Peripheral nerve pain is a particular type of pain caused by damage to the peripheral nervous system. This is a network of nerves that transmit information between the brain and other parts of the body. When these nerves become damaged, they sometimes send confused messages to the brain. This may result in pain that can be described as stabbing, burning, shooting, aching or like an electric shock. Peripheral neuropathy is a side effect of systemic anti-cancer therapy (SACT) that has a detrimental impact on quality of life.

Qutenza is indicated for the management of neuropathic pain. It is a patch for use on your skin. Qutenza contains a synthetic form of capsaicin, which is the compound that gives chilli peppers their heat sensation. The capsaicin acts on pain sensing nerves in the skin, making them less sensitive to pain.

The purpose of this guideline is to provide guidance for:

• Haematology Clinical Nurse Specialist within NHS Ayrshire & Arran hospitals on the administration of transdermal Qutenza patches.

• Haemato-oncology patients with peripheral neuropathy following SACT.
• Patients who have tried two oral medications at maximum tolerated dose in accordance with NICE Guideline 173 .
• Patients who are experiencing significant side effects and not able to tolerate the oral medications stipulated in NICE Guideline 173 .

• Patients with unstable or poorly controlled hypertension and / or cardiovascular disease.

• CNS must successfully complete the Qutenza e-Learning module.
• CNS must complete period of supervised practice with a practitioner competent in the administration of Qutenza.
• CNS must keep training record for PDR / NMC revalidation purposes.

• Identification of appropriate patients in line with NICE Guideline 173 , initial information provision and consent.
• Qutenza information provision written and verbal.
• Explanation of side effects to patient / carer / family including:
  • localised pain or burning sensation
  • skin redness or irritation
  • transient increase in blood pressure
  • papules in the area of treatment
  • itching
  • nausea
  • sensitivity to heat (eg, hot shower/bath, direct sunlight, vigorous exercise) for a few days.
• Verbal consent.
• Prescription for Qutenza (A minimum interval of 60 days between treatments should be observed as per SPC)
• Inform the patient:
  • not to touch the patch
  • to inform you immediately if any of the side effects become severe or irritation of the eyes or airways occurs
  • if given to treat acute pain during/after Qutenza treatment, medications (such as opioids) may affect the ability to perform potentially hazardous activities (eg, driving or operating machinery)

Preparation

• Monitor the patient’s blood pressure prior to and during treatment.
• Nitrile gloves must be worn when handling, applying and cleaning capsaicin residue from the skin. Do not use latex gloves as they do not provide adequate protection.
• Administer Qutenza in a well-ventilated treatment area and use a face mask.
• Inspect the Qutenza (capsaicin) 8% pouch. Do not use if the pouch has been torn or damaged.
• Use Qutenza only on dry, intact (unbroken) skin.
• Prepare to treat acute pain during and following the procedure with local cooling and/or appropriate analgesics.

Application

1. Mark painful areas (including areas of hypersensitivity and allodynia), clip hair (if necessary, do not shave), gently wash treatment area with mild soap and water, and dry thoroughly.
2. Before removing the protective release liner, cut Qutenza to fit the treatment area, using the tracing paper if necessary.
3. Apply the Qutenza patch within 2 hours of opening the pouch.
4. Peel back a small section of the release liner and place the adhesive side of the patch on the treatment area.
5. Slowly peel back the release liner from under the patch while smoothing the patch down on to the treatment area.
6. Leave in place for 30 minutes for feet or 60 minutes for elsewhere on the body.
7. A rolled gauze dressing may be used to ensure Qutenza maintains contact with the treatment area.

Documentation

• Document procedure within FormStream.
• Dictate a letter to the patients GP.
• Arrange a follow up appointment for 12 weeks with the CNS.
• Provide patient with CNS contact details.

1. NICE. Neuropathic pain in adults: pharmacological management in non-specialist settings. CG173. Updated 2020. Available from: https://www.nice.org.uk/guidance/cg173 
2. Qutenza.com. Prescription Treatment For DPN and PHN | QUTENZA (Capsaicin) | QUTENZA (Capsaicin)
3. Scottish Medicines Consortium. Capsaicin (Qutenza). capsaicin (Qutenza) (scottishmedicines.org.uk)
4. EMC. Qutenza 179mg cutaneous patch. Qutenza 179mg cutaneous patch - Summary of Product Characteristics (SmPC) - (emc) (medicines.org.uk)