ABSTRACT. Original Articles /

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1 Original Articles / 550; 7(): 9-95 J Thai Rehabil Med 007; 7(): ,..,..,..,.. ABSTRACT Efficacy of topical capsaicin and methyl salicylate as an adjuvant therapy in chronic non-specific low back pain treatment: a comparison study Autayakool K, Suethanapornkul S, Teeranet G. Department of Physical Medicine and Rehabilitation, Pramongkutklao Hospital Objectives: To compare the efficacy of topical capsaicin and methy salicylate (PMK balm) as adjuvant therapy in chronic non-specific low back pain treatment Study Design: Double-blinded, randomized controlled trial Setting: Out-patient clinic of Physical Medicine and Rehabilitation, Pramongkutklao Hospital Subjects: The 7 patients with chronic non-specific low back pain (greater than months) between January and August 005 were recruited and randomly assigned into groups. Methods: Topical capsaicin and methy salicylate were applied four times a day to painful areas in group I and II respectively for a 4-wk treatment period. All subjects completed the Short-form McGill Pain Questionnaire, Correspondence to: Dr.Kanit Autayakool, Department of Physical Medicine and Rehabilitation, Rajavithi Hospital. Kanit_a@hotmail.com Thai version (Th-SF-MPQ) before and at the fourth week after treatment. The visual analog scale (VAS) was used to obtain subjective pain intensity before, at the second and the fourth week after treatment. Results: The topical capsaicin group showed significant diminished in the total score and the present pain intensity of Th-SF-MPQ (p=0.00 and p=0.05, respectively), the VAS (p=0.09) and the mean difference of total score (p=0.0) and VAS before and the second week after treatment (p=0.0). The methyl salicylate group showed significant decrease in the present pain intensity of the Th-SF- MPQ only (p=0.047). Conclusion: Topical capsaicin as an adjuvant therapy showed better results in improvement of chronic nonspecific low back pain than methyl salicylate. Key words: Capsaicin, methyl salicylate, chronic back pain J Thai Rehabil Med 007; 7(): 9-95 : ( - ) : Double blinded, randomized controlled trial : : 7 54 : 4 methyl salicylate 4 4 Short-form McGill Pain Questionnaire (Th-SF-MPQ) 4 visual analog scale (VAS), 4 : Th-SF-MPQ (, p=0.00;, p=0.05) (VAS) (p=0.09) (p=0.0) (p=0.0) methyl salicylate 550; 7()

2 Th-SF-MPQ (p=0.047) : :,, 550; 7(): 9-95 () () Saal Saal (), Carey () 4, () () J Thai Rehabil Med 007; 7() () 0 0%methyl salicylate menthol counterirritant (9) Mathias (.. 995) () 4 5 vanilloid receptor (5) c-nociceptors receptors (6) immunostaining c-nociceptors (7) 00 capsicum tincture % (methyl salicylate) erector spinae muscle - - (visual analog scale, VAS) 5 - (straight leg raising test 60 ) - (spondyloarthropathy) ( )

3 - McGill Pain Questionnaire (Th- SF-MPQ) (0) - (pain descriptors) (sensory score) (affective score) 4 0- (total score) 45 - (present pain intensity) visual analog scale (VAS) % Th-SF-MPQ 4 VAS ( ) - Chi-square test Fisher exact test - paired t-test (pain scale) independent t-test (pain scale) - p < ( 5.7) 9 ( 64.) methyl salicylate 4 (0.%) 9 (69.%) VAS (,, ) 4 (p=0.00) (p=0.) 4 p=0.0 p=0.04 p-value ( ) 4 ( ) ( ) ( ) VAS (SD) VAS ; 7()

4 : / :. /. : myofascial pain / 4 4 / : / : / VAS 4 VAS (p=0.0) 4 (p=0.00) (p>0.05) (n=4) 5 / 9 / 6 / 7 / 7 / 9 / 5 (n=) 4 / 9 5 / 0 / 5 6 / 7 7 / 6 9 / p-value Mean total score 0 Methyl salicylate Methyl salicylate 4 J Thai Rehabil Med 007; 7() methyl salicylate VAS 4 (, mean difference) (p=0.0) VAS (p=0.0) VAS 4 (p=0.4 p=0.05 ) 0.05% VAS VAS methyl salicylate mean difference p-value VAS ( ) VAS ( 4 ) (, mean difference )

5 - Mathias () 0.05% 4 myofascial pain Mathias () 0-4 vanilloid receptor (5) 0 - () capsaicin patch (640 ) (. ) Braddom RL. Physical Medicine and Rehabilitation, nd ed. Philadephia: W.B. Saunders, 000: Saal JA and Saal JS. Nonoperative treatment of herniated lumbar intervertebral disc with radiculopathy and outcome study. Spine 99;4:4-.. Carey TS, Evans A, Haler N. Careseeking among individuals with chronic low back pain.spine 995;0:-. 4. Bogduk N, Management of chronic low back pain. Newcastle Bone and Joint Institute, Royal New Castle Hospital, NSW. J Aus Med 004; 0(): Caterina MJ, Julius D. The vanilloid receptor: a molecular gateway to the pain pathway. Annu Rev Neurosci 00; 4: Szallasi A, Blumberg PM. Vanilloid (capsaicin) receptors and mechanisms. Pharmacol Rev999; 5: Nolano M, Simone DA, Wendelschafer- Crabb G, Johnson T, Hazen E, Kennedy WR. Topical capsaicin in humans: parallel loss of epidermal nerve fibers and pain sensation.pain 999; : Mathias BJ, Dillingham TR, Zeigler DN, Chang AS, Belandres PV. Topical capsaicin for chronic neck pain: a pilot study. Am J Phys Rehabil 995; 74: Melzack R. Myofascial trigger points: relationship to acupuncture and mechanism of pain. Arch Phys Med Rehabil 9; 6: ,,. Short-form of McGill Pain Questionnaire. 004; 4: -9.. Backnoja MM, Malan TP, Tuchman M, Mollen M, Brady S, Soumekh S, et al. A single one-hour application of highconcentration capsaicin patches lead to four weeks of pain relief in postherpetic neuralgia patients. American Academy of Neurology Annual Meeting. Honolulu, Hawaii; March 9-April 5, ; 7()