Presented at the 2012 AAPM Annual Meeting « Back

Eight Percent Capsaicin Patch (Qutenza) for Chronic Phantom Limb 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: The 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 24-year-old active duty soldier with a several-year history of functionally limiting phantom limb syndrome following traumatic amputation of both legs presented for treatment of pain described as severe, burning phantom pain that mimicked the combat-related fire that severely burned his feet/legs. The patient reported constant 6/10 pain and required up to 70 mg of oxycodone and transdermal clonidine for relief. Botox and acupuncture provided no pain relief. He was unable to tolerate prostheses. Materials and Methods: He was treated in clinic with two 8% capsaicin patches applied to the distal end of both residual limbs for 60 minutes, after initial application of 5% lidocaine ointment. Results: At his 6-week follow-up appointment, he reported reduction of pain to 2/10 as well as a 50% reduction in Percocet use. This patient reported that the treatment gave him his life back. He was able to tolerate prostheses and sleep duration improved. Conclusions: This case demonstrated the potential remarkable decrease in reported pain scores as well as significant gains in functional improvement and decreased opioid use with this treatment. 8% capsaicin patch treatment for neuralgias not related to herpetic infection may successfully render improved or complete short-, medium-, and long-term pain control in select patients, 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