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@article{Privitera:2021:10.3389/fneur.2021.722875,
author = {Privitera, R and Anand, P and Donatien, P and Misra, V and Woods, D},
doi = {10.3389/fneur.2021.722875},
journal = {Frontiers in Neurology},
pages = {1--10},
title = {Capsaicin 8% patch treatment in non-freezing cold injury : evidence for pain relief and nerve regeneration.},
url = {http://dx.doi.org/10.3389/fneur.2021.722875},
volume = {12},
year = {2021}
}

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TY  - JOUR
AB  - Introduction: Neuropathic pain associated with Non-freezing Cold Injury (NFCI) is a major burden to military service personnel. A key feature of NFCI is reduction of the intra-epidermal nerve fibre density in skin biopsies, in keeping with painful neuropathy. Current oral treatments are generally ineffective and have undesirable side effects. Capsaicin 8% patch (Qutenza) has been shown to be well-tolerated and effective for reducing neuropathic pain, for up to 3 months after a single 30-minute application.Methods: In this single-centre open label study, 16 military participants with NFCI (mean duration 49 months) received 30-minute Capsaicin 8% patch treatment to the feet and distal calf. Pain symptoms were assessed using a pain diary (with the 11-point Numerical Pain Rating Scale, NPRS) and questionnaires, the investigations included skin biopsies, performed before and three months after treatment.Results: Participants showed significant decrease in spontaneous pain (mean NPRS: -1.1, 95% CI: 0.37 to 1.90; p=0.006), and cold-evoked pain (-1.2, 95% CI 0.40 to 2.04; p=0.006). The time-course of pain relief over 3 months was similar to other painful neuropathies. Patient Global Impression of Change showed improvement (p=0.0001).Skin punch biopsies performed 3 months after the patch application showed significant increase of nerve fibres with structural marker PGP9.5 (intra-epidermal nerve fibres [IENFs], p<0.0001; sub-epidermal nerve fibres [SENFs]; p=<0.0001), and of regenerating nerve fibres with their selective marker GAP43 (p=0.0001). The increase of IENFs correlated with reduction of spontaneous (p=0.027) and cold-evoked pain (p=0.019).Conclusions: Capsaicin 8% patch provides an exciting new prospect for treatment of NFCI, with regeneration and restoration of nerve fibres, for the first time, in addition to pain relief.
AU  - Privitera,R
AU  - Anand,P
AU  - Donatien,P
AU  - Misra,V
AU  - Woods,D
DO  - 10.3389/fneur.2021.722875
EP  - 10
PY  - 2021///
SN  - 1664-2295
SP  - 1
TI  - Capsaicin 8% patch treatment in non-freezing cold injury : evidence for pain relief and nerve regeneration.
T2  - Frontiers in Neurology
UR  - http://dx.doi.org/10.3389/fneur.2021.722875
UR  - https://www.frontiersin.org/articles/10.3389/fneur.2021.722875/abstract
UR  - http://hdl.handle.net/10044/1/90917
VL  - 12
ER  -

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