Bauchy Fanny, Mouraux Andre, Deumens Ronald, Leerink Marjolein, Ulpiano Trillig Antonio, le Polain de Waroux Bernard, Steyaert Arnaud, Joëlle Quetin-Leclercq, Forget Patrice
Department of Anesthesiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
Institute of NeuroScience, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
Pain Res Manag. 2016;2016:9703036. doi: 10.1155/2016/9703036. Epub 2016 Dec 27.
Capsaicin, one of several capsaicinoid compounds, is a potent TRPV1 agonist. Topical application at high concentration (high concentration, >1%) induces a reversible disappearance of epidermal free nerve endings and is used to treat peripheral neuropathic pain (PNP). While the benefit of low-concentration capsaicin remains controversial, the 8%-capsaicin patch (Qutenza®, 2010, Astellas, Netherlands) has shown its effectiveness. This patch is, however, costly and natural high-concentration capsaicinoid solutions may represent a cheaper alternative to pure capsaicin. In this retrospective study, 149 patients were screened, 132 were included with a diagnosis of neuropathic pain, and eighty-four were retained in the final analyses (median age: 57.5 years [IQR25-75: 44.7-67.1], male/female: 30/54) with PNP who were treated with topical applications of natural high-concentration capsaicinoid solutions (total number of applications: 137). Indications were postsurgical PNP (85.7%) and nonsurgical PNP (14.3%) (posttraumatic, HIV-related, postherpetic, and radicular PNP). To assess the feasibility of topical applications of natural high-concentration capsaicinoid solutions for the treatment of PNP. The median treated area was 250 cm [IQR25-75: 144-531]. The median amount of capsaicinoids was 55.1 mg [IQR25-75: 28.7-76.5] per plaster and the median concentration was 172.3 g/cm [IQR25-75: 127.6-255.2]. Most patients had local adverse effects on the day of treatment, such as mild to moderate burning pain and erythema. 13.6-19.4% of the patients experienced severe pain or erythema. Following treatment, 62.5% of patients reported a lower pain intensity or a smaller pain surface, and 35% reported a sustained pain relief lasting for at least 4 weeks. Analgesic topical treatment with natural high-concentration capsaicinoid is feasible and may represent a low cost alternative to alleviate PNP in clinical practice.
辣椒素是几种辣椒素类化合物之一，是一种有效的瞬时受体电位香草酸亚型1（TRPV1）激动剂。高浓度（>1%）局部应用可导致表皮游离神经末梢可逆性消失，用于治疗周围神经病理性疼痛（PNP）。虽然低浓度辣椒素的益处仍存在争议，但8%辣椒素贴片（Qutenza®，2010年，阿斯利康，荷兰）已显示出其有效性。然而，这种贴片成本高昂，天然高浓度辣椒素类溶液可能是纯辣椒素更便宜的替代品。在这项回顾性研究中，筛查了149例患者，其中132例被纳入诊断为神经病理性疼痛，84例被纳入最终分析（中位年龄：57.5岁[四分位间距25%-75%：44.7-67.1]，男/女：30/54），这些患有PNP的患者接受了天然高浓度辣椒素类溶液的局部应用治疗（应用总数：137次）。适应症为术后PNP（85.7%）和非手术性PNP（14.3%）（创伤后、HIV相关、疱疹后和神经根性PNP）。评估天然高浓度辣椒素类溶液局部应用治疗PNP的可行性。中位治疗面积为250平方厘米[四分位间距25%-75%：144-531]。每贴辣椒素类的中位用量为55.1毫克[四分位间距25%-75%：28.7-76.5]，中位浓度为172.3克/平方厘米[四分位间距25%-75%：127.6-255.2]。大多数患者在治疗当天出现局部不良反应，如轻度至中度灼痛和红斑。13.6%-19.4%的患者经历了严重疼痛或红斑。治疗后，62.5%的患者报告疼痛强度降低或疼痛面积减小，35%的患者报告持续疼痛缓解至少4周。天然高浓度辣椒素类的镇痛局部治疗是可行的，可能是临床实践中缓解PNP的低成本替代方法。
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