Hot Topic: Treatment of neuropathic pain with #chili
Nerve pain, known as neuropathic pain, is a type of pain characterized by specific symptoms that stem from damage to nerve structures.
Various therapeutic options are available for the treatment of neuropathic pain. Medicinal treatments are always a symptom-relieving option. Medications used for nerve pain are called antineuropathic co-analgesics. In addition to assessing the indication for suspected neuropathic pain, the expected benefits and side effects must be weighed. Almost all antineuropathic drugs are used ‘off-label.’ In addition to tricyclic antidepressants, selective serotonin and norepinephrine reuptake inhibitors, and antiepileptic drugs, capsaicin is also available as a treatment option.
Capsaicin can be applied not only as creams in low concentrations of 0.025% to 0.075% but also as #Qutenza (capsaicin 8%), a transdermal patch. It is particularly used for postherpetic neuralgia but is an option for all types of neuropathic pain.
Capsaicin works by activating TRPV1 receptors in the free cutaneous nerve endings (nociceptors). This activation initially leads to increased pain sensitivity, followed by depletion of the neuropeptide substance P, which is responsible for transmitting pain signals. Consequently, pain sensitivity in the application area is reduced, and the cutaneous nerve endings degenerate. This could be described as a #chemical denervation. Studies show that the effects of Qutenza can last for several months, making it an interesting option for long-term therapy (Dworkin et al., 2010; Backonja et al., 2014). According to recent study data (Freynhagen et al., 2021), even initial non-responders show progressive improvement with repeated applications.
Qutenza is applied in a medical office. Before application, the skin is cleaned. The application duration is 30-60 minutes. The procedure may be accompanied by temporary burning or stinging, which is considered a normal sign of its effect (Tzeng et al., 2015).
The most common side effects include local skin reactions such as redness, itching, and pain at the application site, which typically subside within 1-3 days. Severe systemic side effects are very rare. Only a capsaicin allergy and open skin lesions represent contraindications.
#Qutenza is an effective treatment option for patients with neuropathic pain. The potential for long-term pain reduction makes it a valuable addition to pain management. The only limitation in Switzerland is insurance coverage, as it requires cost-sharing and prior unsuccessful treatments. This is not the case in other European countries.
- Dworkin, R. H., et al. (2010). “Pharmacologic Management of Acute Pain in Patients with Neuropathic Pain.” Pain Management.
- Backonja, M. et al. (2014). “Safety and Efficacy of Qutenza in Patients with Postherpetic Neuralgia: A Randomized, Controlled Trial.” Pain.
- Tzeng, J. I., et al. (2015). “Capsaicin for the Treatment of Neuropathic Pain.” Cochrane Database of Systematic Reviews.
- AAS (2020). “Qutenza: Guidelines for Use in Clinical Practice.”
- Katz, J., et al. (2017). "Long-term Efficacy and Safety of Qutenza." The Clinical Journal of Pain.
- Freynhagen et al. (2021) Progressive Response to Repeat Application of Capsaicin 179 mg (8% w/w) Cutaneous Patch in Peripheral Neuropathic Pain: Comprehensive New Analysis and Clinical Implications’ Pain Medicine, 22(10), 2021, 2324–2336
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