Topical ambroxol possible treatment of neuropathic pain

Recent research from Europe indicates the potent cough syrup ingredient ambroxol could be effective in alleviating neuropathic pain when used as a cream applied to the skin.

The German scientists concluded that, “[Ambroxol] is therefore considered to be a useful, simple concept for pain management with few side effects. In the case reports presented in this article, this concept was successfully implemented, for the first time, in the form of topical ambroxol 20 % cream in patients with severe neuropathic pain.”

However the European Medicines Agency published an advisory regarding possible complications in the use of ambroxol. They note that, “The risk of anaphylactic reactions and SCARs with ambroxol or bromhexine is low. Frequencies of these side effects are unknown.”

They go on to caution, “Anaphylactic reactions and severe cutaneous adverse reactions (SCARs), including erythema multiforme, Stevens-Johnson syndrome/toxic epidermal necrolysis and acute generalised exanthematous pustulosis, have been reported in patients receiving ambroxol.”

With those warnings out of way, the researchers made these claims based on findings on five of the people they treated, “Four patients with no improvement after lidocaine 5 % and one patient with no response to capsaicin 8 % nevertheless experienced a pain reduction with topical ambroxol.”

Widely available in tablet form, the 20% cream was prepared exclusively for this study by combining the following ingredients, “ambroxol cream 20 %, 50.0 g: ambroxol 10.0 g, dimethyl sulfoxide 5.0 g, made up to 50.0 g with Linola cream.”

Ambroxol is the active ingredient of medications marketed commercially as Mucosolvan, Mucobrox, Mucol, Lasolvan, Mucoangin, Surbronc, Ambolar, and Lysopain. Not available as a cream, it’s sold as a cough syrup, in tablets, pastilles, dry powder sachets, inhalation solutions, drops, ampules as well as effervescent tablets.

As noted in Wikipedia, “Many state-of-the-art clinical studies have demonstrated the efficacy of ambroxol in relieving pain in acute sore throat, with a rapid onset of action, with its effect lasting at least three hours. Ambroxol is also anti-inflammatory, reducing redness in a sore throat.”

Though known as a pain reliever since the 1970’s, it’s use in a topical (locally through the skin) form could offer promise for people where other methods have not been effective.


Frost Bite Warning For Neuropathy Patients

The severe cold gripping Canada over Valentine’s Day weekend may affect people with neuropathy more than those in the general population.

According a news article in, “People with medical conditions such as diabetes, peripheral neuropathy and disease affecting blood vessels are at a greater risk for frost bite and hypothermia.”

Hypothermia and hyperpyrexia can also result from autonomic neuropathy, which attacks the nerves of autonomic system.

At they have a detailed list of some the symptoms that accompany autonomic neuropathy.

There may be no sweating or reduced sweating (anhidrosis and hypohidrosis
Temperature regulation
Hypothermia and hyperpyrexia can result from disruption of the various temperature regulatory mechanisms
Reduced or absent sweating
Blurring of vision
Tunnel vision
Light sensitivity
Difficulty focusing
Reduced lacrimation
Gradual reduction of pupillary size
photo credit: Winnie Sharon Lim Koo MD
Orthostatic hypotension
Other orthostatic symptoms ( nausea, palpitations, light-headedness, tinnitus)
Fainting, passing out and swooning (syncope)
Inability to stand without syncope
abnormal heart rhythm
Supine hypertension
Loss of diurnal variation in blood pressure
Dry mouth
Disturbance of taste
Burning sensation
Hair loss
Dry skin
Pale, cold feet
Worsening of symptoms at night

Medline Plus also warns that, “Autonomic neuropathy may hide the warning signs of a heart attack. Instead of feeling chest pain, if you have autonomic neuropathy, you may only feel sudden fatigue, sweating, shortness of breath, nausea, and vomiting during a heart attack.”

Dr. Aaron Vinik in a Diabetes In Control interview highlighted the confusion between heart attacks and autonomic neuropathy causes of death in his study, “What killed the people was related to the autonomic dysfunction and the fact that they likely died of an autonomic neuropathy complication with the way you try to intensify glycemic control.”

As winter’s frigid temperatures begin to moderate in the Northern Hemisphere and approach in the Southern Hemisphere, people with neuropathy need to be alert to the dangers they face in dealing with freezing temperatures.

Only a regular physical exam by a qualified neurologist will determine the risk the patient may face in dealing with their neuropathy.

Acupuncture Treatment For Peripheral Neuropathy

An ancient treatment for pain relief, acupuncture, may have some use in the treatment of painful diabetic  peripheral neuropathy according to a research paper published in “Experimental and Toxicologic Pathology.”

acupunctureThe study showed acupuncture improved nerve conduction and assessment of subjective symptoms in 16 of the 21 patients who received the treatment over a period of one year.

Only 4 of the 26 patients who received the best medical care but no specific treatment for peripheral neuropathy showed any improvement.

Of the other patients, three in the acupuncture group did not change, while two patients demonstrated an aggravation. In the control group seven people had no change and 15 of the 26 exhibited an aggravation.

Another recent study published in “Experimental and Toxicologic Pathology” indicated acupuncture actually  regenerated nerve cells in rats who had spinal cord injuries.

“The researchers reported electro-acupuncture restored partial function to paralyzed limbs in the injured rats.”

Answering a question posed to Dr Weil, he stated that while acupuncture may not regenerate nerve cells, “The short answer to your question is yes, acupuncture can help relieve the pain of peripheral neuropathy.”

He added, “A practitioner of Chinese medicine can provide you with herbs that may speed recovery, as well as acupuncture treatments.”

Scientists who were funded by the International Pharmacopuncture Institute also reported in a paper released in 2010, demonstrated that, “Acupuncture was significantly more effective than sham for treatment of numbness of the lower extremities, spontaneous pain in the lower extremities, rigidity in the upper extremities and alterations in temperature perception in the lower extremities after therapy.”

Later on the authors go on to suggest acupuncture may aid in nerve regeneration, “Acupuncture treatment improved these symptoms, suggesting that it may accelerate the nerve regenerative process in DPN patients.”

The British Acupuncture Council advises against seeing acupuncture as a cure-all for peripheral neuropathy, because while some studies were encouraging, others did not give promising results.

In summary they wrote, “Treating nerve damage with acupuncture, however, suffers from the same limitations as any other therapy. If the damage is already considerable there is less chance of reducing the pain and loss of sensation.”

The prestigious Mayo Clinic lists acupuncture, along with alpha-lipoic acid, herbs, amino acids and fish oil as potential alternative medical treatments.

Treating a potentially deadly condition such as neuropathy on your own can lead to fatal consequences, so such home-brewed approaches need to thoroughly vetted by consulting experts in the neurological sciences before assuming they will cure your peripheral neuropathy problem.