AUTHOR=Anand Praveen , Privitera Rosario , Donatien Philippe , Misra V. Peter , Woods David R. 

TITLE=Capsaicin 8% Patch Treatment in Non-Freezing Cold Injury: Evidence for Pain Relief and Nerve Regeneration

JOURNAL=Frontiers in Neurology

VOLUME=Volume 12 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2021.722875

DOI=10.3389/fneur.2021.722875

ISSN=1664-2295

ABSTRACT=Introduction: Neuropathic pain associated with Non-freezing Cold Injury (NFCI) is a major burden to military service personnel. A key feature of NFCI is reduction of the intra-epidermal nerve fibre density in skin biopsies, in keeping with painful neuropathy. Current oral treatments are generally ineffective and have undesirable side effects. Capsaicin 8% patch (Qutenza) has been shown to be well-tolerated and effective for reducing neuropathic pain, for up to 3 months after a single 30-minute application. 
Methods: In this single-centre open label study, 16 military participants with NFCI (mean duration 49 months) received 30-minute Capsaicin 8% patch treatment to the feet and distal calf.  Pain symptoms were assessed using a pain diary (with the 11-point Numerical Pain Rating Scale, NPRS) and questionnaires, the investigations included skin biopsies, performed before and three months after treatment.
Results:  Participants showed significant decrease in spontaneous pain (mean NPRS: -1.1, 95% CI: 0.37 to 1.90; p=0.006), and cold-evoked pain (-1.2, 95% CI 0.40 to 2.04; p=0.006).  The time-course of pain relief over 3 months was similar to other painful neuropathies.  Patient Global Impression of Change showed improvement (p=0.0001).
Skin punch biopsies performed 3 months after the patch application showed significant increase of nerve fibres with structural marker PGP9.5 (intra-epidermal nerve fibres [IENFs], p<0.0001; sub-epidermal nerve fibres [SENFs]; p=<0.0001), and of regenerating nerve fibres with their selective marker GAP43 (p=0.0001).  The increase of IENFs correlated with reduction of spontaneous (p=0.027) and cold-evoked pain (p=0.019).
Conclusions: Capsaicin 8% patch provides an exciting new prospect for treatment of NFCI, with regeneration and restoration of nerve fibres, for the first time, in addition to pain relief.