How it Started: Dr. Bertrand had been injecting dextrose 5% then mannitol 5% around nerves and found that these injections would provide almost immediate pain relief in the areas supplied by these nerves. Problem was that most people are not very keen on getting injections, so she decided to see if she could formulate a cream that would provide pain relief.
In March 2012 she and Dr. Ellen Wiebe decided to try a cream containing dextrose to treat vulvodynia, a terribly painful condition of the vulva. Unfortunately, sugar can promote the growth of yeast which could very much worsen vulvodynia. Women with the problem didn’t want to try a cream that might give them such a complication. Since mannitol was even more effective in providing pain relief then dextrose, Dr. Bertrand suggested the cream should be made with mannitol. The 1st few women who tried this cream didn’t like how it felt: mannitol granules were still present in the cream and irritated the skin when they were rubbed in, so the research project was dropped.
Dr. Bertrand got together with Dr. Marylene Kyriazis and they got to work looking for a base that would properly dissolve the mannitol to make the cream smooth. Having found such a base, they decided to test it on the pain people have after finishing a marathon. 123 people who finished the Vancouver marathon of 2013 used the cream containing the mannitol on one leg and the same cream but without the mannitol on the other leg for 5 days after the race. After you run a marathon, your legs tend to be really sore for the 1st 5 days after the race. A lot of people reported that the mannitol cream helped their arthritis, their skin rashes, and their neuropathic pain, but there was no difference between the cream containing the mannitol and the placebo as far as post marathon muscle pain. The cream was relieving superficial pain, but the deep pain felt in the muscles was not relieved: it did not penetrate deep enough to reach inside the muscles.
That set Dr. Bertrand and Dr. Kyriazis on a quest to develop a cream that would allow mannitol to penetrate more deeply, so the mannitol could reach the level of the muscles. They also had to prove that mannitol was indeed the active ingredient capable of switching off the pain signal.
In order to do that, Dr. Bertrand devised an experiment. She applied some capsaicin (cayenne pepper) cream on the upper lips of 25 volunteers. If you have ever tried cayenne pepper, say, in Tabasco sauce, you know how it makes your mouth burn. When their burning sensation reached 8/10 on a scale of 0, no burning at all to 10 being branded with a red hot iron she wiped off the capsaicin cream and on one side of the upper lip she applied the mannitol containing cream while on the other side she applied the same cream but without the mannitol. Neither she, nor the participants knew on which side of the upper lip the mannitol cream was applied. After that, every minute for 10 minutes, she asked the participants to rate their burning sensation on either side of their upper lip. If they still felt some burning after 10 minutes, she applied the cream which had provided them with the most relief on the area which was still uncomfortable. Of the 25 participants, 4 still needed some cream after 10 minutes and it was all on the side that had not received the mannitol. The probability that the mannitol cream and the placebo cream were the same was less than 1/1000. This showed that mannitol was indeed the ingredient of the cream that shut down the pain signal.
The article describing this experiment was published in Archives of Physical Medicine and Rehabilitation (Bertrand H, Kyriazis M, Reeves KD, Lyftogt J, Rabago D. Topical Mannitol Reduces Capsaicin-induced Pain: Results of a Pilot Level, Double-Blind Randomized Controlled Trial. PM&R 2015 PubMedID: 25978942)
The mannitol cream was very effective in providing pain relief for a lot of the people who consulted with Dr. Bertrand for their pain. The average pain relief was 55%, the average time to pain relief was 15 minutes and the relief lasted for 5 hours in at least half the people who applied the cream. It worked for everything from migraine headaches to arthritis to peripheral neuropathy. One young medical student found it relieved her severe back pain and decided to do a research project using the cream for the awful chronic pain people sometimes experience after a bout of shingles. The research project began in September 2015. The results are very encouraging and the majority of participants are now feeling much better.
