- Email: [email protected]
F255 REDUCTION IN CONCOMITANT NEUROPATHIC PAIN (NP) MEDICATION USE AFTER TREATMENT WITH THE CAPSAICIN 8% PATCH: A RETROSPECTIVE ANALYSIS
140
POSTER SESSIONS / European Journal of Pain Supplements 5 (2011) 15–295
8% patch application for 30 minutes to the feet (n = 5 for each of PT and NPT) or 60 minutes to other parts of the body. Pain pre- and post-treatment was assessed using the Visual Analogue Scale (VAS). Results: One hour after the initiation of capsaicin 8% treatment, 16 PT patients had an increase in VAS from baseline, one patient reported no change and eight patients reported a decrease. Of the NPT patients, 18 reported an increase in VAS from baseline, seven reported no change and one reported a decrease. For those patients with an increase in VAS after capsaicin 8% patch treatment, the mean increase was 4.3 (range, 1–9) for PT patients and 3.1 (range, 1–6) for NPT patients. More PT patients had a large increase in VAS (increase of >5) than NPT patients (4 patients vs 1 patient, respectively). All patients completed the intended treatment duration. Conclusions: Observations suggest that capsaicin 8% patch treatment without topical anaesthetic pre-treatment is tolerable and does not result in patients reporting a greater increase in VAS score compared with PT patients. Further studies are warranted. Disclosure: The first author is consultant for and received speaker fees from Astellas Pharma Europe Ltd. The second author does not have any to report.
F254 IS WIND-DOWN OF NEUROPATHIC PAIN POSSIBLE WITH REPEATED CAPSAICIN 8% PATCH (QUTENZA™) TREATMENTS? K.-U. Kern *, W. Nowack. Pain Center and Palliative Center Wiesbaden, Wiesbaden, Germany Background and Aims: Hyperexcitability within the central nervous system from repeated stimulation of peripheral C fibresknown as wind-up-is one mechanism behind neuropathic pain (NP). Reduction of C fibre signalling after treatment with the capsaicin 8% patch may reduce wind-up, potentially leading to an overall wind-down of pain. We present patient cases with evidence of NP wind-down following capsaicin patch treatment. Methods: Patients received capsaicin patch treatment for 1 hour. Pain scores were recorded using the Visual Analogue Scale (VAS) before treatment, at Weeks 4 and 12 and before each re-treatment. Results: A 67-year-old female patient with post-herpetic neuralgia (Patient A) and a 53-year-old male patient with polyneuropathy (Patient B) received capsaicin patch treatment, followed by one or two re-treatments. Both patients responded to each capsaicin patch treatment with a reduction in NP. Pain subsequently returned after each treatment but to a lower level, as assessed by average pain experienced over a one-week period. Patient A’s VAS score was 8 before first capsaicin patch treatment and 6 prior to first and second re-treatments (17 and 25 weeks after initial treatment and first re-treatment, respectively). Patient B’s VAS score was 7 before initial treatment and 6 before re-treatment (13 weeks after initial treatment). At 12 weeks after re-treatment Patient B’s VAS score was 4. Conclusions: Repeated treatment of patients with the capsaicin 8% patch may result in an overall wind-down of pain in some patients. Further research is required to establish whether capsaicin patch treatment can lead to NP resolution. Disclosure: The first author is consultant for and received speaker fees from Astellas Pharma Europe Ltd. The second author does not have anything to declare.
F255 REDUCTION IN CONCOMITANT NEUROPATHIC PAIN (NP) MEDICATION USE AFTER TREATMENT WITH THE CAPSAICIN 8% PATCH: A RETROSPECTIVE ANALYSIS T. Wagner1 *, A. Roth-Daniek1 , C. Poole2 . 1 Klinik fuer Schmerztherapie und Palliativmedizin, Medizinisches Zentrum Staedteregion Aachen, Wuerselen, Germany; 2 Department of Primary Care & Public Health, Cardiff University, Cardiff, UK Background and Aims: Trials have demonstrated that a single application of the capsaicin 8% patch (QUTENZA™) provides NP relief for 3 months. According to the protocols, responding patients had to remain on constant doses of NP co-medications, which would not be the case in clinical practice. We investigated changes in concomitant NP medication use following treatment with the capsaicin patch at a clinic in Germany. Methods: The analysis included all patients treated with the capsaicin patch between 11 March 2010 and 7 February 2011. Pain medication use was assessed on the day of treatment and at Week 8. Pain was assessed using the Numerical Pain Rating Scale (NPRS) on the day of treatment and at Weeks 1, 4 and 8. Results: Of 53 patients eligible for analysis, 37 (69.8%) achieved ≥30% reduction in NPRS score from baseline to Weeks 1–8. There was a 44% reduction in the mean number of concomitant NP medications taken following capsaicin patch treatment (1.38 medications at baseline vs 0.77 medications post-treatment; p < 0.001). Of patients receiving opioids (n = 26), anticonvulsants (n = 26) or antidepressants (n = 21) before capsaicin patch treatment, 11 (42%), 13 (50%) and 10 (48%), respectively, discontinued this medication and 6 (23%), 5 (19%) and 3 (14%), respectively, reduced their daily dosage after capsaicin treatment. Only two patients increased the number of NP medications being taken following treatment. Conclusions: In a real-life clinical setting, treatment with the capsaicin 8% patch results in a statistically and clinically significant reduction in the requirement for concomitant NP medications. Disclosure: T. Wagner has received speaker and consultancy fees from Astellas Pharma Europe Ltd. A. Roth-Daniek has received consultancy fees from Astellas Pharma Europe Ltd. C. Poole is a research consultant/analyst for Astellas.
