Rev. Soc. Esp. Dolor. 2025; 32(1): 29-45 / DOI: 10.20986/resed.2026.4212/2025
Gerardo Correa, Gerardo Correa, Ruperto Correa, Ana María Torres, César Margarit
ABSTRACT
Introduction: Despite the multiple oral and interventional treatments available, localized neuropathic pain remains undertreated and has low response rates. Topical treatment has emerged as an alternative for various patient populations with localized neuropathic pain.
Objectives: To evaluate the results of repeated use of capsaicin patch 8 % (PC8) in localized neuropathic pain in daily clinical practice, assessing the response through spontaneous pain, mechanical allodynia and treated painful area. Study design: observational, retrospective, descriptive case series study. Setting: all patients were treated with PC8 at Clínica RedSalud Providencia or Hospital Clínico Mutual de Seguridad CChC, Santiago de Chile between 2022 and 2024.
Methods: Patients with probable or definite localized neuropathic pain, 'irritable nociceptor' sensory profile (static or dynamic mechanical allodynia), and DN4 Questionnaire ≥ 3/7 were selected. The primary outcome of therapeutic efficacy was the decrease in spontaneous pain intensity, mechanical allodynia and size of the painful area between baseline and the last treatment. Improvement in quality of life, reduction of concomitant consumption of oral analgesics and tolerability of the drug were also evaluated. Monthly evaluations were performed, with periodic applications of PC8 following European standards and according to the technical file. Quality of life was evaluated with the EuroQoL-5D-3L scale.
Results: Of 12 patients analyzed, in two series of six each, the first presented post-traumatic/post-surgical painful scars with neuropathic component ('Scars'), and the second, post-herpetic neuralgia ('PHN'). Three or four applications of PC8 were performed every 3 months, with an average follow-up of 10 months in each series. The entire 'Scars' series had a ≥ 30 % reduction in baseline spontaneous pain intensity and half had ≥ 50 % reduction. In addition, with respect to mechanical allodynia intensity, half presented ≥ 30 % decrease, and ⅓ of the sample ≥ 50 %. All patients presented painful area contraction ≥ 50 %. In the 'PHN' series, with respect to baseline spontaneous pain intensity, ⅔ of patients had a reduction ≥ 30 % and half had a reduction ≥ 50 %. Likewise, regarding mechanical allodynia intensity, half had a reduction ≥ 30 % and 1 patient (17 %) decrease ≥ 50 %. All patients presented painful area contraction ≥ 50 %. 80 % of patients in the 'Scars' series and 40 % in the 'PHN' series reduced opioid consumption due to combination of oral treatment with PC8. All patients improved their quality of life and 11/12 patients (83 %) were reintegrated socially and occupationally at the end of treatment.
Discussion: It is suggested that the capsaicin 8 % patch is a valuable option for the treatment of localized neuropathic pain, providing a significant reduction in spontaneous pain intensity, mechanical allodynia and painful area. In addition, it reduces the consumption of oral drugs, particularly opioids, and improves quality of life, accompanied by good tolerability. This research has limitations inherent to a retrospective study and includes a small number of patients, so prospective studies with similar methodology and population, but with a larger sample size, are suggested.
RESUMEN
Introducción: A pesar de los múltiples tratamientos orales e intervencionistas disponibles, el dolor neuropático localizado sigue siendo infratratado y presenta tasas de respuesta reducidas. El tratamiento tópico se ha constituido como una alternativa para diversas poblaciones de pacientes con dolor neuropático localizado.
Objetivos: Evaluar los resultados del uso repetido del parche de capsaicina al 8 % (PC8) en dolor neuropático localizado en la práctica clínica diaria, valorando la respuesta mediante dolor espontáneo, alodinia mecánica y área dolorosa tratada. Diseño del Estudio: estudio observacional, retrospectivo, descriptivo de series de casos. Lugar: todos los pacientes fueron tratados con PC8 en Clínica RedSalud Providencia o en Hospital Clínico Mutual de Seguridad CChC, Santiago de Chile entre 2022 y 2024.
Métodos: Se seleccionaron los pacientes con dolor neuropático localizado probable o definitivo, perfil sensitivo de ‘nociceptor irrititable’ (alodinia mecánica), y Cuestionario DN4 ≥ 3/7. El resultado primario de la eficacia terapéutica fue la disminución de la intensidad del dolor espontáneo, alodinia mecánica y tamaño del área dolorosa entre el estado basal y el último tratamiento. Se evaluó, además, mejoría en la calidad de vida, reducción de consumo concomitante de analgésicos orales y tolerabilidad del fármaco. Se realizaron evaluaciones mensuales, con aplicaciones periódicas de PC8 siguiendo las normas europeas y según la ficha técnica. Se evaluó calidad de vida con escala EuroQoL-5D-3L.
Resultados: De 12 pacientes analizados, en dos series de seis cada una, la primera presentó cicatrices dolorosas postraumáticas/postquirúrgicas con componente neuropático (‘Cicatrices’), y la segunda, neuralgia postherpética (‘NPH’). Se realizaron 3 o 4 aplicaciones de PC8 cada 3 meses, con seguimiento promedio de 10 meses en cada serie. Toda la serie ‘Cicatrices’ tuvo una reducción ≥ 30 % intensidad del dolor espontáneo basal y la mitad presentó reducción ≥ 50 %. Además, respecto a la intensidad de alodinia mecánica, la mitad presentó disminución ≥ 30%, y un tercio de la muestra ≥ 50 %. Todos los pacientes presentaron reducción del área dolorosa ≥ 50 %. En la serie ‘NPH’, respecto a la intensidad del dolor espontáneo basal, dos tercios de los pacientes tuvieron una reducción ≥ 30 % y la mitad una reducción ≥ 50 %. Asimismo, en relación con la intensidad de alodinia mecánica, la mitad tuvo una reducción ≥ 30 % y 1 paciente (17 %) disminución ≥ 50 %. Todos los pacientes presentaron reducción del área dolorosa ≥ 50 %. El 80 % de los pacientes de serie ‘Cicatrices’ y el 40 % de serie ‘NPH’ redujeron el consumo opioide gracias a combinación del tratamiento oral con PC8. Todos los pacientes mejoraron su calidad de vida y 11/12 pacientes (83 %) se reinsertaron socio-laboralmente al final del tratamiento.
Discusión: Se sugiere que el parche de capsaicina 8 % es una opción valiosa para el tratamiento del dolor neuropático localizado, proveyendo una reducción significativa de la intensidad del dolor espontáneo, alodinia mecánica y área dolorosa. Además, reduce el consumo de fármacos orales, particularmente opioides, y mejora la calidad de vida, acompañándose de buena tolerabilidad. Esta investigación tiene limitaciones inherentes a un estudio retrospectivo e incluye un pequeño número de pacientes, por lo que sugerimos la realización de estudios prospectivos con similar metodología y población, pero con mayor tamaño muestral.
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