One person who wanted to be a participant in this study had severe burning pain in her back for 5 years following a bout of shingles. The pain was so severe she could not wear a bra and the rubbing of the sheets on her back at night would her awake from the pain. Unfortunately, the morning she came into my office to join the study she woke up with another bout of shingles and a rash in the exact same area where she had pain for 5 years. Obviously, she couldn’t be part of the study, so I gave her the formula that had been developed for QR cream, which contains menthol. Menthol makes mannitol penetrate the skin very fast and almost completely. I applied this cream on her rash and within 5 minutes she was pain-free in that area. She said: “could you also please put it on my back?” I did this, and, 10 minutes later, she walked out of my office, completely pain-free for the 1st time in 5 years. 3 days later, her shingles rash had disappeared and her back pain was nowhere to be found. When I saw her a week after that, she was still pain-free. Because of this, I decided that all those who participated in the study should receive this new cream if they were not 100% better after 3 months of using the pure mannitol cream.
As you can see, research involves a lot of trials and errors, but I believe the new QR cream is likely to provide relief for most pain sufferers.
Sometimes things happen in the office that make you want to do research for that particular condition. Unfortunately, running a research project very time and energy consuming, and not all conditions can be used for research projects.
Last year, a woman came to see Dr. Bertrand because she had terrible pain in both her shoulders. “When I looked at her, I could understand why”, said Dr. Bertrand. “She was holding both her arms in the air and scratching her almost bald head which was covered by a thick crust of psoriasis. She told me her itch was so intense that she spent her days scratching her head. She said her children could tell where she had been just by looking at the flakes of skin on the floor. She had tried all the treatments for psoriasis and nothing had relieved her itch. Feeling sorry for her, I gave her some mannitol cream and told her to apply it on her head. 2 minutes later, she smiled and said “this is the 1st time in 10 years my head is not itching.” I supplied her with some mannitol cream and, 6 weeks later, the crust on her scalp had disappeared and she was growing a normal head of blond hair. It appears the cream can eliminate almost any kind of itch, from mosquito bites to psoriasis. If anyone out there wants to carry out a research project on this, I’ll be happy to supply them with mannitol cream and with placebo cream”.
“A woman limped into my office in November 2015 with an acute attack of gout. Her right big toe joint was red and shiny and swollen to the size of a ping-pong ball. When I saw this, I told her “I’ll put some cream on this”. To which she yelled “don’t touch it!” Very gingerly, I hovered over her toe with a thick dollop of cream so that only the cream would touch her toe. Within 1 minute, I was rubbing the cream in and she was not protesting. 5 minutes later, she walked out of my office normally with no trace of a limp. She brought the cream with her down south where she was spending the winter and, 6 weeks later, emailed me from there, that in 2 days her gout had disappeared and had not come back. I know the cream works extremely well for osteoarthritis, particularly of the hands, wrists, ankles, feet and knees, but this is the 1st time I witnessed how fast it works even for a severe acute attack of arthritis. Once again, I’ll be happy to supply anyone wanting to do research on this with all the materials they need.”
“A few months ago, an elderly gentleman hobbled into the examining room using 2 canes, as the soles of his feet were burning so badly he could not bear to put weight on them. He was a longtime diabetic and had not controlled his sugars very well. He had what is called “diabetic neuropathy”. This happens when the nerves which supply the hands and feet are injured by too much sugar for too long. I asked him “which is your sorest foot?” To which he replied “my right one”. I rubbed the cream into his right foot and started taking his medical history. 10 minutes later he said “could you please put some cream on my left foot”. I did this and, after I had finished taking his history, I asked him to walk to the examining table so I could examine him. He stood up, smiled broadly and said “oh! I can dance!” As he was leaving the office, he left his canes behind. I had to remind him to bring them home with him. Diabetic neuropathy is another condition which the cream helps a great deal and which should be researched”.
“A doctor in Australia, who does a lot of research saw how fast the cream was working to relieve another doctor’s very painful shoulder and approached me to do research on necks which suffer from whiplash injury. As I have seen many whiplash sufferers helped by the cream, if this can be arranged, there will probably be a research project on using the cream for those who suffer after a whiplash injury.”