High-dose 8% capsaicin patch in treatment of chemotherapy-induced peripheral neuropathy: single-center experience

Abstract

High-dose capsaicin patch is effective in treatment of neuropathic pain in HIV-associated neuropathy and diabetic neuropathy. There are no studies assessing effectiveness of high-dose capsaicin patch in treatment of chemotherapy-induced peripheral neuropathy. We sought to determine the effectiveness of treatment of pain associated with chemotherapy-induced peripheral neuropathy with high-dose capsaicin patch. Our study group consisted of 18 patients with clinically confirmed oxaliplatin-induced neuropathy. Baseline characteristic including underling disease, received cumulative dose of neurotoxic agent, neuropathic symptoms, prior treatment and initial pain level were recorded. Pain was evaluated with Numeric Rating Scale prior to treatment with high-dose capsaicin and after 1.8 day and after 8 and 12 weeks after introducing treatment. Patients were divided into two groups accordingly to the amount of neurotoxic agent that caused neuropathy (high sensitivity and low sensitivity group). Most frequent symptoms of chemotherapy-induced neuropathy were: pain (88.89%), paresthesis (100%), sock and gloves sensation (100%) and hypoesthesis (100%). Initial pain level was 7.45 ± 1.14. Mean cumulative dose of oxaliplatin after which patients developed symptoms was 648.07 mg/m2. Mean pain level after 12 weeks of treatment was 0.20 ± 0.41. When examined according to high and low sensitivity to neurotoxic agent patients with low sensitivity had higher pain reduction, especially after 8 days after introducing treatment (69.55 ± 12.09 vs. 49.40 ± 20.34%; p = 0.02) and after 12 weeks (96.96 ± 5.56 vs. 83.93 ± 18.59%; p = 0.04). High-dose capsaicin patch is an effective treatment for pain associated with chemotherapy-induced neuropathy in patients treated with oxaliplatin. Patients with lower sensitivity to neurotoxic agents have better response to treatment and pain reduction.

Pain in Platin-Induced Neuropathies: A Systematic Review and Meta-Analysis

“…A total of 282 articles were excluded during the eligibility assessment, and 25 additional papers were identified by scanning the reference lists. Therefore, 96 papers met the inclusion criteria and were used for this review [ 9 – 104 ]. These studies were published between 1980 and 2017.…”

“…In an open-label study, Filipczak-Bryniarska et al demonstrated that the high-dose capsaicin patch was effective in treating pain associated with oxaliplatin-induced neuropathy [ 104 ]. However, this finding should be interpreted with caution, given the limitations of the study design and small number of the participants.…”

Mechanisms, Predictors, and Challenges in Assessing and Managing Painful Chemotherapy-Induced Peripheral Neuropathy

“…Cannabis has demonstrated efficacy for neuropathic pain from peripheral neuropathy caused by HIV and diabetes, [130][131][132][133][134][135][136] but cannot be recommended for CIPN because of a lack of studies for this specific indication. Small quasi-experimental studies provide preliminary evidence that high-dose 8% capsaicin patches 137 and intravenous lidocaine 138 may ameliorate painful CIPN. However, larger studies with control group comparisons are needed to confirm or refute these preliminary findings.…”

Treatment of Chronic Oxaliplatin-Induced Peripheral Neuropathy: A Systematic Review

“…Based on its effectiveness on the treatment of neuropathic pain in HIV-associated neuropathy and post-herpetic neuralgia, high-dose topical capsaicin was tested on the treatment of CIPN-associated pain. A single-centre trial, the application of high-dose capsaicin patch resulted in significant pain relief, without considerable adverse events [23]. In a sample of 18 colon cancer patients undergoing oxaliplatin-based chemotherapy, with painful peripheral polyneuropathy, there was an average pain score in approximately 84% to 97% patients after 12 weeks of application of capsaicin patch.…”