1. Training Academy Module
Zo-Rub® OA and HP Topical Analgesic Creams

2. Zo-Rub® OA Topical Cream
Zo-Rub® OA topical analgesic cream (0.025% capsaicin, 45g) provides targeted action to relieve the pain of osteoarthritis
Indicated for the symptomatic relief of pain associated with osteoarthritis.
It is a topical analgesic cream that works directly at the source to relieve the pain of Osteoarthritis.
Contains Capsaicin, a natural active ingredient that’s clinically proven to work and is suitable for chronic treatment of osteoarthritis.
Reduces joint pain and inflammation with regular use.

3. Zo-Rub® OA Topical Cream
Provides effective topical treatment of pain from osteoarthritis in either large or small joints.
It is a specific treatment for chronic OA pain, whereas topical NSAIDs are primarily for sports type injuries or rheumatic pains and should not be used for chronic, long term pain.
Proven effectiveness in the treatment of osteoarthritis pain when used alone (monotherapy), and in combination with systemic analgesics.
Effective with patients who have contra-indications to systemic analgesics such as NSAIDs and who do not get sufficient relief from paracetamol.
Positioned specifically for OA pain, not sports injuries.

4. How Zo-Rub® OA works
Zo-Rub® OA appears to block pain transmission by reducing levels of substance P – the body’s pain messenger.1,2,3,4
Zo-Rub® also has an anti-inflammatory effect which reduces joint tenderness.2
ZO-RUB
1. Altman RD et al. Capsaicin Cream 0.025% as Monotherapy for Osteoarthritis: A Double-Blind Study. Seminars in Arthritis and Rheumatism 1994; 23 (6): Deal CH et al. Treatment of arthritis with topical capsaicin: a double-blind trial. Clin Ther 1991: 13 (3): Zimmermann M. Pain mechanisms and mediators in osteoarthritis. Seminars in Arthritis and Rheumatism 1989; 18 (4): Marshall KW, Chiu B, Inman RD. Substance P and arthritis: analysis of plasma and synovial fluid levels. Arthritis and rheumatism 1990; 33 (1):

5. What is Substance P?
ZO-RUB
Substance P is a neuropeptide released from the terminals of specific sensory nerves.
The sensory function of substance P is thought to be related to the transmission of pain information into the central nervous system.

6. How Zo-Rub® works
Capsaicin depletes substance P from the whole c-fibre neurone, both peripherally and centrally5.
Repeated dosing leads to the continued depletion of substance P and the subsequent desensitisation of the nerve fibres.
ZO-RUB OA
5. Fitzgerald M. Capsaicin and Sensory Neurones – a review. Pain 1983;15:

7. What it competes with Liniments or rubs Topical NSAIDs
Zo-Rub® OA has proven efficacy for treatment of OA pain supported by clinical data.
Topical NSAIDs
Primarily for short-term treatment of sports injuries vs. Zo-Rub® for chronic OA pain.
Systemic analgesics
Zo-Rub® OA treats only the specific joint without any adverse systemic events.

8. Proven effectiveness for osteoarthritis pain
ZO-RUB OA
In monotherapy, Zo Rub® OA reduces pain by up to 50%1
80% of sufferers experience pain relief1
These results support the beneficial effects of (Zo-Rub® OA) as first-line therapy for OA pain1
Pain Severity VAS
A double-blind, randomised 12 week comparison of Zo-Rub q.i.d. monotherapy (n= 57) or placebo vehicle (n = 56) in patients with OA1
1. Altman RD et al. Capsaicin Cream 0.025% as Monotherapy for Osteoarthritis: A Double-Blind Study. Seminars in Arthritis and Rheumatism 1994; 23 (6):

9. Proven effectiveness for osteoarthritis pain
In combination with oral NSAID’s and Paracetamol
In a separate study, Zo-Rub® OA provided up to 33% more pain relief to the analgesia achieved with oral NSAID’s and Paracetamol alone, when used in combination with these treatments2
This result suggests Zo-Rub® OA would be “…useful in enhancing pain control when added to standard arthritis therapeutic regimens”2
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Prompt reduction in pain scores
Pain Severity VAS: weekly change from baseline.
A double-blind, randomised 4 week comparison of Zo-Rub (n = 36) or placebo vehicle (n = 34), in OA of the knee, in which most patients continued to take concomitant NSAID’s or analgesics2
2. Deal CH et al. Treatment of arthritis with topical capsaicin: a double-blind trial. Clin Ther 1991: 13 (3):

10. Who to recommend to?
Patients suffering from joint pain associated with osteoarthritis, especially chronic long-term pain.

