title: Feasibility of Topical Applications of Natural High-Concentration Capsaicinoid Solutions in Patients with Peripheral Neuropathic Pain: A Retrospective Analysis.
abstract: Background.Capsaicin, one of several capsaicinoid compounds, is a potent TRPV1 agonist. Topical application at high concentration (high concentration, >1%) induces a reversible disappearance of epidermal free nerve endings and is used to treat peripheral neuropathic pain (PNP). While the benefit of low-concentration capsaicin remains controversial, the 8%-capsaicin patch (Qutenza®, 2010, Astellas, Netherlands) has shown its effectiveness. This patch is, however, costly and natural high-concentration capsaicinoid solutions may represent a cheaper alternative to pure capsaicin.Methods.In this retrospective study, 149 patients were screened, 132 were included with a diagnosis of neuropathic pain, and eighty-four were retained in the final analyses (median age: 57.5 years [IQR25-75: 44.7-67.1], male/female: 30/54) with PNP who were treated with topical applications of natural high-concentration capsaicinoid solutions (total number of applications: 137). Indications were postsurgical PNP (85.7%) and nonsurgical PNP (14.3%) (posttraumatic, HIV-related, postherpetic, and radicular PNP).Objectives.To assess the feasibility of topical applications of natural high-concentration capsaicinoid solutions for the treatment of PNP.Results.The median treated area was 250 cm2[IQR25-75: 144-531]. The median amount of capsaicinoids was 55.1 mg [IQR25-75: 28.7-76.5] per plaster and the median concentration was 172.3μg/cm2[IQR25-75: 127.6-255.2]. Most patients had local adverse effects on the day of treatment, such as mild to moderate burning pain and erythema. 13.6-19.4% of the patients experienced severe pain or erythema. Following treatment, 62.5% of patients reported a lower pain intensity or a smaller pain surface, and 35% reported a sustained pain relief lasting for at least 4 weeks.Conclusion.Analgesic topical treatment with natural high-concentration capsaicinoid is feasible and may represent a low cost alternative to alleviate PNP in clinical practice.
authors.affiliation: Department of Anesthesiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
authors.forename: Fanny
authors.identifier: 0000-0001-7611-3931
authors.initials: F
authors.lastname: Bauchy
authors.affiliation: Institute of NeuroScience, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
authors.forename: Andre
authors.initials: A
authors.lastname: Mouraux
authors.affiliation: Institute of NeuroScience, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
authors.forename: Ronald
authors.initials: R
authors.lastname: Deumens
authors.affiliation: Institute of NeuroScience, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
authors.forename: Marjolein
authors.initials: M
authors.lastname: Leerink
authors.affiliation: Department of Anesthesiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
authors.forename: Antonio
authors.identifier: 0000-0002-2245-2978
authors.initials: A
authors.lastname: Ulpiano Trillig
authors.affiliation: Department of Anesthesiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
authors.forename: Bernard
authors.initials: B
authors.lastname: le Polain de Waroux
authors.affiliation: Department of Anesthesiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
authors.forename: Arnaud
authors.identifier: 0000-0003-2142-7540
authors.initials: A
authors.lastname: Steyaert
authors.affiliation: Louvain Drug Research Institute, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
authors.forename: Quetin-Leclercq
authors.initials: QL
authors.lastname: Joëlle
authors.affiliation: Department of Anesthesiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Institute of NeuroScience, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium.
authors.forename: Patrice
authors.identifier: 0000-0001-5772-8439
authors.initials: P
authors.lastname: Forget
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000982:Antipruritics / Q000008:administration & dosage / Q000737:chemistry; D002211:Capsaicin / Q000008:administration & dosage* / Q000031:analogs & derivatives*; D015331:Cohort Studies; D004339:Drug Compounding; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000175:diagnosis* / Q000188:drug therapy*; D010147:Pain Measurement / Q000187:drug effects* / Q000379:methods; D019999:Pharmaceutical Solutions / Q000008:administration & dosage / Q000737:chemistry; D012189:Retrospective Studies
chemical_list: D000982:Antipruritics; D019999:Pharmaceutical Solutions; D002211:Capsaicin