of vitamin D3, and obtain benefit from a vitamin D3 supplement, given either as an intramuscular injection or as an oral dose. Further, a recent study dealing with patients with diabetic neuropathy found that treatments with daily oral doses of vitamin D3 resulted in a significant reduction in the diabetic neuropathic pain.
However, none of the studies carried out to date suggest that vitamin D3 would have any anti-inflammatory and/or anaesthetic or pain relieving properties when applied externally.
The only known treatment in which vitamin D3 is applied transdermal^ is a treatment for psoriasis, in which a cream containing the active form of vitamin D3 (calcitriol) is used. However, this cream is ineffective for the relief of neurogenic inflammation or neuropathic pain.
Brief Description of the Drawings
By way of example only, preferred embodiments of the present invention are described with reference to the accompanying drawings, in which:
Figure 1 is a visual analogue scale diagram showing progress of pain relief for Patient
Figure 2 is a visual analogue scale diagram showing progress of pain relief for Patient
Figure 3 Is a visual analogue scale diagram showing the results of a one-year clinical audit on a number of patients.
In the visual analogue scale: 0 = no pain
10 = worst imaginable pain
Detailed Description of Preferred Embodiments
A cream was prepared using a known pharmaceutical cream base plus 12,000 IU/gram powdered vitamin D3 in the form of cholecalciferol (25 (OH) D3). The cream was designed to be suitable for transdermal application by massaging into the skin. Example 1
Patient 1 - History: MM 1 age 46, female, elite masters middle distance runner with 2- month history of right inferior heel pain treated initially with subcutaneous prolotherapy, complicated by infection, complaining of inability to run, difficulty walking, and pain at rest. Past history of bilateral peripatellar pain treated with failed surgical decompression, Achillodynia.
The patient applied the cream by massaging the cream into the painful area twice a day and after any activity, with the massaging followed by the application of heat where possible. This procedure was followed until all pain and tenderness had disappeared from the area. The treatment was continued for three months, and an assessment of pain was recorded every seven days, as shown in Figure 1. Over this period, the pain reduced from a severe pain to very little pain, with the pattern of pain reduction being a period of steady decrease of pain followed by a plateau, then a further steady decrease followed by another plateau. It is notable that the patient has since continued to run and is pain-free, although continuing to use the cream.
Patient 2 - History: JF, age 24, female, fitness trainer with 8-month history of left inferior heel pain, complaining of inability to run, difficulty walking, affecting work. Has prior treatment with physiotherapy and podiatry without effect. Past history of bilateral Osgood Schlatter Disease, right medial shin splints and peripatellar pain.
The patient applied the cream by massaging the cream into the painful area twice a day and after any activity, with the massaging followed by the application of heat where possible. This procedure was followed until all pain and tenderness had disappeared from the area. The treatment was continued for two months:- as shown in Figure 2, over this period the pain steadily diminished from severe pain to no pain. This patient is still using the cream, and continues to run with no pain.
The patients from Examples 1 and 2 were monitored for serum vitamin D levels at the end of treatment; both showed normal levels. Example 3
A total of 14 patients, all suffering from recalcitrant inferior heel pain (plantar fasciitis) were studied over a period of several months. The patients consisted of three males with a mean age of 56 (range 50 to 60) and 11 females with a mean age of 44 (range 23 to 61).
Inferior heel pain (plantar fasciitis) is a difficult to treat condition, causing high levels of pain and disability for up to four years in one prospective study of 100 patients (BMJ Clinical Evidence Concise June 2006)
The underlying cause of inferior heel pain is postulated to be due to chronic neurogenic inflammation of the distal Tibial nerves branches known as the medial cutaneous calcaneal nerves.
All patients in this study had received prior treatment including physiotherapy, cortison injections and podiatry with taping and orthotics without benefit.
The patients were treated with a cream consisting of a known cream base of a type suitable for transdermal applications of medication to which had been added vitamin D3 in oil base form, at a concentration of 40,000 IU/gram. The cream was gently massaged into the skin over the inflamed portion, at least twice a day. Ten of the 14 patients were treated with the vitamin D3 cream only; four of the patients used the vitamin D3 cream in combination with weekly prolotherapy (injections of 20% glucose, 0.1% lignocaine). All patients were monitored at intervals for blood levels of vitamin D3; all levels were normal.
Over the study period shown, all patients responded to the treatment with a complete recovery, with only one recorded relapse, and no adverse reactions were observed. The progress of the treatment is shown in Figure 3 which shows the visual analogue scores for pain, graphed against time. The solid lines represent the cases treated with vitamin D3 cream only; the broken lines show the four cases treated with the combination of prolotherapy and vitamin D3 cream. Figure 3 shows that there was little difference in outcome between the two treatments, and also shows that there was a strong correlation between initial pain scores and the length of treatment needed:- patients with high initial pain scores required a longer treatment period. However, there was a consistent and high response rate to the treatment with vitamin D3 cream alone.
Further testing on individual cases indicates that the medicament of the present invention is successful in relieving a wide range of forms of neurogenic inflammation and neuropathic pain, including peripheral neuropathic pain. The cream has been successful in relieving all of the following conditions:- plantar fascia, tennis elbow, golfers elbow, knee pain, Achilles tendon pain, neck pain (whiplash injury) low back pain, chronic exertional compartment syndrome, osteo arthritis symptoms of hand and fingers, fibromyalgia pains, hip pains and shoulder pains, contact dermatitis (especially contact dermatitis caused by cement/concrete and by Diesel), acute contusions, sprains and strains, purigo, first-degree burns (including sunburn), chilblains and shingles. In all cases, the condition is treated simply by massaging the cream into the affected area of skin. Many sprains and strains and other injuries causing neuropathic pain can become a cause of chronic pain, and the medicament of the present invention is particularly valuable in that it can be used to treat such pain quickly and effectively, thus preventing the neurogenic inflammation from becoming chronic and hence causing chronic pain.
Whenever the medicament of the present invention has been used, the levels of vitamin D3 in the user's blood have been monitored by a series of regular blood tests and it is interesting that in all cases so far, there have been no significant increases of vitamin D3 levels in the user's blood as a result of the use of the medicament.