11. Why range? Zo-Rub® OA cream is only available in the Pharmacy channel.
With an aging population there is an increasing incidence of pain associated with osteoarthritis, and Zo-Rub® OA provides a clinically proven treatment that can be recommended on its own or in combination with other analgesics.
Zo-Rub® OA has no systemic side effects throughout the rest of the body as it works only on the nerve fibres near the site of application1,2.
Zo-Rub® OA also has no drug-to-drug interactions so it is suitable for use with patients using other medications at the same time2.
As it uses a naturally occurring active ingredient (capsaicin), Zo-Rub® OA can be used for the long term treatment of chronic osteoarthritis pain, as opposed to topical NSAID’s that should not be used for longer then 21 days.
Zo-Rub® OA has great potential for ongoing repeat business with proven clinical effectiveness and the ability to use long term for chronic pain.
1. Altman RD et al. Capsaicin Cream 0.025% as Monotherapy for Osteoarthritis: A Double-Blind Study. Seminars in Arthritis and Rheumatism 1994; 23 (6): Deal CH et al. Treatment of arthritis with topical capsaicin: a double-blind trial. Clin Ther 1991: 13 (3):

12. Companion Selling
Look to sell Zo-Rub® OA in combination with Paracetamol or oral NSAID’s to help provide additional pain relief to that already being achieved by those oral analgesics alone. +

13. Features and benefits for the customer
Simple topical application
Apply only at the site of pain
No systemic side effects1,2.
No drug-drug interactions2
Suitable for use with concomitant medications
Suitable for long-term treatment of chronic OA pain.
Proven effectiveness with treating joint pain associated with osteoarthritis
In monotherapy, reduces pain by up to 50%, and 80% of sufferers experience pain relief.1
In combination therapy, reduces pain by an additional 33% to that already being achieved by oral NSAID’s and Paracetamol.2
1. Altman RD et al. Capsaicin Cream 0.025% as Monotherapy for Osteoarthritis: A Double-Blind Study. Seminars in Arthritis and Rheumatism 1994; 23 (6): Deal CH et al. Treatment of arthritis with topical capsaicin: a double-blind trial. Clin Ther 1991: 13 (3):

14. Features and benefits for the store
Exclusive to Pharmacy channel.
Competitive consumer price point delivering high margin return.
Provides excellent companion selling opportunity and for repeat business .
Ongoing promotional and training support.

15. Zo-Rub® HP Topical Cream
Zo-Rub® HP topical analgesic cream (0.075% capsaicin, 45g) is an effective, well-tolerated treatment for the management of painful diabetic neuropathy and post herpetic neuralgia.
Zo-Rub® HP is indicated for:
the symptomatic relief of neuralgia following Herpes Zoster infections (post-herpetic neuralgia) after open skin lesions have healed.
the symptomatic management of medically diagnosed painful diabetic peripheral polyneuropathy (damage to nerves in the limbs).

16. Relief from the torment of nerve pain
Nerve pain, also called neuralgia or neuropathy, is pain that comes from nerves near the surface of the skin.
It is usually persistent, causing on-going distress to the point where a person can feel tormented by the pain.
Two common causes of nerve pain are:
post-herpetic neuralgia (which may occur after an infection of shingles), and
diabetic neuropathy, which affects some people who have diabetes.

17. Post-herpetic neuralgia
Describes pain that may start after the shingles rash has disappeared and can last for many years.
Usually felt in the area where the shingles rash was.
Post-herpetic neuralgia may be described as:
Sharp and jabbing, burning, or deep and aching pain
Extreme sensitivity to touch and temperature change
Itching and numbness.

18. Diabetic Neuropathy
Describes the condition when a person with diabetes has nerve damage that causes them pain or numbness.
The nerve damage seems to be linked to having high blood glucose levels over a long time.
Diabetic neuropathy can be described as:
Prickling
Burning
Aching
Sharp jabs of needle-like pain.

