A transdermal patch containing 8% capsaicin...
 

Recently approved by FDA:

A transdermal patch containing 8% capsaicin (NGX-4010, Qutenza) showed tolerable safety in long-term use for post-herpetic neuralgia and HIV-related neuropathy, researchers said here.

http://www.qutenza.com/about/whyQutenza.php

The patch also seemed safe and effective in a short-term study in painful diabetic neuropathy, according to research presented at the American Academy of Pain Medicine meeting.

The 8% capsaicin patch was applied for 60 to 90 minutes in the open-label studies reported here, following a preparatory application of lidocaine cream or other topical anesthetic. A single treatment was used in the 12-week diabetic neuropathy study.

Just under half of patients had at least a 30% reduction from baseline in pain scores, and one-third had a reduction of at least 50%.

Maximal pain reductions in most patients were achieved over a two-week period after patch application, and were maintained through week 10, with a slight uptick seen in mean scores at week 12.

Evaluations at the second and sixth weeks after treatment showed 48% and 47% of patients, respectively, reporting "much" or "very much" improvement.

http://www.medpagetoday.com/MeetingCoverage/AAPM/12720

This looks promising for PN and I asked my pharmacist to get the product, so I could try it...

In the meantime, late this afternoon I have tried applying 5% Lidocaine cream one top of one foot and Topricin cream to the other: both products are working well enough, so far, making the pain bearable for now...

This morning I took 2 Curamin tablets, a product that claims a synergistic multiplication of Curcumin benefits by a factor of 20: it worked well enough for my PN foot pain for about 3 hours...

http://www.curamin.com/ingredients/

As usual, the testimonials are glowing and fall barely short of reviving week old corpses...

Action mechanism of Capsicum on Nerve Pain
 

http://www.prescriptiondrug-info.com...008170&ad=true

In 1997, a research team led by David Julius of UCSF showed that capsaicin selectively binds to a protein known as TRPV1 that resides on the membranes of pain and heat sensing neurons.[28] TRPV1 is a heat activated calcium channel, which opens between 37 and 45 °C. When capsaicin binds to TRPV1, it causes the channel to open below 37 °C (normal human body temperature), which is why capsaicin is linked to the sensation of heat.

Prolonged activation of these neurons by capsaicin depletes presynaptic substance P, one of the body's neurotransmitters for pain and heat. Neurons that do not contain TRPV1 are unaffected.

The result appears to be that the chemical mimics a burning sensation, the nerves are overwhelmed by the influx, and are unable to report pain for an extended period of time. With chronic exposure to capsaicin, neurons are depleted of neurotransmitters, leading to reduction in sensation of pain and blockade of neurogenic inflammation. If capsaicin is removed, the neurons recover.

Capsaicin is being explored as a possible prophylaxis for Type 1 diabetes by researchers in Toronto, Canada; capsaicin was injected subcutaneously affecting pancreatic sensory nerves of mice with Type 1 diabetes because of a suspected link between the nerves and diabetes.[29]

In addition, Capsicum kills cancer cells efficiently...

The American Association for Cancer Research reports studies suggesting capsaicin is able to kill prostate cancer cells by causing them to undergo apoptosis.[30][31] The studies were performed on tumors formed by human prostate cancer cell cultures grown in mouse models, and showed tumors treated with capsaicin were about one-fifth the size of the untreated tumors. There have been several clinical studies conducted in Japan and China that showed natural capsaicin directly inhibits the growth of leukemic cells.[32]

Another study carried out at the University of Nottingham suggests capsaicin is able to trigger apoptosis in human lung cancer cells as well.[33]

Capsaicin is also the key ingredient in the experimental drug Adlea, which is in Phase 2 trials as a long-acting analgesic to treat post-surgical and osteoarthritis pain for weeks to months after a single injection to the site of pain.[34] More over, it reduces pain resulted rheumatoid arthritis [35] as well as joint or muscle pain from fibromyalgia or other causes.

The patch is still HUSH-HUSH and a cruel $675.00/pc...
 

The patch is still HUSH-HUSH and a cruel $675.00/pc...

It's only distributed to doctors or hospitals in the US for controlled application and costs $675.00 a piece, which is slated to provide relief for a 12 weeks period...

