Neuropharmacological mechanisms of capsaicin and related substances.

Capsaicin activates poorly myelinated primary afferent neurons, many of which are polymodal nociceptors. Activation is accompanied by membrane depolarization and the opening of a unique, cation-selective, ion channel which can be blocked by the polyvalent dye ruthenium red. The capsaicin-induced activation is mimicked by resiniferatoxin, a potent analogue, and by low pH. Activation is mediated by a specific membrane receptor which can be selectively and competitively antagonized by capsazepine. Repetitive administration of capsaicin produces a desensitization and an inactivation of sensory neurons. Several mechanisms are involved including receptor inactivation, block of voltage activated calcium channels, intracellular accumulation of ions leading to osmotic changes, and activation of proteolytic enzyme processes. Systemic and topical capsaicin produces a reversible antinociceptive and anti-inflammatory action after an initial undesirable algesic effect. Capsaicin analogues, such as olvanil, have similar properties with minimal initial algesic activity. Antinociception produced by capsaicin does not involve neurotoxicity, sensory neuropeptide depletion or activity at peripheral receptors; rather, systemic capsaicin produces antinociception by activating capsaicin receptors on afferent nerve terminals in the spinal cord. Spinal neurotransmission is blocked by a prolonged inactivation of sensory neurotransmitter release. However, local or topical applications of capsaicin block C-fibre conduction and inactive neuropeptide release from peripheral nerve endings. These mechanisms account for localized antinociception and the reduction of neurogenic inflammation, respectively.