title: Posttraumatic and postsurgical neuropathic pain responsive to treatment with capsaicin 8% topical patch.
abstract: Capsaicin 8% patch (Qutenza) is mainly used to treat postherpetic neuralgia and human immunodeficiency virus-associated neuropathy. However, evidence of the efficacy of Qutenza in other forms of neuropathic pain is lacking. A 24-year old Libyan man, with no previous medical history, sustained multiple wounds in the right side of the chest and back after a bomb explosion. The patient experienced pain, which persisted in a wide location around the surgical intervention for a long time, beyond the usual course of natural healing of an acute pain and was different from that suffered preoperatively. The characteristics of the pain included burning, electric shock-like sensation, tingling, and numbness, and it was paroxysmal. The pain was associated with hyperalgesia and intense allodynia in a wide area, approximately of 1,100 cm2. Our initial treatment strategy included pregabalin, tramadol, and duloxetine. However, our patient's pain responded to treatment with capsaicin 8% patch when the initial treatments showed only minimal effectiveness regarding the intensity of pain. Interestingly, the most important finding was that capsaicin 8% patch showed a more than 80% reduction of the area of allodynia associated with the pain, when other treatments failed. Moreover, although recent data showed that in patients who respond to Qutenza, analgesia starts within a few days of treatment and lasts on average 5 months, our patient showed an initial response within 7 days of treatment but a longer duration of more than 18 months. Although further controlled studies are needed to explore the efficacy of the capsaicin 8% patch in patients who experience posttraumatic neuropathic pain, we encourage clinicians to try the capsaicin 8% patch when alternative treatments fail.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Zis
authors.affiliation: Department of Neurology, Evangelismos General Hospital, Athens, Greece; and Pain Relief Clinic, Athens Medical Center, Greece.
authors.forename: Alexandros
authors.initials: A
authors.lastname: Apsokardos
authors.forename: Christina
authors.initials: C
authors.lastname: Isaia
authors.forename: Panagiota
authors.initials: P
authors.lastname: Sykioti
authors.forename: Athina
authors.initials: A
authors.lastname: Vadalouca
mesh_terms: D000287:Administration, Topical; D002211:Capsaicin / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D009437:Neuralgia / Q000188:drug therapy* / Q000209:etiology; D059408:Pain Management; D011183:Postoperative Complications / Q000503:physiopathology*; D018689:Sensory System Agents / Q000008:administration & dosage*; D055815:Young Adult
chemical_list: D018689:Sensory System Agents; D002211:Capsaicin