...So, I tried the next best thing AND, so far, it's working beyond expectations, as long as application is done anew on a daily basis: here is a full report...

http://www0.epinions.com/review/Capz...t_514039975556

Here are additional opinions by sufferers of Peripheral Neuropathy on the use of 0.075% Capsicin "Neuropathy Cream for diabetic foot pain relieving" made by Zostrix...

http://www.amazon.com/Zostrix-Neurop...f=pd_sbs_hpc_9

I like this one best...

4.0 out of 5 stars RELIEF!, August 18, 2008 By L. Granigan (KIngs Mountain, NC) -

This review is from: Zostrix Neuropathy Cream, 2-Ounce Boxes (Health and Beauty)

I have neuropathy in my feet. The pain, burn, tingling and numbness is extremely bad. I have tried electrical stimulation, with some relief, but nothing compared to the relief that I have gotten with the Zostrix Cream. I found it at local drugstore, for much more than amazon is selling it for. I love it! I put it on about 3-4 times a day. There is still some pain, but NOTHING compared to before. Thank you to the makers of Zostrix!

Capsaicin is not a new product. It has been available for about a decade. It never caught on in a major way for shingles pain.

Zostrix was the first product aside from herbal suppliers. It was detailed to doctors, who prescribed it. But I can tell you personally that the product, even when on the shelf where customers can buy it easily is not really popular.

The reason is that it takes 2 or more weeks to start working, if it works at all. Most people cannot stand the severe burning it causes for those 2 weeks.

I am not surprised that Qutenza is highly restricted. Misuse of this ultra strong version could do substantial damage to tissue.
It is 100 times stronger than any topical product available today. Also one patch= $675 !! Better make sure it goes on the correct spot!

You know many products have pepper extract in them. And the makers know that people will not buy it if it is listed clearly in the ingredients! They use the Latin name for it to conceal its real identity, hoping people will buy it out of desperation as another potential useful remedy!
It can appear in ingredient lists as C. chinense, or C. annuum for example. Capsicum is a nightshade vegetable, and many people are intolerant of nightshades. They may create a serious allergic reaction.

http://www.helium.com/items/303428-a...u-need-to-know

I hope you can derive some benefit from capsicum products, but be very vigilant for adverse effects over time. There are many more people who cannot stand this treatment, than like it.

The Qutenza patch, which started my research on the benefits of Capsicin is new, but not very practical or reasonable in price, hence the review of the other OTC Capsicin products available...

What is also interesting is that, besides arthritis pain, Zostrix is now targeting sufferers of Peripheral Neuropathy and these are now providing interesting testimonials...

Having read most of the opinions available on the Internet on the use of Capsicin, I have come to the conclusions that:

Many people do not pay attention to the instructions and are surprised by the intensity of the burning: unless they have an allergy, it's usually their mistake and/or their pain level just doesn't warrant using Capsicin...

However, Capsicin as a nerve de-sensitizer will be really helpful - as far as I can tell from my own experience - if the following conditions are met:

- Serious ongoing neuropathic pain that would normally require taking some debilitating pain relievers, such as Lyrica, opioids, etc...

- Intelligent use of the various strengths of product, starting with the lower concentration of Capsicin of 0.025% and working up through 0.075, to 0.1%...

- Repeated applications at least twice a day until the 'P' substance facilitating neuro-transmission has been mostly depleted and the burning sensation is mostly gone...

- Scrupulous observance of a few basic rules: apply with gloves, do not cover/wrap the area, do not subject to heat or get wet, do not spread accidentally to other areas of the body, etc...

To dismiss Capsicin summarily because one had a bad experience or an allergic reaction may deprive those who could benefit from its careful use from a very useful tool, once it modus operandi is understood...

In conclusion, I should add that Capsicin is going to be BIG BUSINESS, as the rights for Europe to Qutenza have been bought by Astellas for a cool $42 million, plus royalties in the double digits on net sales:

Astellas will commercialize Qutenza in the above-mentioned territories and perform certain development of Qutenza including post-marketing commitments, to support Qutenza in the EU market. NeurogesX will receive EUR 30 million (approximately $42 million) for Qutenza commercialization rights, and EUR 5 million (approximately $7 million) for a license option of NGX-1998, the next-generation liquid formulation which uses the same active ingredient as Qutenza.

http://ngsx.client.shareholder.com/r...leaseID=391009

No Pharmaceutical company will pay this sort of money, unless it's confident the product has an excellent future!...

