Treatment with the high-concentration capsaicin patch was safe and effective for improving pain in patients with chronic pelvic, perineal, and gluteal neuralgia, according to a study published in Pain Physician.1
Few effective medical or surgical treatment options exist for chronic coccygodynia. Analgesics do not have a favorable risk-to-benefit profile, and sacrococcygeal joint infiltration is indicated in fewer than half of patients with pelvic pain.1 Coccygectomy is reserved for patients with pain that have not responded to medical management and who have disabling sacrococcygeal joint instability; the procedure carries the risk of long-term deafferentation pain.2
Capsaicin stimulates cutaneous transient receptor potential vanilloid 1 (TRPV1) nociceptors, and continuous exposure to capsaicin leads to pain desensitization in the treated area.3 The high-concentration (8%) capsaicin cutaneous patch is approved by the European Medicines Agency (EMA) for peripheral neuropathic pain in adults without diabetes and by the US Food and Drug Administration (FDA) for post-herpetic pain.
Coccygodynia exhibits clinical symptoms similar to that of neuropathic pain, such as burning, tingling, and numbness. Amélie Levesque, MD, of Federative Pelvic Pain Center in France, and colleagues examined the safety and efficacy of the 8% capsaicin patch in patients with chronic pelvic, perineal, and gluteal neuralgia.1
Because capsaicin is potentially highly irritating, mucous membranes adjacent to the treatment zone were covered with a layer of petroleum jelly and a dry compress before the capsaicin patch was applied.
A total of 60 patients were treated with the capsaicin patch in this prospective observational study. At 2 months, 24% of patients indicated that their pelvic pain was “very much improved” or “much improved,” compared with baseline.
Overall, patients reported that their pelvic pain was improved by 58% on average. The extent of pain reduction was greater among patients with a good response (“very much improved” or “much improved”).
Summary & Clinical Applicability
With limited medical and surgical treatment options available, chronic coccygodynia can be challenging to treat. Researchers evaluated the safety and efficacy of the high-concentration (8%) capsaicin patch in a prospective observational study. Nearly one-quarter of patients reported that their pain was “much improved” or “very much improved” after 2 months of treatment with the capsaicin patch.
“Our results indicate that it is possible to use the capsaicin patch for chronic pelvic pain, even on the perineum,” Dr Levesque told Clinical Pain Advisor. “The efficacy is comparable to that obtained at other treatment sites. The capsaicin patch could be a new and very interesting treatment for coccygodynia.”
The most common adverse event was a burning sensation in the treated region, which resolved after 12 hours to 10 days.
The study population was small, and the study design was observational and nonrandomized.
A sizeable proportion of patients had pain that was refractory to medical and surgical treatments, which may have reduced the treatment effect.
- Levesque A, Riant T, Labat JJ, Ploteau S. Use of high-concentration capsaicin patch for the treatment of pelvic pain: observational study of 60 inpatients. Pain Physician. 2017;20(1):E161-E167.
- Doursounian L, Maigne JY, Faure F, Chatellier G. Coccygectomy for instability of the coccyx. Int Orthop. 2004;28(3):176-179.
- Kennedy WR, Vanhove GF, Lu SP, et al. A randomized, controlled, open-label study of the long-term effects of NGX-4010, a high-concentration capsaicin patch, on epidermal nerve fiber density and sensory function in healthy volunteers. J Pain. 2010;11(6):579-587. doi: 10.1016/j.jpain.2009.09.019