F256 SUITABILITY OF THE CAPSAICIN 8% PATCH FOR THE TREATMENT OF A RANGE OF NEUROPATHIC PAIN (NP) CONDITIONS T. Wagner1 *, A. Roth-Daniek1 , C. Poole2 . 1 Klinik fuer Schmerztherapie und Palliativmedizin, Medizinisches Zentrum Staedteregion Aachen, Wuerselen, Germany; 2 Department of Primary Care & Public Health, Cardiff University, Cardiff, UK Background and Aims: Clinical trials demonstrated the efficacy of the capsaicin 8% patch (QUTENZA™) for the treatment of NP in two distinct patient populations; post-herpetic neuralgia (PHN) and HIV-distal sensory polyneuropathy, leading to its broad indication for the treatment of peripheral NP in non-diabetic adults. This retrospective analysis describes capsaicin patch efficacy in various NP conditions in a clinical setting. Methods: Patients received capsaicin patch treatment for 30 minutes on the feet and 60 minutes on other body sites. Pain was assessed using the Numerical Pain Rating Scale (NPRS) on treatment day and at Weeks 1, 4 and 8. Results: Fifty three patients with peripheral neuropathy (postsurgical or post-traumatic nerve injuries and mononeuropathies), PHN, failed back surgery syndrome (FBSS)/radiculopathy, polyneuropathy or neuropathy of the face received treatment and completed 8-week follow-up. Patients’ average age was 59.8 years and median duration of primary diagnosis was 25 months. The mean reduction in NPRS score from baseline to Weeks 1–8 in all patients was 48.4% (standard deviation, 38.5); responses to treatment by NP condition are summarised in the Table.
POSTER SESSIONS / European Journal of Pain Supplements 5 (2011) 15–295
8% patch application for 30 minutes to the feet (n = 5 for each of PT and NPT) or 60 minutes to other parts of the body. Pain pre- and post-treatment was assessed using the Visual Analogue Scale (VAS). Results: One hour after the initiation of capsaicin 8% treatment, 16 PT patients had an increase in VAS from baseline, one patient reported no change and eight patients reported a decrease. Of the NPT patients, 18 reported an increase in VAS from baseline, seven reported no change and one reported a decrease. For those patients with an increase in VAS after capsaicin 8% patch treatment, the mean increase was 4.3 (range, 1–9) for PT patients and 3.1 (range, 1–6) for NPT patients. More PT patients had a large increase in VAS (increase of >5) than NPT patients (4 patients vs 1 patient, respectively). All patients completed the intended treatment duration. Conclusions: Observations suggest that capsaicin 8% patch treatment without topical anaesthetic pre-treatment is tolerable and does not result in patients reporting a greater increase in VAS score compared with PT patients. Further studies are warranted. Disclosure: The first author is consultant for and received speaker fees from Astellas Pharma Europe Ltd. The second author does not have any to report.
F254 IS WIND-DOWN OF NEUROPATHIC PAIN POSSIBLE WITH REPEATED CAPSAICIN 8% PATCH (QUTENZA™) TREATMENTS? K.-U. Kern *, W. Nowack. Pain Center and Palliative Center Wiesbaden, Wiesbaden, Germany Background and Aims: Hyperexcitability within the central nervous system from repeated stimulation of peripheral C fibresknown as wind-up-is one mechanism behind neuropathic pain (NP). Reduction of C fibre signalling after treatment with the capsaicin 8% patch may reduce wind-up, potentially leading to an overall wind-down of pain. We present patient cases with evidence of NP wind-down following capsaicin patch treatment. Methods: Patients received capsaicin patch treatment for 1 hour. Pain scores were recorded using the Visual Analogue Scale (VAS) before treatment, at Weeks 4 and 12 and before each re-treatment. Results: A 67-year-old female patient with post-herpetic neuralgia (Patient A) and a 53-year-old male patient with polyneuropathy (Patient B) received capsaicin patch treatment, followed by one or two re-treatments. Both patients responded to each capsaicin patch treatment with a reduction in NP. Pain subsequently returned after each treatment but to a lower level, as assessed by average pain experienced over a one-week period. Patient A’s VAS score was 8 before first capsaicin patch treatment and 6 prior to first and second re-treatments (17 and 25 weeks after initial treatment and first re-treatment, respectively). Patient B’s VAS score was 7 before initial treatment and 6 before re-treatment (13 weeks after initial treatment). At 12 weeks after re-treatment Patient B’s VAS score was 4. Conclusions: Repeated treatment of patients with the capsaicin 8% patch may result in an overall wind-down of pain in some patients. Further research is required to establish whether capsaicin patch treatment can lead to NP resolution. Disclosure: The first author is consultant for and received speaker fees from Astellas Pharma Europe Ltd. The second author does not have anything to declare.