I tried the cream on my feet. My husband brought extra strength by accident. I didn't think my feet could burn any worse then they already do but the burn was completely unbearable. It took a few days to wear off.
I am not saying it can't work for others, definitely not for me. I have a friend who has RA and swears by it for her feet.
hopeful:)

42 million is nothing in the drug world. One reason it is so expensive is that the expectation of sales is low. The smaller the pool of potential patients the higher the price. While patches are costly to make, they are not that costly, and there is no expensive drug in it.
The cost is to cover the smaller user base and the control of dispensing etc.

I used to sell these products, so I know how many left the shelves each week. And each week is a huge exaggeration...they actually sat around until they expired for the most part and we'd have to send them back. When people got the cream on RX they never came back for refills.

Since this thread is so complex with alot of information on it, I'm going to request it be moved to the subforum above, where the informational posts are.

So look for it there in the near future.

Zostrix was put out there specifically for neuropathy caused by Shingles. Even tho it is OTC we used to keep it behind the counter at first, and use it only on RX --because it was only detailed to doctors. But it soon was moved to the BenGay section when advertisments started appearing in magazines for the general public. It was pretty expensive at first.. back then over $25 a tube. Now it is less. This link to Amazon for Zostrix HP ($15) has a very negative but typical review/response:
http://www.amazon.com/Zostrix-Potenc.../dp/B000F5IEK8

I had a tube by another company, here, my son used for hand pain from his overusing his video gaming controller... he liked it and it didn't burn for him. But he didn't use it for very long either. I just couldn't stand it. It was the weaker strength.
In all the years (over 10+) I have been on this board and its predecessor only a handful have ever reported success with it.
That is just the way it is.

There have over the years been other drugs in various pipelines to block Substance P. Merck had one it was going to sell as an antidepressant. But studies didn't pan out for it. It then went RX for nausea from chemo. Emend.
I recall some others now in the pipeline for pain, and only time will tell if they withstand the 3 tiers of clinical trials. It would be nice to have something really effective, so I am ever hopeful. But it might be a long time in coming.

Typically the press releases you can find on the net are very glowing.
They imply great success always, so that perhaps people will invest.

This location is actually the nitty gritty of the Pharm industry, and this is the link to Astellas:
http://www.cafepharma.com/boards/forumdisplay.php?f=68
So far there is only one brief mention of the "pain patch" coming out in Europe in Dec '10. But when Qutenza comes out, the reps will have alot to say about it. (from their perspective). Cafepharma is usually unpleasant IMO, but sometimes interesting data can be had from it.

With all due respect, Mrs. D, one negative review out of a single review is hardly informative...

Here are some 30 odd reviews, evenly divided between those who hate it because they can't see further than "it burns like hell!", have not used the product according to the instructions, are allergic or only suffer mild pain in the first place... AND those who think Capsaicin is nothing short of a miracle...

http://www0.epinions.com/reviews/Capzasin_HP

Also, let's remember that 'Capzaicin HP' is the highest potency available for OTC Capsaicin at 0.1% and that users are well advised to begin with a much lower concentration, such as 0.025%...

Since Qutenza will likely be a low volume product, as you remarked, the $42 million distribution rights paid by Astellas is all the more interesting...

Even more interesting is that there was little to chose in a recent failed clinical test pitting Qutenza for HIV Neuropathy and a .4% Capsaicin patch used as a placebo, both providing around 30% pain improvement over one hour...

http://www.pslgroup.com/dg/24704e.htm

A 30% improvement is nothing to be sneezed at and may well make some type of pain bearable: not having found the 0.04% patch yet, I have ordered the 0.025% Salonpas patches, which I intend to test later on with the view of reporting the results here...

The patch used as placebo was most likely made for the study.
I don't expect it to be available, yet. Often studies are done this way and the patches have to be exactly the same in appearance in order for the study to be properly blinded.

Here is the study abstract:
http://www.ncbi.nlm.nih.gov/pubmed/19821411
So this is what we are discussing. It doesn't work for all. And remains unpredictable.

Let us all know how you do in any case. Remember, this does not change the cause of your pain. It is palliative only. If your pain is being generated in your back and not the feet, then placing patches on the feet may not work consistently. You may have to use them on your back in that case.

Good luck.

