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Abstract(s)
Introdução: A dor neuropática constitui uma das condições dolorosas mais difíceis de reconhecer e tratar, sendo geralmente crónica e incapacitante. As estratégias terapêuticas disponíveis são muitas vezes ineficazes e responsáveis por reações adversas sistémicas que limitam a compliance ao tratamento. Recentemente foi introduzido o adesivo cutâneo de capsaicina 8%, enquanto opção para o alívio desta condição.
Objetivos: Este projeto tem como principal objetivo avaliar a eficácia, tolerabilidade e a perspetiva dos doentes em relação aos resultados decorrentes do tratamento com este adesivo, realizado no Centro Hospitalar da Cova da Beira, E.P.E.. Como objetivo secundário pretende-se uma revisão sistemática acerca da dor neuropática e seu tratamento, com especial ênfase no adesivo de capsaicina 8%.
Métodos: Foi efetuado um estudo retrospetivo que envolveu 21 doentes com diagnóstico de dor neuropática periférica, tratados com o adesivo de capsaicina 8% no Centro Hospitalar Cova da Beira, E.P.E.. A recolha de informação foi realizada através de um questionário aplicado em contexto de consulta. O mesmo contém questões acerca de reações adversas e utiliza a Escala Numérica da Dor e o Patient Global Impression of Change. Foram consultados os processos clínicos dos participantes para obtenção de dados complementares. Para a aplicação do adesivo neste Centro, procede-se de acordo com o protocolo de utilização deste fármaco.
Resultados: Foram estudados dados de 13 mulheres e 8 homens, com idades compreendidas entre os 44 e os 90 anos, com dor neuropática periférica de diferentes etiologias, sendo a pós-cirúrgica a mais frequente. Os doentes foram tratados com o adesivo de capsaicina 8%, sendo que o número de tratamentos realizados variou entre 1 e 5. Segundo dados relativos ao primeiro tratamento, todos os indivíduos completaram o tempo recomendado de aplicação do
adesivo. As reações adversas observadas com mais frequência foram locais e consistiram em eritema, sensação de calor e dor tipo queimadura classificada pela maioria como “leve ou “moderada”. Cerca de 24% da amostra experienciou reações adversas sistémicas, principalmente náuseas.
Utilizando a Escala Numérica da Dor, foi possível observar que a média da intensidade da dor da amostra antes do tratamento com o adesivo era de 7,33 (M=7,33;DP=2,01). Às 2, 6 e 12 semanas após o mesmo, verificaram-se reduções de 1,62 (22,10%), 2,04 (27,83%) e 1,19 (16,63%), respetivamente. Dez doentes (47,62%) atingiram uma redução =30% na intensidade da sua dor, em algum dos momentos avaliados. No grupo que realizou mais do que um tratamento (n=13), a intensidade mínima da dor atingida após o primeiro tratamento foi 1,62 (21%) inferior à inicial. Neste grupo observou-se uma diminuição de 3,23 (44,15%) na intensidade da dor, 12 semanas depois da última aplicação do adesivo, relativamente à dor inicial. Em oito dos participantes (38%) verificou-se uma redução na toma de medicação analgésica concomitante, após o número total de tratamentos.
Relativamente aos resultados obtidos no Patient Global Impression of Change, vimos que 7 doentes afirmaram que o tratamento não resultou ou que levou apenas a algumas melhorias, que não representaram alterações no seu estado geral de saúde e/ou quotidiano. Já cerca de 70% da amostra mostrou-se satisfeita com o tratamento e referiu melhorias significativas que, para alguns, fizeram toda a diferença no quotidiano.
