title: 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.
authors.affiliation: Centre of Pain Medicine and Palliative Care, Wiesbaden, Germany.
authors.forename: Kai-Uwe
authors.initials: KU
authors.lastname: Kern
authors.forename: Walburga
authors.initials: W
authors.lastname: Nowack
authors.forename: Chris
authors.initials: C
authors.lastname: Poole
mesh_terms: D000700:Analgesics / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000627:therapeutic use; D002211:Capsaicin / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D004177:Dipyrone / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000188:drug therapy*; D010147:Pain Measurement; D010892:Pirinitramide / Q000008:administration & dosage / Q000627:therapeutic use; D013997:Time Factors; D057968:Transdermal Patch; D016896:Treatment Outcome
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal; D010892:Pirinitramide; D004177:Dipyrone; D008012:Lidocaine; D002211:Capsaicin
keywords: capsaicin; lidocaine pretreatment; nerve pain; neuralgia; nociceptors; peripheral nervous system; tolerability; topical