Capsaicin 8% Patch for Spinal Cord Injury Focal Neuropathic Pain, a Randomized Controlled Trial

Author:

Olusanya Adedeji1ORCID,Yearsley Aaron1,Brown Nicholas1,Braun Samantha1,Hayes Corey1,Rose Evon2,Connolly Brian1,Dicks Madeline1,Beal Colby1,Helmonds Brett1,Peace Wesley1,Kirkman Bryce1,Nguyen Christina1,Erickson Jacob1,Nguyen Gabby1,Lukose Esha1,Koek Wouter1,Nagpal Ameet S3ORCID,Trbovich Michelle4

Affiliation:

1. The University of Texas Health Science Center at San Antonio , San Antonio, Texas, USA

2. University of the Incarnate World Osteopathic Medical School , San Antonio, Texas, USA

3. Department of Orthopedics and Physical Medicine, Medical University of South Carolina , Charleston, South Carolina, USA

4. Physical Medicine and Rehabilitation, UTHSC at San Antonio , San Antonio, Texas, USA

Abstract

Abstract Background Neuropathic pain (NP) after spinal cord injury (SCI) exacerbates disability, decreases quality of life (QOL), and is often refractory to available therapies. Patients report willingness to trade potential recovery of strength, bowel, bladder, or sexual function for pain relief. One proposed mechanism causing NP is up-regulation of transient receptor potential vanilloid 1 (TRPV 1) proteins in uninjured C fibers and dorsal root ganglia causing neuronal excitability. Recent studies have found up-regulation of TRPV 1 proteins after SCI. Objective We hypothesize the application of capsaicin 8% patch (C8P), FDA approved for NP in diabetic peripheral neuropathy and post-herpetic neuralgia, will improve pain, function and QOL in persons with SCI. Methods Randomized single-blind crossover design in which 11 persons with SCI and NP refractory to two oral pain medications received C8P or a control low dose Capsaicin 0.025% patch (CON) over two 12-week periods. Pain (VAS, MPI-SCI), quality of life (WHO-QOL), and functional status (SCIM) were measured at 2–4-week intervals. Results There was a main treatment effect of C8P over CON on VAS and MPI-SCI outcomes with pain reduction of 35% and 29% at weeks 2 and 4, respectively. C8P also demonstrated a main treatment effect over CON on the SCIM mobility subscale. WHO-QOL scores did not improve with C8P. Conclusions C8P improves pain and mobility for patients with SCI and refractory NP. Larger studies should be performed to evaluate impact of repeat applications and QOL outcomes.

Funder

Foundation for Physical Medicine and Rehabilitation

Publisher

Oxford University Press (OUP)

Subject

Anesthesiology and Pain Medicine,Neurology (clinical),General Medicine

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