Since there are a number of clinical studies on Capsaicin, we can always quote that, which we like the most, or which better supports our respective arguments...

NGX-4010 [Qutenza], a high-concentration capsaicin patch, for the treatment of postherpetic neuralgia: a randomized, double-blind, controlled study with an open-label extension.

OBJECTIVES: To assess the efficacy, tolerability, and safety of NGX-4010, a high-concentration capsaicin dermal patch (capsaicin 640 microg/cm(2), 8%) in patients with postherpetic neuralgia (PHN).

METHODS: Patients were randomized to receive NGX-4010 or control patch in a 4-week, double-blind study. This was followed by an open-label extension phase (up to 48 weeks total) where patients could receive up to three additional treatments no sooner than 12 weeks after initial treatment. The primary efficacy variable was mean change from baseline in mean morning and evening numerical pain rating scale (NPRS) scores.

RESULTS: During days 8-28 after the double-blind treatment, NGX-4010 patients had a mean change in NPRS scores from baseline of -32.7% compared with -4.4% for control patients (P = 0.003). Mean NPRS scores decreased from baseline during week 1 in both treatment groups, remained relatively stable through week 12 in NXG-4010 patients, but returned to near baseline during weeks 2-4 in controls. Mean change in NPRS scores from baseline during weeks 2-12 was -33.8% for NGX-4010 and +4.9% for control recipients. A similar decrease in NPRS scores from baseline was maintained with subsequent NGX-4010 treatments, regardless of the number of treatments received. Transient increases in application site pain were adequately managed with analgesics. No increases in application site reactions or adverse events were observed with repeated treatments. No patients discontinued the study due to an adverse event.

CONCLUSION: NGX-4010 is a promising topical treatment for PHN patients, which appears to be tolerable, generally safe, and effective.

http://www.ncbi.nlm.nih.gov/pubmed/20113411

I guess if the FDA based its decision on your study, Qutenza would NOT have been approved...

Also, note that there was no longer any competition with the low dose Capsaicin patch that had done so well in previous tests...

so keep using the capsaicin and see how it works out long term for you if it is helping you now. let us know how it goes.

Over time--
 

--most of us have learned to look critically at studies/papers that come out trumpeting "magnificent" results, especially those published int he US, as opposed to those that come from Canada, Europe, or Japan, places in which the influence of big pharma on what gets published and what doesn't isn't as pervasive.

Still, many of us would like to have new drugs that show promise for the relief of neuropathic (and other) pain. Substances based on capsaicin are certainly worth investigating, and it is likely they will have positive effects for at least some people, though these may be variable based on dose, formulation, and particular genetic background. In that sense, they'll be very much like other drugs used for neuropathic pain--anti-epileptics, anitdepressants, and even opiates and synthetic equivalents (such as Tramadol) work well for some and not others.

In all probability, individual differences in genetic make-up, substance metabolism, and pain mechanism explain the highly variable results associated with these trials, though many of these are still too complex to disentangle. The problem comes when studies that show equivocal results on symptoms, or other effects not intended, are either suppressed or relegated to less widely disseminated media channels.

Qutenza was passed by the FDA under the Orphan Drug Act:

http://www.checkorphan.org/grid/news...etic-neuralgia

What this means:
http://en.wikipedia.org/wiki/Orphan_drug

I think this partially explains the high price of these patches.

Qutenza could have a substantial market, based on the percentage of population affected by Peripheral Neuropathy, bearing in mind that the European approval is much wider in scope than that of the FDA, as it applies to PN in general...

It is estimated that about 8% of the UK population suffer from neuropathic pain. HIV-associated polyneuropathy affects 29% to 62% of patients with HIV and AIDS.

Of course, a lot will depend on pricing, insurance coverage and modalities of application...

However, I am far more interested in what the clinical trials have shown: the efficacy of cheap, low dose Capsaicin patches, even though they were used for a short time interval, when they're far better suited for repeated applications of longer duration, which should have a beneficial effect on overall efficacy...

Clinical Study:

http://www.ukmi.nhs.uk/applications/...newDrugID=4080

This basically means that the inexpensive low dose 0.04% patch available OTC - think of the Salonpas 0.025% Hot patch, as a readily available substitute - had 3/4 of the efficacy of the expensive Qutanza that need to be applied in a controlled environment by prescription...

