A review of the high-concentration capsaicin patch and experience in its use in the management of neuropathic pain

Abstract

Abstract:In the European Union, the high-concentration capsaicin patch is licensed for the management of neuropathic pain conditions in nondiabetic patients, including postherpetic neuralgia (PHN) and HIV-associated distal sensory polyneuropathy (HIV-DSP). However, in the USA, the Food and Drug Administration approved its use only in PHN patients. Capsaicin is a transient receptor potential vanilloid-1 agonist, which increases the intracellular calcium ion concentration. This triggers calcium-dependent protease enzymes causing cytoskeletal breakdown and leads to the loss of cellular integrity and 'defunctionalization' of nociceptor fibres. Efficacy and therapeutic effect has been shown in several clinical studies of PHN and HIV-DSP. The high-concentration capsaicin patch and its practical application are different from low-concentration creams; one application can help for up to 3 months. The process of setting up of a service to use the capsaicin 8% patch is also discussed.

The Effectiveness and Safety of Topical Capsaicin in Postherpetic Neuralgia: A Systematic Review and Meta-analysis

“…Patients need to continuously reapply capsaicin cream throughout the day due to the low concentration of the active ingredient (0.025–0.075%) (Das et al, 2013). The four-times-daily application may threaten medication compliance (Jorge et al, 2011).…”

“…While capsaicin cream (which requires frequent application) may reduce adherence, a capsaicin patch could potentially improve a patient’s adherence, as such a patch only needs to be reapplied every 3 months (Das et al, 2013). This could be accounted for by the down-regulation of TRPV-1 receptors (Jorge et al, 2011).…”

“…For the initial treatment of PHN, the recommended first- and second-line agents are gabapentin, a lidocaine patch, opioid analgesics, and tricyclic antidepressants (Dworkin et al, 2003). Like the cream formulation, capsaicin patches may cause a burning sensation (Das et al, 2013). As placement of the patch can be quite painful, a local topical anesthetic or opioid pain relievers must be used concurrently during application (FDA, 2009).…”

“…As placement of the patch can be quite painful, a local topical anesthetic or opioid pain relievers must be used concurrently during application (FDA, 2009). A capsaicin patch may also increase blood pressure during initial application (Das et al, 2013). In fact, the FDA recommends blood-pressure monitoring for at least an hour after the application of a capsaicin patch.…”

What role for capsaicin in diabetic peripheral neuropathy?

“…It binds to the transient receptor potential vanilloid 1 receptor heat-activated calcium channel and causes it to open at normal body temperature 10. Agonist action at the receptor probably accounts for the initial burning experienced with topical capsaicin.…”