Rational treatment of chemotherapy-induced peripheral neuropathy with capsaicin 8% patch: from pain relief towards disease modification
Praveen Anand,1 Enas Elsafa,1 Rosario Privitera,1 Kalnisha Naidoo,1 Yiangos Yiangou,1 Philippe Donatien,1 Hani Gabra,2 Harpreet Wasan,2 Laura Kenny,2 Amin Rahemtulla,3 Peter Misra11Department of Neurology; 2Medical Oncology; 3Hematology, Imperial College London, Hammersmith Hospital, London W12 0NN,...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Dove Medical Press
2019-07-01
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| Series: | Journal of Pain Research |
| Subjects: | |
| Online Access: | https://www.dovepress.com/rational-treatment-of-chemotherapy-induced-peripheral-neuropathy-with--peer-reviewed-article-JPR |
| _version_ | 1819136641034354688 |
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| author | Anand P Elsafa E Privitera R Naidoo K Yiangou Y Donatien P Gabra H Wasan H Kenny L Rahemtulla A Misra P |
| author_facet | Anand P Elsafa E Privitera R Naidoo K Yiangou Y Donatien P Gabra H Wasan H Kenny L Rahemtulla A Misra P |
| author_sort | Anand P |
| collection | DOAJ |
| description | Praveen Anand,1 Enas Elsafa,1 Rosario Privitera,1 Kalnisha Naidoo,1 Yiangos Yiangou,1 Philippe Donatien,1 Hani Gabra,2 Harpreet Wasan,2 Laura Kenny,2 Amin Rahemtulla,3 Peter Misra11Department of Neurology; 2Medical Oncology; 3Hematology, Imperial College London, Hammersmith Hospital, London W12 0NN, UKPurpose: Chemotherapy-induced peripheral neuropathy (CIPN) with associated chronic pain is a common and disabling condition. Current treatments for neuropathic pain in CIPN are largely ineffective, with unfavorable side-effects. The capsaicin 8% patch (capsaicin 179 mg patch) is approved for the treatment of neuropathic pain: a single topical cutaneous application can produce effective pain relief for up to 12 weeks. We assessed the therapeutic potential of capsaicin 8% patch in patients with painful CIPN, and its mechanism of action.Patients and methods: 16 patients with chronic painful CIPN (mean duration 2.5 years), in remission for cancer and not receiving chemotherapy, were treated with 30 min application of capsaicin 8% patch to the feet. Symptoms were monitored using the 11-point numerical pain rating scale (NPRS), and questionnaires. Investigations were performed at baseline and three months after patch application, including skin biopsies with a range of markers, and quantitative sensory testing (QST).Results: Patients reported significant reduction in spontaneous pain (mean NPRS: −1.27; 95% CI 0.2409 to 2.301; p=0.02), touch-evoked pain (−1.823; p=0.03) and cold-evoked pain (−1.456; p=0.03). Short-Form McGill questionnaire showed a reduction in neuropathic (p=0.0007), continuous (p=0.01) and overall pain (p=0.004); Patient Global Impression of Change showed improvement (p=0.001). Baseline skin biopsies showed loss of intra-epidermal nerve fibers (IENF), and also of sub-epidermal nerve fibers quantified by image analysis. Post-patch application skin biopsies showed a significant increase towards normalization of intra-epidermal and sub-epidermal nerve fibers (for IENF: structural marker PGP9.5, p=0.009; heat receptor TRPV1, p=0.027; regenerating nerve marker GAP43, p=0.04). Epidermal levels of Nerve Growth Factor (NGF), Neurotrophin-3 (NT-3), and Langerhans cells were also normalized. QST remained unchanged and there were no systemic side-effects, as in previous studies.Conclusion: Capsaicin 8% patch provides significant pain relief in CIPN, and may lead to regeneration and restoration of sensory nerve fibers ie, disease modification.Keywords: capsaicin, neuropathic pain, chemotherapy, skin biopsy |
| first_indexed | 2024-12-22T10:38:12Z |
| format | Article |
| id | doaj.art-86dacd5f3dcc4bbe9e33697649cfe941 |
| institution | Directory Open Access Journal |
| issn | 1178-7090 |
| language | English |
| last_indexed | 2024-12-22T10:38:12Z |
| publishDate | 2019-07-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Journal of Pain Research |
