Pain-relieving effectiveness, quality of life and tolerability of repeated capsaicin 8% patch treatment of peripheral neuropathic pain in Scandinavian clinical practice.

P Hansson,M Strömberg,T.S Jensen,G Kvarstein

doi:10.1002/ejp.1180

Abstract

ContextClinical trials have demonstrated the efficacy and safety of the capsaicin 8% patch in patients with peripheral neuropathic pain (PNP); however, few studies have assessed this treatment in a clinical practice.ObjectiveTo determine whether treatment and re‐treatment with the capsaicin 8% patch reduce PNP intensity in clinical practice.MethodsThree non‐interventional, observational studies were concurrently conducted in Denmark, Norway and Sweden. Patients with probable or definite PNP received one or two treatments with the capsaicin 8% patch according to usual clinical practice. All analyses were performed on combined data.ResultsOverall, 382 and 181 patients received treatment and re‐treatment, respectively, with the capsaicin 8% patch. At the group level, a significant reduction in mean level of ‘usual pain’ intensity (Numerical Pain Rating Scale) over the last 24 h’ score was observed from baseline to Weeks 2 through 8 [−1.05 (95% confidence interval: −1.27, 0.82); p < 0.001] with 28% and 31% of patients reporting a ≥30% reduction in pain after first treatment and re‐treatment, respectively. Improvements in health‐related quality of life (EQ‐5D‐3L index) and overall health status (Patient Global Impression of Change) were observed early (Week 1) and throughout the treatment periods. Most application site reactions subsided within a week after treatment. Following treatment and re‐treatment, 57% and 71% of patients, respectively, were willing to undergo further treatment with the capsaicin 8% patch.ConclusionIn Scandinavian clinical practice, capsaicin 8% patch treatment was associated with significant reductions in pain intensity and was well tolerated with over half of patients willing to undergo re‐treatment.

Highlights

Neuropathic pain is defined as pain due to a lesion or disease of the somatosensory nervous system [International Association for the Study of Pain (IASP), 2012]
This study demonstrates that in Scandinavian clinical practice, the capsaicin 8% patch provided effective pain relief in a proportion of patients with peripheral neuropathic pain (PNP) and was generally well tolerated
The overall group of patients had a significant reduction in Numerical Pain Rating Scale (NPRS) ‘usual’ pain from first treatment baseline and re-treatment baseline to Weeks 2 through 8 along with clear improvements in Patient Global Impression of Change (PGIC) and health-related quality of life (HRQoL) throughout the study

Summary

Introduction

Neuropathic pain is defined as pain due to a lesion or disease of the somatosensory nervous system [International Association for the Study of Pain (IASP), 2012]. Used pharmacological treatments include antidepressants, anticonvulsants, topical lidocaine and opioids. These treatments, are limited by central nervous system adverse effects, such as somnolence and dizziness, and for the latter, the potential for drug dependence (Attal et al, 2010; Finnerup et al, 2010, 2015; Tesfaye et al, 2011; Smith et al, 2012; Gahr et al, 2013). Current evidence indicates that less than half of patients with neuropathic pain obtain sufficient pain relief with current systemic analgesics (Finnerup et al, 2010)

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