Capsaicin Spray For Neuropathic Cough

Today's post from fauquierent.blogspot.com (see link below) is written by an ear, nose and throat specialist who has encountered patients living with irritating and frequent coughing as a result of neuropathy and nerve disorder. This would come under the heading of autonomic neuropathy, in that it's one of those involuntary functions that neuropathy can seriously disrupt. He suggests using a capsaicin spray to numb the irritated nerves and thus reduce the urge to cough. Many neuropathy patients will be familiar with capsaicin as a strong chili-based cream for the feet and legs and one of the few that can genuinely reduce neuropathic pain (despite the very real risk of 'burning' and discomfort). However, the problem here is that you first need to be sure where your persistent cough is coming from. Is it genuinely a case of laryngeal sensory neuropathy, or have you got a severe cold, an allergy, or do you smoke? Many patients with other conditions which themselves lead to neuropathy may suffer from coughing as a by product of those conditions. Coughing appears regularly among people living with HIV for instance. Whether the capsaicin spray is useful for all these other cough sorts is a question you need to discuss with your doctor.

Capsaicin Spray to Treat Neuropathic Chronic Cough
Posted by Fauquier ENT at 4/30/2015

I recently learned of this unusual form of treatment to help with neuropathic chronic cough by respected laryngologist Dr. Robert Bastian. Capsaicin is what provides the heat in chili peppers and has been used alternatively as an irritant to induce cough in the pulmonary literature, but also numbness in chronic pain situations.

As it pertains to laryngeal sensory neuropathy (LSN) or sensory neuropathic cough (SNC), it does not actually fix anything, but rather just helps reduce the symptoms of the chronic cough leading to reduction in frequency and severity. It is hypothesized to help with the neuropathic cough by nerve desensitization by exhausting the internal supply of substance P, a neurotransmitter.

Typically prepared at 0.03% strength by a compounding pharmacy, it is sprayed directly against the back wall of the mouth (not on the tongue or palate). The "heat" will be felt for about 5 minutes. Do not eat/drink for 10 minutes to prevent capsaicin neutralization. Use 4 times per day for 2-3 weeks before deciding whether it is helping.

According to the experience reported by Dr. Bastian, this capsaicin oral spray can help with cough symptoms in one of 3 ways:

It may ultimately reduce frequency and severity of cough after initial period cough worsening.

It may act as a counter-irritant to abort or minimize a cough attack. Often neuropathic cough is preceded by a "tickle" in the throat. Some patients will use the capsaicin spray as soon as they feel this tickle thereby reducing the duration of subsequent cough (anecdotally, a cough may last only 20 seconds rather than 2 minutes).

Capsaicin spray can be used as a cough scheduler. Using this spray will often trigger a coughing attack... but than there will be an unusually long period of being cough-free. According to Dr. Bastian, capsaicin spray is the fourth thing to try when dealing with neuropathic cough.

At least for me...

Step 1) Typically, after neuropathic cough is finally diagnosed, treatment is initially attempted with neuropathic medications including gabapentin, amitriptyline, pregabalin, etc.

Step 2) Should all these medications fail to help, I than try botox injections to the vocal cords. (More info on botox injections to address chronic cough here.)

Step 3) Should botox fail to help, injection of the superior laryngeal nerve with lidocaine or marcaine is attempted. Potentially, if relief is obtained with this type of injection without significant side effects, this nerve could potentially be surgically cut to make the effects "permanent."

Step 4) Should that method fail to work, capsaicin oral spray can be tried as a last resort.

Keep in mind, that capsaicin oral spray is not used to treat generic chronic cough. It is used to treat NEUROPATHIC chronic cough. In fact, this spray may make the cough worse if the cough is reflux induced (spicy things exacerbate reflux).

More info on laryngeal sensory neuropathy causing chronic cough can be found here.

Reference:
The Use of Capsaicin for Sensory Neuropathic Cough. Bastian Medical Media 7/31/14

http://fauquierent.blogspot.com/2015/04/capsaicin-spray-to-treat-neuropathic.html