Capsaicin 8% dermal patch in clinical practice: an expert opinion

Abstract

Introduction: Neuropathic pain (NP) is caused by a lesion or disease of the somatosensory system, which can severely impact patients' quality of life. The current-approved treatments for NP comprise of both centrally acting agents and topical drugs, including capsaicin 8% dermal patches, which is approved for the treatment of peripheral NP. Areas covered: The authors summarize literature data regarding capsaicin use in patients who suffer from NP and discuss the clinical applications of this topical approach. Expert opinion: Overall, the capsaicin 8% dermal patch is as effective in reducing pain intensity as other centrally active agents (i.e. pregabalin). Some studies have also reported fewer systemic side effects, a faster onset of action and superior treatment satisfaction compared with systemic agents. In our opinion, capsaicin 8% dermal patches also present additional advantages, such as a good systemic tolerability, the scarcity of adverse events, the possibility to combine it with other agents, and a good cost-effective profile. It is important to note that, as the mechanism of action of capsaicin 8% is the 'defunctionalization' of small afferent fibers through interaction with TRPV1 receptors, the peripheral expression of this receptor on nociceptor fibers, is crucial to predict patient's response to treatment.

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“…This information may support the use of HCCPs earlier in the treatment journey even as a rst-line treatment option and is in line with current thinking about treatment algorithms for the treatment of focal neuropathic pain [32,33]. Consideration of a rst-line treatment with HCCP may be of special interest to the often poly-medicated post-surgical patients as systemic exposure to capsaicin is low and use of HCCP does not seem to lead to major drug interactions and systemic side effects often associated with oral pain treatments [34].…”

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“…For example, sensitivity to capsaicin is mediated by non-mechanosensory C fibers, while during heat perception, mostly mechanosensory C fibers and BC fibers are involved [29,222].…”

Beyond Hot and Spicy: TRPV Channels and their Pharmacological Modulation

“…While blocking of TRPV1 channels directly prevents Ca 2+ influx and subsequent signal transduction from sensory neurons, overactivation by agonists lead to internalization and subsequent desensitization of afferent nerve endings or degeneration of neurons by Ca 2+ -induced neurotoxicity [57]. Today, this therapeutic concept is used in form of transdermal application of high dose capsaicin for the treatment of neuropathic pain in the periphery [58]. Also, the local application of the highly potent agonist resiniferatoxin (RTX) as a "molecular scalpel" in the treatment of extensive pain (cancer) is under clinical trial [57].…”