19. How Zo Rub® HP works
Substance P is the primary neurotransmitter of painful stimuli from the peripheral to the central nervous system.5
It is found in high concentrations in the slow conducting C-fibres which transmit deep, prolonged pain stimuli.
Applied to the relevant dermatome, Zo-Rub® HP specifically blocks C-fibre conduction by depleting substance P from peripheral sensory nerve endings and blocking its production by the dorsal root ganglia.5
Pain relief increases gradually with continued use (4+ weeks).1-5
The selective action of Zo-Rub® HP spares other sensations; e.g. touch and vibration, which is important for awareness of injury in a diabetic foot.5
1. Biesbroeck R et al. A double-blind comparison of topical capsaicin and oral amitriptyline in painful diabetic neuropathy. Advances
in Therapy 1995; 12 (2): Daily GE for the Capsaicin Study Group. Effect of capsaicin on daily activities of patients with painful diabetic neuropathy. Diabetes Care 1992; 15 (2): Bernstein JE etc al. Topical capsaicin treatment for chronic post herpetic neuralgia. J Am Acad Dermatol 1989; 21: Watson PC et al. A randomised vehicle-controlled trial of topical capsaicin in the treatment of post herpetic neuralgia. Clin Ther 1993: 15 (3): Sheffler NM et al. Treatment of painful diabetic neuropathy with capsaicin 0.075%. J Am Pod Med Assoc 1991; 81 (6):

20. Efficacy in Post-Herpetic Neuralgia
Pain improvement in Zo-Rub® HP patients rose from 50% at 2 weeks to 64% at 6 weeks.4
This benefit was maintained or amplified in 86% of patients in a 2 year, open label follow-up trial.4
Zo-Rub HP
4. Watson PC et al. A randomised vehicle-controlled trial of topical capsaicin in the treatment of post herpetic neuralgia. Clin Ther 1993: 15 (3):

21. Efficacy in Post-Herpetic Neuralgia
At 2 weeks Zo-Rub® HP-treated patients experienced over 80% greater mean pain relief than those using vehicle (measured by visual analogue scale).4
Zo-Rub HP
4. Watson PC et al. A randomised vehicle-controlled trial of topical capsaicin in the treatment of post herpetic neuralgia. Clin Ther 1993: 15 (3):

22. Efficacy in Diabetic Neuropathy
90% of Zo-Rub® HP treated patients showed pain improvement after 8 weeks compared with 50% receiving vehicle.5*
Results demonstrated Zo-Rub® HP Cream is as effective as Amitriptyline, but without the adverse side effects.1
*Investigators global evaluation
Zo-Rub HP
1. Biesbroeck R et al. A double-blind comparison of topical capsaicin and oral amitriptyline in painful diabetic neuropathy. Advances
in Therapy 1995; 12 (2): Sheffler NM et al. Treatment of painful diabetic neuropathy with capsaicin 0.075%. J Am Pod Med Assoc 1991; 81 (6):

23. Efficacy in Diabetic Neuropathy
Patients using Zo-Rub® HP showed an improved quality of life2
“…provided pain relief in patients with established painful diabetic neuropathy and increased their productivity, mobility and ability to sleep and participate in recreational activities.”2
Zo-Rub HP
2. Daily GE for the Capsaicin Study Group. Effect of capsaicin on daily activities of patients with painful diabetic neuropathy. Diabetes Care 1992; 15 (2):

24. Who to recommend to?
Patients suffering from diabetic neuropathy or post herpetic neuralgia.

25. Why range? Zo-Rub® HP cream is only available in the Pharmacy channel.
Zo-Rub® HP has no systemic side effects throughout the rest of the body as it works only on the nerve fibres near the site of application1-5.
Zo-Rub® HP also has no drug-to-drug interactions so it is suitable for use with patients using other medications at the same time.
As it uses a naturally occurring active ingredient (capsaicin), Zo-Rub® HP can be used for the long term treatment of neuropathic pain.
Zo-Rub® HP has great potential for ongoing repeat business with proven clinical effectiveness and the ability to use long term for chronic neuropathic pain.
1. Biesbroeck R et al. A double-blind comparison of topical capsaicin and oral amitriptyline in painful diabetic neuropathy. Advances
in Therapy 1995; 12 (2): Daily GE for the Capsaicin Study Group. Effect of capsaicin on daily activities of patients with painful diabetic neuropathy. Diabetes Care 1992; 15 (2): Bernstein JE etc al. Topical capsaicin treatment for chronic post herpetic neuralgia. J Am Acad Dermatol 1989; 21: Watson PC et al. A randomised vehicle-controlled trial of topical capsaicin in the treatment of post herpetic neuralgia. Clin Ther 1993: 15 (3): Sheffler NM et al. Treatment of painful diabetic neuropathy with capsaicin 0.075%. J Am Pod Med Assoc 1991; 81 (6):

