What are the indications for the Bell Buka (capsaicin or lidocaine) pain patch?

Indications for Bell Buka Pain Patch

Primary FDA-Approved and Guideline-Supported Indications

Bell Buka pain patches containing capsaicin or lidocaine are indicated for localized neuropathic pain conditions, including postherpetic neuralgia, painful diabetic peripheral neuropathy, HIV-associated peripheral neuropathy, and localized musculoskeletal pain. 1, 2

Capsaicin Formulations

High-Concentration Capsaicin (8% Patch):

• Postherpetic neuralgia - designated as first-line treatment with excellent efficacy (NNT = 2), providing pain relief lasting up to 12 weeks from a single 30-60 minute application 1, 3
• HIV-associated peripheral neuropathy - 31% of patients achieve >30% pain reduction compared to 14% with placebo 1, 3
• Painful diabetic peripheral neuropathy - FDA-approved indication for localized neuropathic foot pain 1, 3
• Chemotherapy-induced peripheral neuropathy - considered as a treatment option (Grade III, C recommendation) 3

Low-Concentration Capsaicin (0.025-0.075% Cream):

• Localized neuropathic pain syndromes - applied 3-4 times daily for 6 weeks, particularly effective for diabetic neuropathy when contraindications to oral therapy exist 1, 3
• Peripheral neuropathic pain - recommended by consensus guidelines despite equivocal randomized trial data 4

Lidocaine Formulations

Lidocaine 4-5% Patches:

• Postherpetic neuralgia - first-line treatment with 60% of patients achieving moderate to complete pain relief using the 12-hour daily application protocol 1
• Painful diabetic polyneuropathy - effective for localized pain, particularly nighttime foot pain 1
• HIV-associated peripheral neuropathy - demonstrated efficacy in controlled trials 1
• Low back pain - significantly improves pain qualities when added to existing analgesic regimens 5, 6
• Osteoarthritis of the knee - reduces pain intensity as monotherapy or add-on therapy 7
• Localized musculoskeletal pain - myalgias, arthralgias, and myofascial pain 5
• Acute localized pain - low to moderate-quality evidence supports use in emergency department settings 8

Application Protocols and Safety Considerations

Capsaicin 8% Patch Protocol:

• Mandatory pretreatment with topical lidocaine 4% for 60 minutes to reduce application-related discomfort 1, 3
• Applied for 30-60 minutes under medical supervision (60 minutes for postherpetic neuralgia, 30 minutes for other conditions) 3
• Consider short-acting opioids or acetaminophen during and up to 7 days post-application for breakthrough pain 3
• Can be reapplied every 90 days if pain returns 1, 3

Lidocaine Patch Protocol:

• Apply up to 3-4 patches for 12 hours within a 24-hour period, followed by a 12-hour patch-free interval 1, 5
• Can be applied to dorsal or plantar surfaces of affected areas 1
• Minimal systemic absorption reduces systemic side effects, allowing safe combination with other pain medications 1

Critical Safety Warnings (FDA-Mandated)

Capsaicin Contraindications:

• Do not use on wounds or damaged skin 9
• Avoid contact with eyes, lips, nose, and mucous membranes 9
• Do not apply heat to treated area immediately before or after use 9
• Stop use if severe burning persists or blistering occurs 9

Lidocaine Contraindications:

• Do not use on large areas, cut, irritated or swollen skin, or puncture wounds 2
• Contraindicated in advanced liver failure and known hypersensitivity to amide anesthetics 1, 5
• Do not bandage or apply local heat (such as heating pads) to the area with a medicated patch 2
• Monitor for signs of systemic absorption: dizziness, confusion, bradycardia 1, 5
• Avoid excessive heat application as it increases systemic absorption 1

Multimodal Pain Management Strategy

When topical agents provide inadequate relief, combine with or transition to:

• Gabapentin (100-300 mg starting dose, titrated to 900-3600 mg daily) for neuropathic pain 1
• Pregabalin (50 mg three times daily, titrated to 100 mg three times daily) 1
• Tricyclic antidepressants (nortriptyline, desipramine 10-25 mg starting dose, titrated to 50-150 mg) 1
• SNRIs (duloxetine, venlafaxine) as part of multimodal strategy 4

Topical agents are most appropriate for:

• Well-localized pain affecting specific areas 1, 5
• Patients with contraindications to oral medications 3
• Patients preferring to avoid systemic side effects 1

Topical agents are unlikely to benefit:

• Central neuropathic pain or widespread pain distribution 5
• Patients requiring systemic analgesia for diffuse pain 1