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Injection site pain, and erythema: case report A 46-year-old man developed injection site pain during treatment with treprostinil, and erythema during subsequent treatment with capsaicin [Qutenza]. The man was diagnosed with pulmonary hypertension secondary to HIV. He was treated with SC treprostinil infusions [dosage not stated]. He reported intense pain at the puncture site during the first 4–5 days of infusion. His visual analogue scale (VAS) score was 9–10, requiring him to be confined to bed. His pain subsequently became more tolerable (VAS 2), observing induration and inflammation, which was supported at the time. Changing his puncture site was delayed to every 5–6 weeks on medical advice, with an infusion of 0.042 mL/h. He reported performing primary treatment with cold, paracetamol [acetaminophen], tramadol and gabapentin, but achieved no relief. Concomitant treatment was introduced, comprising nifedipine, lorazepam and paracetamol. In his first consultation, he was started on treatment with lidocaine patches over 12 hours every 24 hours, beginning before puncture site rotation and continuing while pain persisted. However, he sought advice after a month, having experienced no improvement. The man started off-label treatment with 8% capsaicin patches for an hour on the periumbilical abdominal site, with lidocaine/prilocaine cream pretreatment. Erythema was noted in the administration site [duration of treatment to reaction onset and outcome not stated], but there was no further incident. Good treatment tolerance was reported, and he was discharged. At his 1-month follow-up, he reported remarkable pain reduction (VAS 2–3), which allowed him to lead a normal life; the same level of analgesia continued at his 3-month follow-up. Author comment: "The issue with treprostinil is the high rate of drop-outs due to pain at the injection site . . . The treatment with capsaicin 8% patch, was performed for one hour, according to the protocol, the peri-umbilical abdominal area (injection site) was delimited and the patch administered for one hour . . . erythema at the administration site was subsequently subsequently observed, albeit with no further incidents". Trinidad JM, et al. Using the 8% capsaicin patch for treatment of pain by subcutaneous infusion of treprostinil. Revista de la Sociedad Espanola del Dolor 19: 134-137, No. 3, 2012 [Spanish; summarised from a translation] 803095729 Spain

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Reactions 16 Nov 2013 No. 1478