| spelling | doaj.art-86dacd5f3dcc4bbe9e33697649cfe9412022-12-21T18:29:06ZengDove Medical PressJournal of Pain Research1178-70902019-07-01Volume 122039205246820Rational treatment of chemotherapy-induced peripheral neuropathy with capsaicin 8% patch: from pain relief towards disease modificationAnand PElsafa EPrivitera RNaidoo KYiangou YDonatien PGabra HWasan HKenny LRahemtulla AMisra PPraveen Anand,1 Enas Elsafa,1 Rosario Privitera,1 Kalnisha Naidoo,1 Yiangos Yiangou,1 Philippe Donatien,1 Hani Gabra,2 Harpreet Wasan,2 Laura Kenny,2 Amin Rahemtulla,3 Peter Misra11Department of Neurology; 2Medical Oncology; 3Hematology, Imperial College London, Hammersmith Hospital, London W12 0NN, UKPurpose: Chemotherapy-induced peripheral neuropathy (CIPN) with associated chronic pain is a common and disabling condition. Current treatments for neuropathic pain in CIPN are largely ineffective, with unfavorable side-effects. The capsaicin 8% patch (capsaicin 179 mg patch) is approved for the treatment of neuropathic pain: a single topical cutaneous application can produce effective pain relief for up to 12 weeks. We assessed the therapeutic potential of capsaicin 8% patch in patients with painful CIPN, and its mechanism of action.Patients and methods: 16 patients with chronic painful CIPN (mean duration 2.5 years), in remission for cancer and not receiving chemotherapy, were treated with 30 min application of capsaicin 8% patch to the feet. Symptoms were monitored using the 11-point numerical pain rating scale (NPRS), and questionnaires. Investigations were performed at baseline and three months after patch application, including skin biopsies with a range of markers, and quantitative sensory testing (QST).Results: Patients reported significant reduction in spontaneous pain (mean NPRS: −1.27; 95% CI 0.2409 to 2.301; p=0.02), touch-evoked pain (−1.823; p=0.03) and cold-evoked pain (−1.456; p=0.03). Short-Form McGill questionnaire showed a reduction in neuropathic (p=0.0007), continuous (p=0.01) and overall pain (p=0.004); Patient Global Impression of Change showed improvement (p=0.001). Baseline skin biopsies showed loss of intra-epidermal nerve fibers (IENF), and also of sub-epidermal nerve fibers quantified by image analysis. Post-patch application skin biopsies showed a significant increase towards normalization of intra-epidermal and sub-epidermal nerve fibers (for IENF: structural marker PGP9.5, p=0.009; heat receptor TRPV1, p=0.027; regenerating nerve marker GAP43, p=0.04). Epidermal levels of Nerve Growth Factor (NGF), Neurotrophin-3 (NT-3), and Langerhans cells were also normalized. QST remained unchanged and there were no systemic side-effects, as in previous studies.Conclusion: Capsaicin 8% patch provides significant pain relief in CIPN, and may lead to regeneration and restoration of sensory nerve fibers ie, disease modification.Keywords: capsaicin, neuropathic pain, chemotherapy, skin biopsyhttps://www.dovepress.com/rational-treatment-of-chemotherapy-induced-peripheral-neuropathy-with--peer-reviewed-article-JPRCapsaicinNeuropathic painChemotherapySkin biopsy. |
| spellingShingle | Anand P Elsafa E Privitera R Naidoo K Yiangou Y Donatien P Gabra H Wasan H Kenny L Rahemtulla A Misra P Rational treatment of chemotherapy-induced peripheral neuropathy with capsaicin 8% patch: from pain relief towards disease modification Journal of Pain Research Capsaicin Neuropathic pain Chemotherapy Skin biopsy. |
| title | Rational treatment of chemotherapy-induced peripheral neuropathy with capsaicin 8% patch: from pain relief towards disease modification |
| title_full | Rational treatment of chemotherapy-induced peripheral neuropathy with capsaicin 8% patch: from pain relief towards disease modification |
| title_fullStr | Rational treatment of chemotherapy-induced peripheral neuropathy with capsaicin 8% patch: from pain relief towards disease modification |
| title_full_unstemmed | Rational treatment of chemotherapy-induced peripheral neuropathy with capsaicin 8% patch: from pain relief towards disease modification |
| title_short | Rational treatment of chemotherapy-induced peripheral neuropathy with capsaicin 8% patch: from pain relief towards disease modification |
| title_sort | rational treatment of chemotherapy induced peripheral neuropathy with capsaicin 8 patch from pain relief towards disease modification |
| topic | Capsaicin Neuropathic pain Chemotherapy Skin biopsy. |
| url | https://www.dovepress.com/rational-treatment-of-chemotherapy-induced-peripheral-neuropathy-with--peer-reviewed-article-JPR |
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