A 46-year-old patient diagnosed with pulmonary hypertension secondary to HIV was treated with subcutaneous treprophylaxis.
She complains of severe pain in the puncture site (periumbilical abdominal area) during the first days (4-5) of the infusion, with very severe intensity (VAS 9-10) requiring bedridden pain.
Thereafter, pain becomes more tolerable (VAS 2), observing an induration and inflammation of the area that remains over time.
By medical indication, it prolongs the change in the puncture site (on one side and on the other side of the alba line), currently rotating every 5-6 weeks.
Your current infusion dose is 0.042 ml/h.
The concomitant treatment is non-compliance with 30 mg prolonged release ceftriaxone 1 mg and paracetamol.
The patient also reported having made primary treatment measures with cold, paracetamol, tramadol and gabapentin at effective doses without achieving any relief.
In a first consultation, after ruling out the use of major opioids, an initial treatment with 2% lidocaine patch was prescribed for 12 hours every 24 hours, starting administration prior to rotation of the puncture site and during the puncture site.
However, the patient came one month later without improvement and with the same intensity of pain.
Searches were conducted in PubMed and Tripdatabase, using the terms "capsaicin patch", "capsaicin", "capsaicin", "remodulin" and "trpulmonary hypertension".
Only two recent unpublished clinical trials addressing "Immm Chapnel London" and "Uniperi Rochester officiency" have been located.
At this time, we propose the possibility of experimental treatment with capsaicin 8% patch (Qutenza®), indicating to the patient its use off-label and signing the informed consent.
Previous treatment was performed for one hour with EMLA cream, according to protocol, the periumbilical abdominal area was delimited (puncturing site) and patch was administered for one hour.
Subsequently, erythema was observed at the administration site, with no further incidence.
Good tolerance of treatment and discharge home.
At one month follow-up, the patient reported having changed the puncture point to the treated area with a marked reduction in pain (VAS 2-3) that allows her to have a normal life.
Patient satisfaction is "very high" and does not require adjuvant treatment or rescue.
At 3 months follow-up, the same level of analgesia is maintained.
