Place du patch de capsaïcine à haute concentration (8 %) dans la stratégie thérapeutique des douleurs neuropathiques périphériques

Topical treatments represent new treatment option for the management of neuropathic pain (NP). They have a specific action on the painful area which limits the risk of systemic adverse drug reactions and interaction with other medicinal product. Qutenza, high concentration (8%) capsaicin patch, is indicated for the treatment of peripheral NP in non-diabetic adults. This treatment has been approved in 2009 on the basis of controlled clinical trials conducted in post-herpetic neuralgia and painful HIV associated neuropathy. The Transparency Committee specifies that Qutenza should be restricted to patients who have failed to respond to standard therapies for NP. Treatment recommendations for the management of NP established in 2010 by the SFETD (French chapter of IASP), presented Qutenza as an “emerging” drug but its place in the therapeutic strategy was not clearly defined. Since, new studies have been conducted and our clinical experience has increased, its place in the strategy should be reviewed. Hence, capsaicin patches prescription takes place in case of non-response to first line treatment. In case of failure or partial response, patches can be proposed alone or in combination. In every instance, the prescription of capsaicin patches should be considered before the use of strong opioids for peripheral neuropathic pain.