26. Features and benefits for the customer
Simple topical application
Apply only at the site of pain
Free from systemic side effects and toxicity1-5.
No known systemic drug interactions
Important for older patients on concomitant medications
Different mode of action than other analgesics or NSAID’s.
Selective action spares other sensations – e.g. touch and vibration; important for awareness of injury in a diabetic foot.5
Effective in treating Post Herpetic Neuralgia
Pain improvement4 and increased pain relief4
Effective in treating Diabetic Peripheral Neuropathy
Pain improvement5 and improved quality of life2
1. Biesbroeck R et al. A double-blind comparison of topical capsaicin and oral amitriptyline in painful diabetic neuropathy. Advances
in Therapy 1995; 12 (2): Daily GE for the Capsaicin Study Group. Effect of capsaicin on daily activities of patients with painful diabetic neuropathy. Diabetes Care 1992; 15 (2): Bernstein JE etc al. Topical capsaicin treatment for chronic post herpetic neuralgia. J Am Acad Dermatol 1989; 21: Watson PC et al. A randomised vehicle-controlled trial of topical capsaicin in the treatment of post herpetic neuralgia. Clin Ther 1993: 15 (3): Sheffler NM et al. Treatment of painful diabetic neuropathy with capsaicin 0.075%. J Am Pod Med Assoc 1991; 81 (6):

27. Features and benefits for the store
Exclusive to Pharmacy channel.
Competitive consumer price point delivering high margin return.
Ongoing promotional and training support.

28. Instructions for use Little and often is the rule
Apply one small bead of cream per application site, 3-4 times daily.
Apply to affected area by gently massaging with your fingers.
More than a single blob won’t work any better and just wastes the cream.
May cause temporary burning on application – this burning is observed more frequently when applied less than 3-4 times daily.
Applying Zo-Rub® OA and HP may cause a mild to moderate localised burning sensation which usually decreases or disappears with time and regular use. This is quite normal, particularly during the early stages of treatment, and is a sign that the cream is working.
This sensation is caused by the initial, transient release of substance P from the nerve endings in the skin. Over the first few days or weeks of treatment this effect will gradually reduce.
You don’t need to cover the whole painful area as the cream acts on the nerves across the wider area.

29. Special instructions and warnings
Always wash hands immediately after use – unless using the cream on your hands.
Avoid applying near eyes, mucosa or broken, damaged and irritated skin.
Avoid taking a hot bath or shower just before or after applying cream as it can enhance the burning sensation.
Don’t bandage the affected area tightly.
Not recommended for use on children.
Discontinue use if adverse reaction occurs.

30. Questions customers may ask
How long can I use Zo-Rub® for?
You can use Zo-Rub® for as long as pain relief is required for your condition. It contains a naturally occurring active ingredient and has no systemic side effects so it can be used for long term chronic pain.
I need to use the cream for pain in or on my hands – should I still wash them after use?
If possible wash any unaffected areas, but don’t wash any areas on your hands that require pain relief.
Zo-Rub® HP is three times stronger than OA and has the same ingredient – can I use it to get even more relief for my osteoarthritis pain?
Zo-Rub® HP is not indicated for the relief of pain associated with osteoarthritis – use Zo-Rub® OA instead.
I get a burning sensation when I use the cream – should I stop using it?
This is a typical reaction when using a capsaicin cream, and usually is a sign that the cream is working. Make sure that you are applying 3-4 times per day as indicated, as this sensation will be prominent if used less. The sensation should lessen over the first few days or weeks of application, but if you suffer a severe and prolonged reaction consult a healthcare professional.
Will the cream work even better if I put more on and really work it into the skin?
No, more than the recommended small bead of cream doesn’t work any better and just wastes the cream. You also don’t need to use the cream on the entire area of pain as it works on the nerve fibres across the wider area.
I have pain from a pinched nerve in my back – can I use Zo-Rub® HP to treat it?
No, Zo-Rub® HP is for neuropathic pain where there has been actual damage to the nerve fibres near the surface of the skin, rather than a pinched nerve which is the mechanical compression of a nerve root. Use only as indicated.