Zis Panagiotis, Apsokardos Alexandros, Isaia Christina, Sykioti Panagiota, Vadalouca Athina
Department of Neurology, Evangelismos General Hospital, Athens, Greece; and Pain Relief Clinic, Athens Medical Center, Greece.
Pain Physician. 2014 Mar-Apr;17(2):E213-8.
Capsaicin 8% patch (Qutenza) is mainly used to treat postherpetic neuralgia and human immunodeficiency virus-associated neuropathy. However, evidence of the efficacy of Qutenza in other forms of neuropathic pain is lacking. A 24-year old Libyan man, with no previous medical history, sustained multiple wounds in the right side of the chest and back after a bomb explosion. The patient experienced pain, which persisted in a wide location around the surgical intervention for a long time, beyond the usual course of natural healing of an acute pain and was different from that suffered preoperatively. The characteristics of the pain included burning, electric shock-like sensation, tingling, and numbness, and it was paroxysmal. The pain was associated with hyperalgesia and intense allodynia in a wide area, approximately of 1,100 cm2. Our initial treatment strategy included pregabalin, tramadol, and duloxetine. However, our patient's pain responded to treatment with capsaicin 8% patch when the initial treatments showed only minimal effectiveness regarding the intensity of pain. Interestingly, the most important finding was that capsaicin 8% patch showed a more than 80% reduction of the area of allodynia associated with the pain, when other treatments failed. Moreover, although recent data showed that in patients who respond to Qutenza, analgesia starts within a few days of treatment and lasts on average 5 months, our patient showed an initial response within 7 days of treatment but a longer duration of more than 18 months. Although further controlled studies are needed to explore the efficacy of the capsaicin 8% patch in patients who experience posttraumatic neuropathic pain, we encourage clinicians to try the capsaicin 8% patch when alternative treatments fail.
8%辣椒素贴剂（Qutenza）主要用于治疗带状疱疹后神经痛和人类免疫缺陷病毒相关性神经病变。然而，缺乏Qutenza在其他形式神经病理性疼痛中疗效的证据。一名24岁的利比亚男子，无前科病史，在炸弹爆炸后右侧胸部和背部多处受伤。患者经历了疼痛，这种疼痛在手术干预部位周围广泛区域持续了很长时间，超出了急性疼痛自然愈合的正常病程，且与术前疼痛不同。疼痛的特点包括烧灼感、电击样感觉、刺痛和麻木，呈阵发性。疼痛伴有广泛区域（约1100平方厘米）的痛觉过敏和强烈的痛觉超敏。我们最初的治疗策略包括使用普瑞巴林、曲马多和度洛西汀。然而，当最初的治疗对疼痛强度仅显示出最小效果时，我们的患者使用8%辣椒素贴剂治疗后疼痛得到缓解。有趣的是，最重要的发现是，当其他治疗无效时，8%辣椒素贴剂使与疼痛相关的痛觉超敏区域减少了80%以上。此外，尽管最近的数据显示，对Qutenza有反应的患者在治疗后几天内开始出现镇痛作用，平均持续5个月，但我们的患者在治疗7天内就出现了初始反应，且持续时间超过18个月。尽管需要进一步的对照研究来探索8%辣椒素贴剂在创伤后神经病理性疼痛患者中的疗效，但我们鼓励临床医生在替代治疗无效时尝试使用8%辣椒素贴剂。
