Capsaicin 8% Patch for Peripheral Neuropathic Pain: Review of Treatment Best Practice from ‘Real-World‘ Clinical Experience

Abstract

SUMMARY The capsaicin 8% patch is licensed in Europe for the treatment of peripheral neuropathic pain in nondiabetic adults. In controlled trials it provided pain relief for up to 3 months with a single 30- or 60-min application. In this article, a group of pain specialists from Germany and the UK share their considerable experience of real-world use of the capsaicin 8% patch. This experience comes from treating >200 patients with a variety of neuropathic pain etiologies including postherpetic neuralgia, peripheral neuropathy and cancer-related neuropathy. These patients, a slight majority of whom were female, had experienced neuropathic pain for varied lengths of time (3 months to >15 years) and the majority were receiving concomitant medications for their pain at the time of capsaicin 8% patch treatment. Observations by the group suggest that patients with positive symptoms might respond best to therapy. To optimize response to treatment, the group reports that it is important to achieve good adhesion of the patch to the skin. The experience of the group is that the capsaicin 8% patch is a tolerable treatment and local anesthetic pretreatment may not always be required. Cooling measures used after treatments were found to be the most practical and beneficial means of relieving any treatment-related discomfort. The group observed that transient, clinically important increases in blood pressure owing to treatment-related discomfort are very rare and they have seen no correlation between treatment-related discomfort or erythema and response to treatment. In the real-life clinical setting, response to capsaicin 8% patch treatment may be higher than observed in the clinical trial program. Response to retreatment also appears to be equal to that of the first treatment, even in patients treated for the fifth time. It was also observed that patients receiving capsaicin 8% patch treatment are often able to reduce their intake of concomitant pain medications. Observations from real-life use of the capsaicin 8% patch will help to maximize its therapeutic potential.

Financial & competing interests disclosure

T Wagner has received honoraria for educational lectures from Astellas Pharma Europe Ltd, Cephalon, Mundipharma, Grunenthal, Pfizer, TEVA-AWD and MSD. K-U Kern is a consultant for and received speaker fees from Astellas Pharma Europe Ltd, Eisai, Berlin Chemie, betapharm, Boehringer Ingelheim, Grünenthal, Lilly, medi Bayreuth and Sanofi Pasteur MSD. J England has received honoraria from Bristol-Myers Squibb. T Wagner, J England and K-U Kern have all undertaken QUTENZA speaker tours while A Sell and J England have both supervised live QUTENZA clinics and training events, all funded by Astellas Pharma Europe Ltd. All authors have received consultancy honoraria from Astellas Pharma Europe Ltd. Open Access was supported by Astellas Pharma Europe Ltd. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Writing assistance was provided by Adelphi Communications Ltd, supported by Astellas Pharma Europe Ltd.

Notes

† In the authors‘ experience, small-fiber neuropathy may only be a negative indicator for treatment success if the treating healthcare professional is inexperienced. Therefore, they do not recommend treating patients with small-fiber neuropathy if it is the healthcare professional‘s first time using the capsaicin 8% patch.

NP: Neuropathic pain.

Additional information

Funding

T Wagner has received honoraria for educational lectures from Astellas Pharma Europe Ltd, Cephalon, Mundipharma, Grunenthal, Pfizer, TEVA-AWD and MSD. K-U Kern is a consultant for and received speaker fees from Astellas Pharma Europe Ltd, Eisai, Berlin Chemie, betapharm, Boehringer Ingelheim, Grünenthal, Lilly, medi Bayreuth and Sanofi Pasteur MSD. J England has received honoraria from Bristol-Myers Squibb. T Wagner, J England and K-U Kern have all undertaken QUTENZA speaker tours while A Sell and J England have both supervised live QUTENZA clinics and training events, all funded by Astellas Pharma Europe Ltd. All authors have received consultancy honoraria from Astellas Pharma Europe Ltd. Open Access was supported by Astellas Pharma Europe Ltd. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. Writing assistance was provided by Adelphi Communications Ltd, supported by Astellas Pharma Europe Ltd.