Presented at the 2012 AAPM Annual Meeting « Back

Eight Percent Capsaicin Patch (Qutenza) for Chronic Post-Mastectomy Pain

Benjamin A. Moses, MD, benjamin.moses@amedd.army.mil¹, Daniel B. Brewer, MD², Tanya L. Panula, RN-BC³, Brandon J. Goff, DO¹, (1) U.S. Army, San Antonio, Texas, (2) Brooke Army Medical Center, San Antonio, Texas, (3) U.S. Army, Adkins, Texas

Introduction/Statement/Problem: An 8% capsaicin patch is FDA approved and used for treatment of postherpetic neuralgia, but has not been extensively studied in the United States in non-HSV-related neuralgias. A 66-year-old woman with a history of Stage 3 breast cancer underwent bilateral mastectomies in September 2001, followed by extensive radiation and subsequent resection of two left ribs for suspicion of recurrence. She suffered chronic pain over the surgical scars, and radiation plexitis, responding only partially to Botox and steroid/anesthetic injections over many years. Oral analgesics to include opioids, NSAIDSs, benzodiazepines, and gabapentin were used, but the patient was unhappy with side effects. At presentation, she was taking one to two Vicodin daily for reported 6/10 pain, and requesting to taper off. Materials and Methods: Treated in clinic with two 8% capsaicin patches applied to the skin of her left axilla and left upper back for 60 minutes, after initial application of 5% lidocaine ointment. Results: At follow-up she reported 1/10 pain with total resolution of functional limitations, lasting 6 weeks. A second application done with EMLA cream yielded no improvement in pain or functionality. The third application, again performed with 5% lidocaine ointment, yielded results similar to the first application but were sustained at 2-month follow-up. Conclusions: 8% capsaicin patch treatment for post-radiation/post-surgical neuralgias not related to herpetic infection may successfully render complete short-, medium-, and long-term pain control and warrants further study. References: 1)Bernstein JE, Bickers DR, Dahl MV, Roshal JY. Treatment of chronic postherpetic neuralgia with topical capsaicin. J Am Acad Dermatol. 1987 Jul;17(1):93-6. 2)Mason L, Moore RA, Derry S, Edwards JE, McQuay HJ. Systematic review of topical capsaicin for the treatment of chronic pain. BMJ. 2004 Apr 24;328(7446):991. 3)Simpson DM, Gazda S, Brown S, Webster LR, Lu SP, Tobias JK, Vanhove GF; NGX-4010 C118 Study Group. Long-term safety of NGW-4010, a high-concentration capsaicin patch, in patients with peripheral neuropathic pain. J Pain Symptom Manage. 2010 Jun;39(6):1053

Funding: None