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@article{Anand:2019:10.2147/JPR.S213912,
author = {Anand, P and Elsafa, E and Privitera, R and Naidoo, K and Yiangou, Y and Donatien, P and Gabra, H and Wasan, H and Kenny, L and Rahemtulla, A and Misra, P},
doi = {10.2147/JPR.S213912},
journal = {Journal of Pain Research},
pages = {2039--2052},
title = {Rational treatment of chemotherapy-induced peripheral neuropathy with capsaicin 8% patch: from pain relief towards disease modification},
url = {http://dx.doi.org/10.2147/JPR.S213912},
volume = {12},
year = {2019}
}

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TY  - JOUR
AB  - Purpose: 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-
AU  - Anand,P
AU  - Elsafa,E
AU  - Privitera,R
AU  - Naidoo,K
AU  - Yiangou,Y
AU  - Donatien,P
AU  - Gabra,H
AU  - Wasan,H
AU  - Kenny,L
AU  - Rahemtulla,A
AU  - Misra,P
DO  - 10.2147/JPR.S213912
EP  - 2052
PY  - 2019///
SN  - 1178-7090
SP  - 2039
TI  - Rational treatment of chemotherapy-induced peripheral neuropathy with capsaicin 8% patch: from pain relief towards disease modification
T2  - Journal of Pain Research
UR  - http://dx.doi.org/10.2147/JPR.S213912
UR  - http://hdl.handle.net/10044/1/71611
VL  - 12
ER  -

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