Clinicians have utilized compression therapy for decades to ensure a one-way flow of the circulatory system in order to counteract the negative outcomes of edema. Clinicians are familiar with venous insufficiency, lymphatic dysfunction and the negative consequences of these issues for patients. Compression therapy, specifically graduated compression, is a mainstay in treatment for each of these conditions.
Pain is a physiologic entity that is a result of an underlying alteration in homeostasis. This can also be true with lower extremity edema. Many patients with edema also experience pain that can be recalcitrant to treatment.
As clinicians may be aware, capsaicin is a byproduct of the chili pepper. When capsaicin comes in contact with human tissue, it causes a burning sensation, which in turn initiates the process of defunctionalization of the nerve stimulus that caused the pain sensation in the first place. One may employ topical capsaicin to help address pain associated with nerve conditions such as diabetic neuropathy in the lower extremity.
What A Small Prospective Trial Revealed
With this in mind, I recently conducted a single-center, active control, prospective trial of Nufabrx compression socks with capsaicin in order to assess the efficacy of the modality in regard to pain relief and its impact on quality of life.
The study involved 20 patients, ranging between 20 to 75 years of age, who had a foot and ankle disability index of at least 55 (based on the majority of people having moderate difficulty in weightbearing living) and foot pain.
I utilized the Foot and Ankle Orthopedic Quality of Life Scale (FAOQ) to assess improvements in quality of life in regard to activity level and pain level. Pre-study FAOQ scores were 55.2 and post-study scores were 53.46 with an average decrease in score of 1.74 points, showing an improvement of the quality of life.
For the study, I used the Foot and Ankle Disability Index (FADI) score to evaluate the functional limitations of people with various foot and ankle conditions. Study participants completed this questionnaire prior to study enrollment and at two, six and 12 weeks after enrollment. The pre-study FADI score was 72.73 and the post FADI average score was 77.14 with an improvement of 4.42 points and an overall decrease in functional limitations of subjects.
One patient stated that she could walk more during the day and did not experience the amount of pain she would normally feel by the end of the day. Another participant who is a chef and stands on his feet for 10 hours a day said, “I can definitely stand longer and have less pain and fatigue while working.” Another woman experienced relief from her neuropathy pain and swelling. She noted that since she wore the socks, she “ … felt less foot pain and pressure, allowing me to be more active.”
One patient indicated that she far preferred putting on a pair of socks. She said it was much easier and cleaner than having to apply a topical cream. “The medicine ended up sitting on my nightstand but having the medication built into the sock made it much easier and cleaner,” the patient noted. She also stated that she felt more aware of the benefits of capsaicin by having it directly built into the socks.
With this study’s overall improvement of pain scale scores and decrease in disability index scores, the results suggest that wearing Nufabrx socks may help decrease edema and pain.
Dr. Schoenhaus is a Diplomate of the American Board of Foot and Ankle Surgery. She is in private practice in Boca Raton and Boynton Beach, Fla. One can follow Dr. Schoenhaus online at @jsfootdoc and www.bocaratonfootcare.com.
Has this study been published?
Not yet. We hope to get published this year.