Capsaicin cutaneous patch (Qutenza®) is licensed for the treatment of peripheral neuropathic pain in non-diabetic adults.  It is applied to the affected area for 30 or 60 minutes (depending on body site and indication) as a single application and can be repeated every 90 days as necessary.

Up to four patches can be applied at any one time.  The mean treatment area in trials for post-herpetic neuralgia equated to the use of two patches per application.

Two randomised active-controlled trials have shown mean improvements in pain control scores of 23-30% over 12 weeks compared with 11-20% with a low-strength capsaicin patch (not commercially available).  A reduction of at least 30% is considered a clinically moderately important improvement.

Data on repeated use are limited.  There have been no comparative trials against standard therapies for neuropathic pain.

Trials have mostly included patients with post-herpetic neuralgia or painful HIV neuropathy.  Clinical data presented to the European Medical Agency in support of an indication for diabetic neuropathy were considered not to be sufficient as only small numbers of patients were included.

Capsaicin patches cause pain and erythema at the application site in the majority of patients.  A local anaesthetic should be applied for 60 minutes prior to application.  Pre- and post-treatment with an opioid may be required.  Blood pressure should be monitored during the treatment process as transient increases may occur.

In trials, the majority of patients were taking concomitant neuropathic pain medication and there is no indication that the use of capsaicin patches reduced the use of concomitant therapy.

Patches will need to be applied in a clinic setting by suitably trained staff.  It is expected they will initially be used exclusively by specialist pain clinics in secondary care.