title: Mechanism- and experience-based strategies to optimize treatment response to the capsaicin 8% cutaneous patch in patients with localized neuropathic pain.
abstract: The capsaicin 8% cutaneous patch is an emergent new treatment option for patients with peripheral neuropathic pain. In randomized controlled clinical studies relevant pain relief for 12 weeks was achieved in about one third of patients following a single application. The first part of this paper is a review of the pathophysiology, pharmacology, and published clinical trials with the capsaicin 8% cutaneous patch. The second part reports on outcomes of an interdisciplinary expert workshop, where new treatment results of three major German pain centers were presented and reviewed with the objectives of obtaining responder rates for different pain syndromes, assessing maintenance of effect under real-life conditions, and giving recommendations for practical care. The 12 week responder rates with pain relief of ≥ 30% were comparable in patients with mononeuropathies (37.9%) and postherpetic neuralgia (38.8%). Similar responder rates were seen in a subgroup of patients with cervical spine radiculopathy and back pain (46.7%). In HIV-associated neuropathy the responder rates were high (47.8%) but lower in patients with other polyneuropathies (17.6%). Response rates were nearly identical after 1 week (46.6%) and 4 weeks (43.3) and dropped only slightly at 12 weeks (37.4%). In a subgroup of 54 patients who underwent a second treatment, efficacy was maintained. Response rates in patients with or without lidocaine pretreatment were comparable. Treatment with the capsaicin 8% cutaneous patch was generally safe and well tolerated. The workshop panel recommended further investigation of opportunities to improve the application procedure and to perform studies on the skin penetration and distribution of capsaicin. A modified quantitative sensory testing (QST) should be developed for clinical practice in order to better understand the correlation of sensory profiles and response to capsaicin treatment.
authors: Center for Biomedicine and Medical Technology Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany. fra.ger@medwiss-extern.de
authors: R-D
authors: RD
authors: Treede
authors: T
authors: T
authors: Wagner
authors: K-U
authors: KU
authors: Kern
authors: I W
authors: IW
authors: Husstedt
authors: G
authors: G
authors: Arendt
authors: F
authors: F
authors: Birklein
authors: T
authors: T
authors: Cegla
authors: R
authors: R
authors: Freynhagen
authors: H-H
authors: HH
authors: Gockel
authors: M-L
authors: ML
authors: Heskamp
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authors: Jager
authors: R
authors: R
authors: Joppich
authors: C
authors: C
authors: Maier
authors: A
authors: A
authors: Leffler
authors: H-H
authors: HH
authors: Nagelein
authors: R
authors: R
authors: Rolke
authors: S
authors: S
authors: Seddigh
authors: C
authors: C
authors: Sommer
authors: S
authors: S
authors: Stander
authors: G
authors: G
authors: Wasner
authors: R
authors: R
authors: Baron
mesh_terms: D000293:Adolescent; D000328:Adult; D002211:Capsaicin / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000188:drug therapy*; D059408:Pain Management; D017410:Practice Guidelines as Topic; D018689:Sensory System Agents / Q000627:therapeutic use*; D013997:Time Factors; D057968:Transdermal Patch
chemical_list: D018689:Sensory System Agents; D002211:Capsaicin