Treatment of Neuropathic Pain with the Capsaicin 8% Patch: Is Pretreatment with Lidocaine Necessary?

Abstract

The capsaicin 8% patch can effectively treat neuropathic pain, but application can cause discomfort or a burning sensation. Until March 2013, it was recommended that patients be pretreated with a topical anesthetic, for example lidocaine, before capsaicin patch application. However, speculation existed over the need for pretreatment and its effectiveness in alleviating treatment-associated discomfort. This article compares tolerability to and efficacy of the capsaicin patch in pretreated and non-pretreated patients. All patients received a single capsaicin patch application. Pretreated patients received a lidocaine plaster before and intravenous lidocaine and metamizole infusions during capsaicin patch application. Pain levels, assessed using a Numeric Rating Scale (NRS), were used to determine tolerability and efficacy. All patients (pretreated n = 32; non-pretreated n = 26) completed 100% of the intended capsaicin patch application duration. At the time of capsaicin patch removal, 69% of pretreated and 88% of non-pretreated patients reported an NRS score increase, which returned to baseline by 6 hours post-treatment. There was no significant difference in mean NRS score between patient groups at any time during or after capsaicin patch treatment. Response was similar between patient groups; capsaicin patch treatment provided rapid and significant pain reductions that were sustained over 12 weeks. The same proportion of pretreated and non-pretreated patients reported willingness to receive retreatment with the capsaicin patch. This analysis shows that the capsaicin 8% patch is generally tolerable, and the small discomfort associated with patch application is short-lived. Lidocaine pretreatment does not have a significant effect on tolerability, efficacy, or patient willingness to receive retreatment.

Psychophysical and vasomotor evidence for interdependency of TRPA1 and TRPV1-evoked nociceptive responses in human skin: an experimental study

“…It is unclear whether nociceptor activation per se is a crucial aspect of this desensitization process. Some clinical studies have asserted that the use of local anesthetics do not reduce the efficacy of the capsaicin-ablation 44,68,83 . Experimental studies have found an association between the pain experienced during patch application and the efficacy of the desensitization…”

Application of the capsaicin 8% cutaneous patch in neuropathic pain of the head and face: A case series

“…Since these patients were shown to be refractory to recommended first- and second-line systemic or topical medication for the treatment of neuropathic pain (8) or suffered from intolerable adverse effects of systemic medication, treatment with capsaicin 8% was offered, not in accordance with SmPC. Although recent studies have shown that there is no need for pretreatment with topical anesthetics (25), all patients were pretreated with lidocaine cream 4% for 60 minutes before the capsaicin patch was applied as recommended previously (9). If the capsaicin 8% patch was to be applied close to mucous membranes, specifically close to the eye, special protection of these areas was carried out (covering the eye with compress and plaster before application).…”

Pharmacotherapy of Painful Diabetic Neuropathy: A Clinical Update

“…The transient application site reactions do not improve with lidocaine plaster pre-treatment. [127] Moreover, the lidocaine plaster does not improve the efficacy, tolerability, and compliance to capsaicin patch therapy.…”