Posttraumatic and postsurgical neuropathic pain responsive to treatment with capsaicin 8% topical patch

Capsaicin 8% patch (qutenza) is mainly used to treat postherpetic neuralgia and human immunodeficiency virus-associated neuropathy. however,evidence of the efficacy of qutenza in other forms of neuropathic pain is lacking. a 24-year old libyan man,with no previous medical history,sustained multiple wounds in the right side of the chest and back after a bomb explosion. the patient experienced pain,which persisted in a wide location around the surgical intervention for a long time,beyond the usual course of natural healing of an acute pain and was different from that suffered preoperatively. the characteristics of the pain included burning,electric shock-like sensation,tingling,and numbness,and it was paroxysmal. the pain was associated with hyperalgesia and intense allodynia in a wide area,approximately of 1,100 cm2. our initial treatment strategy included pregabalin,tramadol,and duloxetine. however,our patient's pain responded to treatment with capsaicin 8% patch when the initial treatments showed only minimal effectiveness regarding the intensity of pain. interestingly,the most important finding was that capsaicin 8% patch showed a more than 80% reduction of the area of allodynia associated with the pain,when other treatments failed. moreover,although recent data showed that in patients who respond to qutenza,analgesia starts within a few days of treatment and lasts on average 5 months,our patient showed an initial response within 7 days of treatment but a longer duration of more than 18 months. although further controlled studies are needed to explore the efficacy of the capsaicin 8% patch in patients who experience posttraumatic neuropathic pain,we encourage clinicians to try the capsaicin 8% patch when alternative treatments fail.