Conclusão: A aplicação do adesivo de capsaicina 8% é bem tolerada. Reações adversas são comuns mas maioritariamente locais, o que torna esta terapêutica segura, e não comprometem a adesão ao tratamento. De acordo com os resultados, concluímos que na sua maioria, os doentes experienciam uma redução na intensidade da dor, embora em graus variáveis. Para cerca de metade da amostra verificou-se uma redução clinicamente significativa (=30%) na intensidade da dor, em algum momento até às 12 semanas após o primeiro tratamento. O momento em que a intensidade da dor se mostrou mais baixa foi às 6 semanas. Foi possível observar uma diminuição adicional da intensidade da dor com aplicações subsequentes. Neste estudo comprovamos a vantagem do adesivo de capsaicina 8% na redução da medicação analgésica concomitante para o alívio da dor. Grande parte da amostra (70%) mostrou-se satisfeita com esta terapêutica, sentindo melhorias no seu estado clínico geral, com aumento da qualidade de vida relacionada com a saúde.
Tendo em conta a dificuldade no tratamento da dor neuropática periférica e a grande percentagem de doentes que não obtêm alívio com as diferentes terapias disponíveis, é notável a eficácia do adesivo de capsaicina 8%, assim como o seu perfil de segurança e tolerabilidade.
Background: Neuropathic pain is one of the most difficult to recognize and treat and it is usually chronic and disabling. Available treatment strategies are often ineffective in pain relief and cause systemic adverse drug reactions that limit compliance to treatment. Thus, topical analgesics must be taken into account in the therapeutic spectrum of peripheral neuropathic pain. A cutaneous patch with capsaicin with an 8% concentration has recently been added as an option for the relief of this condition. Objectives: This study was designed with the aim of evaluating the efficacy, tolerability and patient’s perspective regarding improvements resulting from treatment with capsaicin 8% patch, held at the Centro Hospitalar Cova da Beira, E.P.E.. As a secondary objective, we intend to do a systematic review on neuropathic pain and its treatment, with special emphasis on the capsaicin 8% patch. Methods: Retrospective study involving 21 patients diagnosed with peripheral neuropathic pain and treated with capsaicin 8% patch in Centro Hospitalar Cova da Beira. Data were acquired through a questionnaire asking about adverse reactions and using the Numerical Pain Rating Scale and the Patient Global Impression of Change. Medical records were consulted to obtain additional data. The application of the patch was made in accordance to the protocol of this drug. Results: We studied data from 13 women and 8 men with ages between 44 and 90 years with peripheral neuropathic pain of various etiologies, being the post-surgical found in most cases. Patients were treated with capsaicin 8% patch and the number of treatments performed ranged between 1 and 5. According to data about the first treatment, all subjects completed the recommended time for patch application. Adverse reactions seen more often were local and consisted of erythema, warmth and burning pain in treated skin. This pain was present in about half of the sample and ranked by most as "mild" or "moderate". Systemic adverse events were present in about 24%, especially nausea. Using the Numerical Pain Rating Scale, we found that the average pain intensity experienced by patients before any treatment with the patch was 7.33 (M = 7,33, SD = 2,01). At 2, 6 and 12 weeks after treatment, reductions were 1.62 (22,10%) 2.04 (27,83%) and 1.19 (16,63%), respectively. Ten patients (47,62%) achieved a =30% decrease in pain intensity at any of the assessed moments (2,6 and/or 12 weeks). In the group of patients who underwent more than one treatment (n=13), the minimum pain intensity reached after the first treatment was 1.62 (21%) lower than the initial. In this group we observed a decrease of 3.23 (44.15%) 12 weeks after the last application of the patch. In eight subjects (38%) there was a decrease in concomitant analgesic medication after the total number of treatments. About the results obtained in Patient Global Impression of Change, we saw that 7 patients said the treatment did not work or that it only led to a few improvements, which did not represent changes in general health and/or daily life. About 70% of the sample, which selected high values in this instrument, expressed satisfaction with the treatment and noted significant improvements that, for some, made all difference in everyday life. Conclusion: The application of capsaicin 8% patch is well tolerated. Adverse reactions are common, but mostly local, which makes this treatment a safe one, and do not compromise compliance. According to the results, we conclude that the majority of patients experience a reduction in pain intensity, although in varying degrees. For about half of the sample there was a clinically significant reduction (=30%) in pain intensity at some point until 12 weeks after the first treatment. The moment in which pain intensity was lower was at week 6. It was possible to find additional decrease in pain intensity with subsequent patch applications. We proved the advantage of capsaicin 8% patch in reducing the concomitant analgesic medication for pain relief in some patients. Most patients (70%) expressed satisfaction with this therapy, experiencing improvements in overall clinical status, with increased quality of life related to health. Given the difficulty in treating neuropathic pain and the large percentage of patients who do not obtain relief with different therapies, the effectiveness of capsaicin 8% patch is remarkable, as well as its safety and tolerability.
