Qutenza® (Capsaicin 8%) Topical Treatment

Capsaicin acts on TRPV1, a receptor found on pain-sensing nerve fibers in the skin. Everyday low-concentration capsaicin creams produce a mild warming sensation and must be applied several times a day.

Qutenza is different. Its high concentration produces a process sometimes described as defunctionalization: overstimulated pain fibers in the treated skin become less able to send pain signals. Over the following weeks, the nerve endings gradually recover — which is why relief can persist well beyond the day of application.

Because the medication is delivered into the skin rather than taken by mouth, it avoids many of the systemic side effects, drug interactions, and sedation associated with some oral nerve-pain medications.

Qutenza must be applied by a healthcare professional — it is not a patch you take home and apply yourself.

Your physician first identifies and marks the painful area. A topical numbing medication or local cooling may be used beforehand to improve comfort. The patch is then cut to fit the treatment area and left in place for 30 minutes for the feet, or 60 minutes for other locations.

After the application time, the patch is removed and a cleansing gel is used to take away any remaining capsaicin, followed by gentle cleansing of the skin. The full visit typically takes longer than the application itself because of preparation, application, removal, and a period of observation.

Most patients experience burning, stinging, or increased pain in the treated area during application and for a period afterward. This is expected and is related to how the medication works.

Your care team can help manage this discomfort with local cooling, and in some cases oral pain medication. The sensation typically settles over the hours to days following treatment.

Commonly reported effects at the application site include:

• ✦Redness (erythema)
• ✦Pain, burning, or stinging
• ✦Itching
• ✦Temporary swelling or dryness
• ✦Small areas of bruising or, less commonly, blistering

Qutenza is not an immediate-relief treatment. Because it works by reducing the function of overactive pain fibers, improvement typically develops over the days to weeks following application rather than on the same day.

For patients who respond, a single application may provide relief for up to about three months. Responses vary considerably: some patients experience substantial improvement, others modest benefit, and some little or none.

If you respond and the benefit wears off, treatment may be repeated — but no more often than every three months, and only after your physician reassesses your condition.

Qutenza is generally well tolerated when applied correctly by trained staff, but there are important precautions.

Transient increases in blood pressure can occur during and shortly after treatment, usually related to treatment-associated pain, so blood pressure is monitored. Patients with unstable or poorly controlled hypertension or a history of cardiovascular events may require additional evaluation before treatment.

Other precautions include:

• ✦Qutenza is for topical use only — not for the face, scalp, or above the hairline
• ✦It should not be applied to broken or damaged skin
• ✦Accidental exposure can irritate skin, eyes, and airways, so application follows a careful protocol
• ✦Coughing, sneezing, or eye irritation can occur from airborne capsaicin during application
• ✦Sensation in the treated area may be temporarily reduced — take care to avoid burns or injury you might not feel

Tell your physician about your full medical history, including cardiovascular conditions and any prior reaction to capsaicin products.

Oral medications for neuropathic pain — such as gabapentinoids, certain antidepressants, and other agents — work throughout the body and must generally be taken every day. They can be effective, but some patients experience sedation, dizziness, cognitive fog, weight change, or drug interactions.

Qutenza works locally in the treated skin and is applied only a few times a year at most. For patients who cannot tolerate oral medications, who prefer to avoid adding another daily pill, or whose pain remains inadequately controlled, it may be a useful addition to the plan.

It is not a replacement for a comprehensive approach. For many patients the best results come from combining treatments — which may include medications, physical therapy, procedures, and management of the underlying condition such as diabetes.

If you have nerve pain following shingles, or painful diabetic neuropathy affecting your feet, and conventional treatment has not provided adequate relief, Qutenza may be worth discussing.

At NuvMed in Frisco, TX, our physicians evaluate the cause and characteristics of your nerve pain before recommending treatment, and will review whether Qutenza fits alongside your other therapies.

Contact NuvMed today to schedule a consultation and learn whether this treatment may be appropriate for you.