BUT, when the low dose patch is used as designed, that is for repetitive applications of much longer duration, I feel that it will likely not only outperform Qutenza, but will also have fewer side effects...

http://www.amazon.com/SALONPAS-Hot-C.../dp/B000BRPZPM

I'll soon know, as DHL just called to inform me of the delivery of a bunch of Salonpas patches that I can't wait to try out...

The control patch difference with the 8% patch is not that terribly much different.

The Orphan status of the product allows for less restrictions by the FDA and typically an easier approval. Only time will tell.

Maybe someone else will come out with a different % and different application directions, which would be OTC and just as effective. We'll have to wait and see.

Let us know how it goes with the Salonpas with Capsaicin.
Sometimes the regular one will make the skin red for a while, so if you get that side effect you won't know if it is the Capsaicin or the stickem from the patch.

There is a substantial difference in strength between 8% and 0.04%: it's a 200 to 1 ratio...

Between 8% and the 0.025% Salonpas patches, the ratio is even greater at 320 to 1...

I just covered one foot - top and bottom - with the 0.025% Capsaicin Hot Salonpas patch and the other one with the Salonpas Gel patch, a much more substantial looking patch made with 0.025% Capsaicin and 1.25% Menthol: I plan to keep them on for 8 hours, baring any painful reaction...

Having recently used 0.075% Zostrix cream for as long, it should be fine: however, the area is now covered, which tends to amplify the effects...

Preliminary report:

Well, the first 4 hours of the experiment have gone by without any hitch:

- The all Capsaicin 0.025% Hot Salonpas patch is thin enough to fit inside a shoe and one patch cut in two will cover most of one foot, top and bottom for about $1.00, if bought in packs of 10. There is no burning but a mild stinging sensation that is relieved by not wearing socks when at home...

- The 0.025% Capsaicin, 1.25% Menthol Salonpas Gel patch is much thicker and 2 will be required to cover a foot top and bottom, which may no longer fit comfortably inside certain shoes: cost $4.81 for a set of 6, or $1.60 per foot. They are much more comfortable to wear and there is no stinging at all...

So far, the winner appears to be the combination Capsaicin/Menthol (CM) patch, as there is no stinging and no Peripheral Neuropathy pain noticeable at present. The foot with patches on top and bottom with socks on will still fit inside some Crox...

Starting tomorrow, I plan to wear one (CM) patch on top of the foot one day alternating with one patch on the bottom the next day - for 8 hours (12 noon to 8:00 pm) for one whole week to assess the remaining Neuropathic pain at the end of the period: cost ~80 cents per foot per day, which should hopefully be affordable for most...

Alternatively, one should be able to wear the patch in bed for 8 hours, so that it won't interfere with the wearing of shoes during day time...

End of 8 hour period Report:

Actually, the patches remained on for about 9 hours, as I went for a snooze at 7:00 pm and woke 2 hours later when I dutifully removed both set of patches...

- No redness whatsoever on either foot and no side effect. The left foot where the all Capsaicin patch was located is a bit more sensitive and felt less numb, while the right foot is its usual numb self at superficial skin level...

- The pain, usually in the 6/7 range is barely noticeable, perhaps in the 1/2 range to put a number on it...

- I am not taking any other pain management medicine orally or otherwise, except for anti-inflammatory herbs, such as Curamin (high absorption Cucurmin) Bromelain, Boswellia, Turmeric and Astaxanthin...

So far, so good...

Instead of continuing the experiment as planned, wearing one Capsaicin/Menthol patch for 8 consecutive hours on top of the foot one day alternating with one patch on the bottom the next day, starting at 12 noon tomorrow, I now intend to wait for the pain to return to at least a level 5 before using the Capsicum/Menthol patches again and proceeding with the rest of the experiment...

In conclusion, the 0.025% Capsaicin/1.25% Menthol patch has proven best, as contrary to the whole Capsaicin patch, there is no stinging while wearing it and it's more comfortable.

Although both patches have substantially lowered the pain at a similarly low level, because the CM patch is thicker and more substantial in bulk, it may be best worn at night when it won't interfere with wearing shoes...

I wonder if you have tried high % menthol alone?

I use Biofreeze for burning pain... 3.5% It also has Ilex in it which is an antioxidant. It always works for me.