F255 REDUCTION IN CONCOMITANT NEUROPATHIC PAIN (NP) MEDICATION USE AFTER TREATMENT WITH THE CAPSAICIN 8% PATCH: A RETROSPECTIVE ANALYSIS T. Wagner1 *, A. Roth-Daniek1 , C. Poole2 . 1 Klinik fuer Schmerztherapie und Palliativmedizin, Medizinisches Zentrum Staedteregion Aachen, Wuerselen, Germany; 2 Department of Primary Care & Public Health, Cardiff University, Cardiff, UK Background and Aims: Trials have demonstrated that a single application of the capsaicin 8% patch (QUTENZA™) provides NP relief for 3 months. According to the protocols, responding patients had to remain on constant doses of NP co-medications, which would not be the case in clinical practice. We investigated changes in concomitant NP medication use following treatment with the capsaicin patch at a clinic in Germany. Methods: The analysis included all patients treated with the capsaicin patch between 11 March 2010 and 7 February 2011. Pain medication use was assessed on the day of treatment and at Week 8. Pain was assessed using the Numerical Pain Rating Scale (NPRS) on the day of treatment and at Weeks 1, 4 and 8. Results: Of 53 patients eligible for analysis, 37 (69.8%) achieved ≥30% reduction in NPRS score from baseline to Weeks 1–8. There was a 44% reduction in the mean number of concomitant NP medications taken following capsaicin patch treatment (1.38 medications at baseline vs 0.77 medications post-treatment; p < 0.001). Of patients receiving opioids (n = 26), anticonvulsants (n = 26) or antidepressants (n = 21) before capsaicin patch treatment, 11 (42%), 13 (50%) and 10 (48%), respectively, discontinued this medication and 6 (23%), 5 (19%) and 3 (14%), respectively, reduced their daily dosage after capsaicin treatment. Only two patients increased the number of NP medications being taken following treatment. Conclusions: In a real-life clinical setting, treatment with the capsaicin 8% patch results in a statistically and clinically significant reduction in the requirement for concomitant NP medications. Disclosure: T. Wagner has received speaker and consultancy fees from Astellas Pharma Europe Ltd. A. Roth-Daniek has received consultancy fees from Astellas Pharma Europe Ltd. C. Poole is a research consultant/analyst for Astellas.
F256 SUITABILITY OF THE CAPSAICIN 8% PATCH FOR THE TREATMENT OF A RANGE OF NEUROPATHIC PAIN (NP) CONDITIONS T. Wagner1 *, A. Roth-Daniek1 , C. Poole2 . 1 Klinik fuer Schmerztherapie und Palliativmedizin, Medizinisches Zentrum Staedteregion Aachen, Wuerselen, Germany; 2 Department of Primary Care & Public Health, Cardiff University, Cardiff, UK Background and Aims: Clinical trials demonstrated the efficacy of the capsaicin 8% patch (QUTENZA™) for the treatment of NP in two distinct patient populations; post-herpetic neuralgia (PHN) and HIV-distal sensory polyneuropathy, leading to its broad indication for the treatment of peripheral NP in non-diabetic adults. This retrospective analysis describes capsaicin patch efficacy in various NP conditions in a clinical setting. Methods: Patients received capsaicin patch treatment for 30 minutes on the feet and 60 minutes on other body sites. Pain was assessed using the Numerical Pain Rating Scale (NPRS) on treatment day and at Weeks 1, 4 and 8. Results: Fifty three patients with peripheral neuropathy (postsurgical or post-traumatic nerve injuries and mononeuropathies), PHN, failed back surgery syndrome (FBSS)/radiculopathy, polyneuropathy or neuropathy of the face received treatment and completed 8-week follow-up. Patients’ average age was 59.8 years and median duration of primary diagnosis was 25 months. The mean reduction in NPRS score from baseline to Weeks 1–8 in all patients was 48.4% (standard deviation, 38.5); responses to treatment by NP condition are summarised in the Table.