Ointment made from chiles’ capsaicin relieves some pain
Q: For several decades, I have found capsaicin ointment to be effective when other remedies for pain are inadequate. It eliminated the discomfort I felt after vein removal from my calf. It gives long-lasting relief from peripheral neuropathy in my feet and the unbearable itch my wife got months after a severe case of shingles.
We do have to be careful not to get the ointment in the eyes or on other sensitive areas. Also, we don’t expose treated areas to sun because it produces an intense burning sensation. I apply the ointment with a foam brush or rubber gloves.
A: You are smart to use a brush or gloves to apply this ointment. That reduces the chance you will get some in your eyes, nose, mouth or another sensitive spot.
Capsaicin is the compound that makes chile peppers hot. Repeated application to the skin depletes substance P from the sensory nerves, allowing temporary relief from pain. This apparently is because capsaicin activates the transient receptor potential channel vanilloid 1 (TRPV1) (Pharmacology & Therapeutics, April 2021).
Because of this action, scientists have been trying to improve absorption through the skin for treating diabetic neuropathy (Advanced Pharmaceutical Bulletin, Aug. 2022). As you have noted, available capsaicin ointments can ease pain. The main side effect is the burning sensation when it is first applied.
Q: A year or two ago, there was a “60 Minutes” show about repurposed drugs
for COVID-19. It suggested that an old antidepressant medication, fluvoxamine, might be helpful. I have not heard anything more about fluvoxamine. Could you see where in development this drug is for treating COVID-19? A:
Other readers have also wondered what happened to research on fluvoxamine for treating COVID-19. This chemical cousin of fluoxetine (Prozac) was marketed in Switzerland as an antidepressant in 1984. The Food and Drug Administration approved it for treating obsessive compulsive disorder in 1994 as Luvox (fluvoxamine).
A pilot study involving 152 COVID-19 patients suggested that this drug might be beneficial against SARS-COV-2 (JAMA, Dec. 8, 2020). A larger trial involving 1,288 COVID-19 patients recently reported that fluvoxamine “did not improve time to sustained recovery” (JAMA, Jan.
12, 2023). The authors concluded that the data do not support the use of this medication for COVID-19.
Q: You have written often about vitamin B12 deficiency,
but I can find nothing about too much B12. I had a blood test recently that revealed excess B12. Although I take a daily multivitamin, I do not take a B12 supplement. Where could excess vitamin B12 come from? Also, what problems could arise? I will have to consult with my doctor, but I’d like to know what questions to ask. A:
First, check your multivitamin to make sure that the dose of vitamin B12 (cobalamin) is under 1,000 mcg (aka 1 mg). Health care providers might prescribe such a high dose to correct a deficiency, but it is too much to take without medical supervision.
Your doctor will probably run blood tests to rule out problems with the liver or kidneys. Another possible cause of elevated vitamin B12 levels is a blood disorder. In any case, the physician must do a complete diagnostic workup to track down the reason for elevated vitamin B12 levels.