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8 Articles in this Series
Introduction
8% Capsaicin Patch Effective for Post-surgery and Phantom Limb Pain
Fibromyalgia Pain Reduced by Low-dose Naltrexone
Helping to Improve Pain Care in Hospice Patients
Patient Selection Key to Spinal Cord Stimulation Success
Patients at High Risk for Substance Abuse Benefit from Combined Therapy
Prolotherapy Benefits Patients With Scoliosis
Scheduled Screens Increased Compliance
Web Tool Helps Management of Neuropathic Pain

8% Capsaicin Patch Effective for Post-surgery and Phantom Limb Pain

The use of 8% capsaicin patch may be beneficial in managing short-, medium-, and long-term pain in patients with post-radiation/post-surgical neuralgias, as well as those with chronic phantom limb pain, according to 2 case reports, presented by Benjamin Moses, MD, et al, from the US Army in Texas.1,2

The first case involved a 66-year-old woman who presented with a history of Stage 3 breast cancer.1 In September 2001, she underwent bilateral mastectomies and had radiation treatment, followed by resection of 2 left ribs (recurrence suspected). The patient developed radiation plexitis and chronic pain near her surgical scars. Over several years, the patient responded moderately to steroid/anesthetic injections and botulinum toxin A (Botox). Oral analgesics were prescribed, but the patient disliked the side effects. At presentation, the patient reported 6 out of 10 on the pain scale and was taking 1 to 2 acetaminophen and hydrocodone (Vicodin), but requested to be tapered off the opioid.

After initial pretreatment with 5% lidocaine ointment, the patient was treated with two 8% capsaicin patches applied for one-60 minute session. The patient reported significant reduction in pain (1/10 on the pain scale), with results lasting 6 weeks. A second and third application were subsequently administered, the second being done with 2.5% lidocaine and 2.5% prilocaine cream (EMLA cream), which demonstrated no improvement in functionality or pain, and the third again involving 5% lidocaine ointment, which was similar in effect to the first application.

The second case involved a 24-year-old soldier with phantom limb syndrome resulting from amputation of both legs.2 The patient presented with severe burning phantom pain (6/10 on the pain scale) echoing the fire that burned his legs and feet. Unable to tolerate prosthesis and not receiving adequate pain management from acupuncture and botulinum toxin A (Botox), the patient was taking up to 70 mg oxycodone (OxyContin) and transdermal clonidine for pain management.

Treatment included an initial application of 5% lidocaine ointment, followed by the 60-minute application of two 8% capsaicin patches on the distal ends of both residual limbs. After 6 weeks, the patient reported 2 out of 10 on the pain scale, 50% reduction in acetaminophen and oxycodone (Percocet) use, improved sleep duration, and can now tolerate use of a prostheses.

Treatment with an 8% capsaicin patch for patients with post-radiation/post-surgical neuralgias and for those with chronic phantom limb pain may be beneficial for pain management; however, further study is needed, noted the investigator.

References

  1. Moses BA, Brewer DB, Panula TL, Goff BJ. Eight percent capsaicin patch (Qutenza) for chronic post-mastectomy pain. Pain Med. 2012;13(2):Abstract 231.
  2. Moses BA, Brewer DB, Panula TL, Goff BJ. Eight percent capsaicin patch (Qutenza) for chronic phantom limb pain. Pain Med. 2012;13(2):Abstract 232.
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