The mechanism for menthol is this:

There are two temperature type nerves, one that relays heat and one cold. The cold sensors have neurological priority in reporting pain. (I guess this is a survival mechanism).
So when the cold sensors are stimulated by menthol, the heat ones never get registered by the brain as long as the menthol is there working.

So it is no surprise that the mixed patch is working better.

Menthol is often added to compounded dermatological creams too, for patients with chronic itching problems. But that dose is much lower in range, more like .25%.

We have had several discussions on the subject of Menthol. You might do a search here to find them.

That was exactly my thinking as well, since the Menthol in the Salonpas patches clearly removes the sting without diminishing the effects of the Capsaicin...

Likewise, Qutenza specifies the use of Lindocaine first to lessen the burning sensation before applying the high Capsaicin concentration...

Those who complain about the burning of the Capsaicin, which is the main problem encountered, might well benefit by applying some menthol based cream first...

The one problem with the patch, I am finding out now, is that the areas not covered yesterday are now causing pain and it's really hard to cover the entire foot with patches...

I'll continue experimenting with both patches and Capsaicin cream, as another poster with PN has reported here some good results with Zostrix over a 10 years period...

Experiment with Capsaicin 0.075% cream used over a 3.5% Menthol application:

Following the success of the Salonpas Capsaicin/Menthol patch used yesterday - where the Menthol prevented the Capsaicin from imparting a burning sensation - both feet are still mostly pain free (1 to 2 level), except for an area not covered by the patch...

Following Mrs D's suggestion concerning Menthol, I have now applied a 3.5% Menthol solution called Biofreeze, both by means of a spray on one part of the left foot and with a roll-on applicator on the other part to test both type of applications, as the roll-on solution appears much thicker...

I have waited some 45 minutes for the Menthol solution to completely dry, before coating over the Menthol with the 0.075% Capsaisin cream and this should hopefully reduce or even prevent the burning sensation experienced by many as the main drawback of Capsaicin, while leaving intact its ability to desensitize the nerve receptors...

Here is the post by Pete on treating the pain symptoms caused by Peripheral Neuropathy with Zostrix, a cream made with 0.075% Capsaicin...

I'm new to the forum but will post this reply for what it's worth.

I have suffered from a Peripheral neuropathy for years and use to have that burning feeling on the tops of my feet, especially in hot weather and more especially after taking a walk. My regular physician told me to use Zostrix Cream (over the counter medication). He said it would take several days to start working but should, in my case, relieve the burning sensation and it did. I know apply enough to the tops of my feet once a day to cover (not too much) and for the past 10+ years I've been pretty much pain free from burning feet. Other than that I get pains in my feet and lower legs (that irritating feeling one gets) that sometimes keeps me from being able to get to sleep at night. I guess my doc knew I wasn't the type of person to take advantage of a medication and so prescribed Percocet. I take 1/2 to 1 tablet, only when needed, about 1/2 to 1 hour before bedtime and am able to get to sleep without any problems. I realize this medication isn't for everyone as it’s a narcotic but in my case it certainly helps and I'm very careful to use this drug in moderation.

I do hope your doctor can prescribe something that may give you some relief; I do know how one can suffer from nerve pain, no fun at all!

Best of luck!

http://neurotalk.psychcentral.com/thread122507.html

Double post deleted...

Some 6 Hours later: TOTAL SUCCESS and final conclusion!...

The prior application of Biofreeze 3.5% Menthol, both in spray and roll-on gel forms totally prevented any burning or stinging when the 0.075% Capsaicin contained in Zostrix was applied 45 minutes later...

Pain level in both feet is still at 1 to 2, instead of the usual 6 to 7, since application of the Capsaicin/Menthol patch yesterday, showing that both methods - cream combination or ready made Capsaicin/Menthol Salonpas patch - work very well to control certain types of Neuropathic pain...

The advantage of the Salonpas patch is that it's quickly applied, requires no gloves, creates no mess and allows the wearing of socks immediately afterward. The drawback is that it creates bulk when used on top and bottom of the foot, making it difficult to fit in a normal size shoe. Also, the patch shape makes it more difficult to cover the entire foot, leaving some uncovered areas still prone to pain, but it's the perfect solution when traveling by air in these days of check-out restrictions...

The combination Menthol/Capsaicin creams, though a bit more messy to apply, is ideal for home use as compounded shapes, such as a foot can easily be 100% coated and they will cost much less than the patches in the long run...

