Qutenza
Learn more about various pain treatments and methods for diagnosing pain.
Treatment of neuropathic pain with Qutenza (R).
What is nerve pain?
Nerve pain, so-called neuropathic pain, is a type of pain with characteristic symptoms based on damage to nerve structures. In addition to these, there are also so-called nociceptive and nociplastic pains.
How is neuropathic pain treated?
There are various therapeutic options for the treatment of nerve pain. Medicinal treatments always represent a symptom-relieving option. Medications used for nerve pain are called antineuropathic co-analgesics. In addition to the indication in suspected neuropathic pain, the expected benefit and side effects must be weighed. Almost all antineuropathics are used “off-label.” This means that they were not developed specifically for nerve pain. In addition to tricyclic antidepressants, selective serotonin and norepinephrine reuptake inhibitors, and antiepileptics, capsaicin is also available as a treatment option.
What is capsaicin and how is it applied?
Capsaicin is a natural substance found in chili peppers and certain types of paprika, responsible for their pungency.
In addition to creams in low concentrations of 0.025% to 0.075%, capsaicin is also available as #Qutenza(R) (capsaicin 8%) in the form of a transdermal patch. The application is local via the skin. It is used in particular for postherpetic neuralgia, but is an option for all neuropathic pains.
How does Qutenza(R) work?
Capsaicin works by activating the TRPV1 receptors on the free nerve endings (nociceptors) in the skin. This activation initially leads to increased pain sensitivity, followed by depletion of the neuropeptide substance P, which is responsible for transmitting pain signals. As a result, pain sensitivity in the application area decreases. The cutaneous nerve endings degenerate. One could speak of chemical denervation.
How long does one application work?
Studies show that the effect of Qutenza can last for several months, making it an interesting option for long-term therapy. According to the latest studies, even if there is no initial effect, a gradual response may occur after repeated application.
How is the application performed?
Qutenza is applied in a doctor’s office. Application at home by patients is not possible. 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.
What side effects can be expected?
The most common side effects are local skin reactions, such as redness, itching, and pain in the application area. These subside within 1–3 days. Serious systemic side effects are very rare. Only a capsaicin allergy and open skin lesions represent contraindications.
Conclusion
Qutenza represents an effective treatment option for patients with neuropathic pain. The possibility of long-term pain reduction makes it a valuable addition to pain management. In Switzerland, the only limitation is cost coverage, as cost approval and prior unsuccessful treatments are required. This is not the case in other European countries.
LITERATURE
- 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
