ObjectiveTo investigate the response of patients with peripheral neuropathic pain (PNP) to capsaicin 8% patch treatment in a clinical setting.DesignRetrospective analysis.SettingThe Clinic for Pain Therapy and Palliative Medicine at the Medical Centre for the region of Aachen, Germany.SubjectsPatients diagnosed with PNP who attended the clinic for capsaicin 8% patch treatment between January 13, 2010 and February 7, 2011.Outcome MeasuresPain intensity was assessed using the Numeric Pain Rating Scale (NPRS) at baseline and following each capsaicin 8% patch treatment. Changes in prescribed concomitant neuropathic pain (NP) medications and response duration were recorded.ResultsOverall, 68 patients with PNP conditions, including facial neuropathy (severe trigeminal neuralgia in V2), polyneuropathy, post-herpetic neuralgia, and mononeuropathies, received 96 treatments with the capsaicin 8% patch. The 53 patients with a follow-up of ≥8 weeks demonstrated a 48.4% mean reduction in NPRS score from baseline to Weeks 1–8. Among the 37 responders (those exhibiting ≥30% reduction in NPRS score from baseline to Weeks 1–8), the median time to re-treatment was 125 days. Following treatment, there was a significant (P < 0.001) 54% reduction in the mean number of prescribed concomitant NP medications taken by patients.ConclusionsThis analysis demonstrates that in clinical practice, the capsaicin 8% patch provides rapid and sustained pain reductions in patients with a variety of PNP conditions and a significant reduction in prescribed concomitant NP medications. The capsaicin 8% patch can be a valuable addition to the NP treatment armory for certain patients.
Neuropathic pain is thought to affect up to 8% of the adult population in the UK. The condition can severely impact on patients' quality of life and can be difficult to treat. The capsaicin 8% patch has been developed to directly target the source of peripheral neuropathic pain and has been shown to provide pain relief for up to 3 months from a single 30- or 60-minute application. Adherence to the capsaicin 8% patch application procedure is important to achieve effective treatment. The authors are a group of health professionals experienced in using the capsaicin 8% patch. In this article the authors describe the optimal patch application procedure from their real-world clinical experience and provide recommendations on how to optimize the therapeutic benefit of the patch. Other key aspects of the application procedure are also addressed, including the importance of patient management, the ideal treatment setting, the best way to manage application-associated discomfort and post-treatment care. The observations and learning that the authors have gained from their clinical experience with the capsaicin 8% patch will help others to maximize the benefit gained with this novel treatment option.
SUMMARY The capsaicin 8% patch is licensed in Europe for the treatment of peripheral neuropathic pain in nondiabetic adults. In controlled trials it provided pain relief for up to 3 months with a single 30- or 60-min application. In this article, a group of pain specialists from Germany and the UK share their considerable experience of real-world use of the capsaicin 8% patch. This experience comes from treating >200 patients with a variety of neuropathic pain etiologies including postherpetic neuralgia, peripheral neuropathy and cancer-related neuropathy. These patients, a slight majority of whom were female, had experienced neuropathic pain for varied lengths of time (3 months to >15 years) and the majority were receiving concomitant medications for their pain at the time of capsaicin 8% patch treatment. Observations by the group suggest that patients with positive symptoms might respond best to therapy. To optimize response to treatment, the group reports that it is important to achieve good adhesion of the patch to the skin. The experience of the group is that the capsaicin 8% patch is a tolerable treatment and local anesthetic pretreatment may not always be required. Cooling measures used after treatments were found to be the most practical and beneficial means of relieving any treatment-related discomfort. The group observed that transient, clinically important increases in blood pressure owing to treatment-related discomfort are very rare and they have seen no correlation between treatment-related discomfort or erythema and response to treatment. In the real-life clinical setting, response to capsaicin 8% patch treatment may be higher than observed in the clinical trial program. Response to retreatment also appears to be equal to that of the first treatment, even in patients treated for the fifth time. It was also observed that patients receiving capsaicin 8% patch treatment are often able to reduce their intake of concomitant pain medications. Observations from real-life use of the capsaicin 8% patch will help to maximize its therapeutic potential.
Neuropathic pain is difficult to treat and can have a severe effect on quality of life. The capsaicin 8% patch is a novel treatment option that directly targets the source of peripheral neuropathic pain. It can provide pain relief for up to 12 weeks in patients with peripheral neuropathic pain. Treatment with the capsaicin 8% patch follows a clearly defined procedure, and patch application must be carried out by a physician or a health care professional under the supervision of a physician. Nonetheless, in our experience, nurses often take the lead role in capsaicin 8% patch application without the involvement of a physician. We believe that the nurse’s key role is of benefit to the patients, as he or she may be better placed, because of time constraints and patient relationships, to support the patient through the application procedure than a physician. Moreover, a number of frequently prescribed drugs, including botulinum toxin and infliximab, can be administered by health care professionals without the requirement for physician supervision. Here we argue that current guidance should be amended to remove the requirement for physician supervision during application of the capsaicin 8% patch.
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