Background: Neuropathic pain is one of the most difficult to recognize and treat and it is usually chronic and disabling. Available treatment strategies are often ineffective in pain relief and cause systemic adverse drug reactions that limit compliance to treatment. Thus, topical analgesics must be taken into account in the therapeutic spectrum of peripheral neuropathic pain. A cutaneous patch with capsaicin with an 8% concentration has recently been added as an option for the relief of this condition. Objectives: This study was designed with the aim of evaluating the efficacy, tolerability and patient’s perspective regarding improvements resulting from treatment with capsaicin 8% patch, held at the Centro Hospitalar Cova da Beira, E.P.E.. As a secondary objective, we intend to do a systematic review on neuropathic pain and its treatment, with special emphasis on the capsaicin 8% patch. Methods: Retrospective study involving 21 patients diagnosed with peripheral neuropathic pain and treated with capsaicin 8% patch in Centro Hospitalar Cova da Beira. Data were acquired through a questionnaire asking about adverse reactions and using the Numerical Pain Rating Scale and the Patient Global Impression of Change. Medical records were consulted to obtain additional data. The application of the patch was made in accordance to the protocol of this drug. Results: We studied data from 13 women and 8 men with ages between 44 and 90 years with peripheral neuropathic pain of various etiologies, being the post-surgical found in most cases. Patients were treated with capsaicin 8% patch and the number of treatments performed ranged between 1 and 5. According to data about the first treatment, all subjects completed the recommended time for patch application. Adverse reactions seen more often were local and consisted of erythema, warmth and burning pain in treated skin. This pain was present in about half of the sample and ranked by most as "mild" or "moderate". Systemic adverse events were present in about 24%, especially nausea. Using the Numerical Pain Rating Scale, we found that the average pain intensity experienced by patients before any treatment with the patch was 7.33 (M = 7,33, SD = 2,01). At 2, 6 and 12 weeks after treatment, reductions were 1.62 (22,10%) 2.04 (27,83%) and 1.19 (16,63%), respectively. Ten patients (47,62%) achieved a =30% decrease in pain intensity at any of the assessed moments (2,6 and/or 12 weeks). In the group of patients who underwent more than one treatment (n=13), the minimum pain intensity reached after the first treatment was 1.62 (21%) lower than the initial. In this group we observed a decrease of 3.23 (44.15%) 12 weeks after the last application of the patch. In eight subjects (38%) there was a decrease in concomitant analgesic medication after the total number of treatments. About the results obtained in Patient Global Impression of Change, we saw that 7 patients said the treatment did not work or that it only led to a few improvements, which did not represent changes in general health and/or daily life. About 70% of the sample, which selected high values in this instrument, expressed satisfaction with the treatment and noted significant improvements that, for some, made all difference in everyday life. Conclusion: The application of capsaicin 8% patch is well tolerated. Adverse reactions are common, but mostly local, which makes this treatment a safe one, and do not compromise compliance. According to the results, we conclude that the majority of patients experience a reduction in pain intensity, although in varying degrees. For about half of the sample there was a clinically significant reduction (=30%) in pain intensity at some point until 12 weeks after the first treatment. The moment in which pain intensity was lower was at week 6. It was possible to find additional decrease in pain intensity with subsequent patch applications. We proved the advantage of capsaicin 8% patch in reducing the concomitant analgesic medication for pain relief in some patients. Most patients (70%) expressed satisfaction with this therapy, experiencing improvements in overall clinical status, with increased quality of life related to health. Given the difficulty in treating neuropathic pain and the large percentage of patients who do not obtain relief with different therapies, the effectiveness of capsaicin 8% patch is remarkable, as well as its safety and tolerability.