PainRelief.com Interview with:
Kai-Uwe Kern MD, PhD
Institute of Pain Medicine/Pain Practice
Wiesbaden, Germany
PainRelief.com: What is the background for this study?
Response: In recent studies a progressive response to high-concentration capsaicin patch (HCCP) with repeated treatment was observed, meaning that patients with insufficient pain relief after the first application of HCCP, still may respond to a second, third, or even fourth application. Based on these latest findings, and also on my personal clinical experience, we aimed to systematically analyse the pool of patients in my Pain Practice with at least two HCCP treatments.
PainRelief.com: What are the main findings?
Response: Most patients underwent high-concentration capsaicin patch treatment for neuropathic back pain, along with post-operative or post-traumatic neuropathic pain. We observed a significant reduction in opioid treatment among patients with at least two HCCP applications and an important improvement in pain intensity in two-thirds of patients. Notable, this improvement was more pronounced in patients, who received multiple HCCP applications compared to those with exactly two applications.
PainRelief.com: What should readers take away from your report?
Response: Patients with different pain etiologies of neuropathic pain seem to benefit from repeated high-concentration capsaicin patch applications. When patients treated with high-concentration capsaicin patch for neuropathic pain do not respond after the first application, physicians should be aware of the potential for positive outcomes with subsequent applications. Discussing the possibility of repeated treatments with patients at the start of therapy can play an important role in managing their expectations and enable them to take full advantage of the therapeutic potential of HCCP.
Additional to the progressive response, there is also promising evidence suggesting a potential reduction in the need for concomitant opioid use with HCCP therapy. This reduction not only offers patients relief from the burden of potential side effects associated with opioids but also aligns with broader efforts to minimize the risk of misuse and dependency.
PainRelief.com: What recommendations do you have for future research as a result of this study?
Response: While our study has provided valuable insights, it is important to acknowledge its limitations due to its retrospective and single-institutional study design. To advance our understanding, a prospective and systematically collection of important variables like pain intensity and sleep quality, as well as broader aspects of health-related quality of life, is needed. Conducting such research in multiple pain practices with a more diverse patient pool would provide a richer data set. In addition, taking into account other covariates such as alternative therapies would facilitate the use of advanced analytical methods, leading to a more comprehensive interpretation of the results.
We are further interested, inter alia, in the question how many applications of HCCP -whether it is three, four, or more – still result in a reduction in pain or a decrease in concomitant medication usage.
More from a practical point of view we discussed in our study team the question how to support physicians in collecting (as systematically as possible) patient-related outcomes to assess not only pain intensity, but also functional status, quality of life and treatment satisfaction related to HCCP treatment with no or little additional documentation effort. This holistic approach could provide a comprehensive understanding of the overall impact of HCCP treatment on patient well-being.
Further research should investigate the influence of specific patient characteristics, such as age, gender, underlying health conditions, pain phenotype and pain aetiology, on the (early or delayed) response to HCCP treatment. This could facilitate personalised treatment approaches tailored to individual patient needs and factors that may influence treatment outcomes.
Disclosures: The study was financially supported by Grünenthal GmbH, Aachen, Germany.
Citation: Kern KU, Quandel T, Theis S, Schubert T. Characteristics and outcomes of peripheral neuropathic pain patients with repeated applications of high-concentration capsaicin cutaneous patch: Results of a retrospective chart review in Germany. Pain Pract. 2024 Feb 7. doi: 10.1111/papr.13345. Epub ahead of print. PMID: 38321913.
https://pubmed.ncbi.nlm.nih.gov/38321913/
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Last Updated on February 16, 2024 by PainRelief.com