Background and aims - Neuropathic pain is an unpleasant sensory and emotional experience and can be as a result of surgery or trauma and 5% of patients may still have a degree of pain one year from their initial injury (1). High-concentration capsaicin patch is a well-established treatment for peripheral neuropathic pain.  Following discussion with the local cardio-thoracic department it was apparent that post-surgical neuropathic pain management was inadequate. 

Methods - Following a search of the current Qutenza database (n=230) we identified 30 patients that would meet the clinical criteria of neuropathic chest wall pain. 4 records were discounted due to lack of complete data.  Demographics - n=26 patients - 13 male, 13 female age range 25-80 years
Average patch application n=4. Pre and post pain (VAS 0-10) and BPI (British Pain Inventory) scores were taken with percentage relief scores and qualitative comments

Results - There were significant changes to both VAS and BPI scores. Pain decreased from 7.4 (severe) to 4.1 (mild/moderate) and BPI from 40 to 28. 65% of patients’ rated more than 50% relief with comments such as ‘best treatment so far’.
Conclusions – High strength capsaicin appears to be effective in treating neuropathic chest wall pain and offers significant benefits to some patients with persistent severe pain.  For some patients symptoms resolved completely, whilst for others therapeutic efficacy may have been deleted due to the presence of continued psycho-social factors.

(1)Gottschalk A, Cohen SP Yang S et al. Preventing and treating pain after thoracic surgery. Anaesthesiology 2006;104:594-600

CAPSAICIN PATCH FOR NEUROPATHIC CHEST WALL PAIN - LOCAL AUDIT FINDINGS