Thank you Qutenza: your clinical study pitting 8% Capsaicin expensive prescription patches against a control 'placebo' 200 times weaker at 0.04% Capsaicin, STILL showing 75% comparative efficacy, truly opened my eyes: sometimes, less is much more..

Note: while 0.04% Capsaicin patches are not currently available commercially, the Salonpas 0.025% Capsaicin/1.25% Menthol patches, available over the counter at $4.81 for 6 pieces have fit the bill very nicely...

Posters/readers who have followed these tests may be interested in a new thread just started to review the merits of TPR 20, a single application topical cream for pain management pain where Capsaicin has been replaced by Lidocaine and no gloves are required...

http://neurotalk.psychcentral.com/thread124981.html

My neck and upper back is so sensitive to the touch am I wondering how I would react to apply biofreeze and then Zostrix.

I know when I put Biofreeze like cream on my back before it made the burning pain worse even though it was a cooling feeling.

Also the instructions for the Zostrix cream says put a pea sized amount on the affected area. My area is large. Its half of teh back of my neck, both my sholder blades and sometimes triceps.

I am concerned about putting too much on.

Does qutenza work longer with more applications?
 

Hi everyone!

My struggle with pain began many years ago. I was diagnosed with RSD when I was 14 and had 6+ horrible months; couldn't walk, was incredibly drugged, etc. Thankfully because of some wonderful doctors my RSD is in remission.

Now I am dealing with residual nerve damage. After a few years of unsuccessful nerve blocks, lasting only a few days each, and different medications; neurotin, elavil, etc. 5 weeks ago got the qutenza patch. This patch has been some what of a miracle for me. I am finally off the elavil and feeling great but I feel the pain slowly creeping back.

So my question is for anyone who knows or has had the qutenza application. If the pain relief lasted 5 weeks the first time and I need to wait until week 12 for another application will the next application last maybe 6 weeks... I'm not sure if it works like that but it would be wonderful if it did.

Any comments would be appreciated. Thank you!!!

Welcome to NeuroTalk:

I'd ask this question over at RSD forum too.
http://neurotalk.psychcentral.com/forum21.html

The problem with this patch for PNers as I see it, is that we cannot stand Capsaicin in the first place.

The second problem is that our PN is more global, and targeting where the patch should be placed is difficult if not impossible for some of our posters.

As far as lasting quality... drug studies can be deceptive as we have all learned in the past decade. They didn't do them on very many patients for these patches, so those post marketing results may be very different than what the studies suggest.

If doctors knew it was shorter duration for these very expensive patches, they may not be so eager to suggest or prescribe them. So the drug company may not release that data...this is common with other drugs too. That is how the industry works.
Glaxo was forced by the Attorney General of NY state to release ALL of its studies on Paxil several years ago, and that revealed many studies of ineffectiveness.

Also I believe the post herpetic neuralgia is the approved indication for this patch. You used it for an off label purpose, and there may be few if any studies including RSD. That is another question you should ask the manufacturer.

So it is difficult to answer your question. Have you called the manufacturer and asked there? You "may" get a response or not, but it is worth a try, IMO.

capsaicin patch
 

FWIW, my daughter had it done in January...needed a LOT of sedation due to the severe pain. Lasted about 1/2 hour, but reduced pain considerable for over a month. Second session was a failure.

I tried capsaicin cream. First application went fine. Second application awoke me 4 hours later in the middle of the night with extreme burning. Caused irritation and redness that lasted several days. If you choose to try it I would start by applying it to a very small area the first week or two.

I would suggest that the severe redness etc, may be a hint that you may be intolerant to Nightshade vegetables.

I found this out myself, that I get lots of burning from potatoes.

Solanine in these veggies (esp potatoes) is an alkaloid suspected of causing much grief. Tomatoes which are also in this family, stimulate histamine release as well, which can show up in the skin.
If you search here : nightshades you will find some interesting links.
Here is my thread so far on histamine reactions and the skin:
http://neurotalk.psychcentral.com/thread161714.html

The nightshades can be problematic for some people. The tomatoes and hot peppers, also have that histamine issue, which the potatoes do not.

So, Clay, you may want to google
1)nightshade vegetable reactions
2) histamine releasing foods
3)histamine containing foods
and see if that may help you.