Session Information
Title: Fibromyalgia, Soft Tissue Disorders, Regional and Specific Clinical Pain Syndromes: Clinical Focus
Session Type: Abstract Submissions (ACR)
Background/Purpose: Carpal tunnel syndrome (CTS) is a clinical syndrome manifested by signs and symptoms of irritation of the median nerve at the level of the carpal tunnel in the wrist. CTS is the most frequent pressure neuropathy. The conservative treatments for chronic neuropathic pain that currently exist are only moderately effectively. Oral pharmaceuticals for neuropathic pain have significant side effects, and treatment efficacy tends to be modest. The use of topical analgesics allows direct application of medications to the area of pain. Capsaicin causes a brief initial sensitization followed by a prolonged desensitization of the local pain nerves. This occurs through stimulation of the transient receptor potential vanilloid-1 (TRPV1) expressing pain nerve fibers. Capsaicin dermal is an adhesive patch containing a high concentration (8 %) of synthetic capsaicin. It has not been studied yet in patients with CTS.
Methods: The patients with clinically and electrophysiologically confirmed CTS, indicated for the treatment of highly concentrated capsaicin 8% patch due to neuropathic pain, were included in the study. The aim of the study was to determine the proportion of patients who achieve at least a 30% reduction in pain intensity on the Numeric Pain Rating Scale (NPRS) compared with baseline. There were also observed absolute and percentage decline in the scale of NPRS and prior and concomitant medications. Patients were monitored in four visits – before treatment of capsaicin patch and after 3, 6 and 12 months of application. On all visits were evaluated clinical status, monitored the intensity of pain and quality of life. The intensity of pain was evaluated using a range of intensity of pain – NPRS. Quality of life was assessed using the EQ-5D questionnaire.
Results: Altogether, 30 patients (four male) with symptomatic CTS were included in this study between April 2012 and April 2014. Capsaicin dermal patch reduced NPRS scores from baseline 6.3 points to 4.3 points after 3 months treatment (p< 0.001). 71 % of patients experienced at least a 30% reduction of pain intensity measured with NPRS score, 64 % of patients had at least a 50% reduction of pain intensity. The quality of life assessed by EQ-5D questionnaire improved significantly from 0.51 to 0.69 (three months after patch administration, p< 0.001). The consumption of concomitant medication decreased from 81% of patients at baseline to 52% after 3 months. Pain intensity decreased and EQ-5D questionnaire improved significantly gradually during the visits after 6 and 12 months. NPRS scores decreased after 12 months to 3.4 points. Capsaicin dermal patch was well tolerated. The most common adverse events were transient, mostly mild, application reaction in 8% of patients.
Conclusion: Capsaicin in the form of 8% dermal patch is a new treatment for peripheral neuropathic pain in patients with CTS. This study showed a high therapeutic efficacy, excellent tolerability and a significant improvement in quality of life, persisting for 12 months after administration.
Acknowledgement: This work was supported by the project MH for consensual development of research organization 023728.
Disclosure:
O. Sleglova,
None;
M. Hakl,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/clinical-efficacy-of-the-high-concentration-capsaicin-patch-for-the-treatment-of-carpal-tunnel-syndrome/