1. health and fitness
2. disease
3. chronic pain

“Too Busy for Post-Shingles Nerve Pain”
Educational Event
Please see full prescribing information for Qutenza® (capsaicin) 8% patch.
Q2011462-4
Brought to you by NeurogesX, Inc.
1
Today’s Agenda
 Introducing our expert speaker
 Educational overview of post-shingles nerve pain
 Understanding treatment options
 Meet the expert speaker
 Getting help & updates from NeurogesX
2
What Is Shingles?
Shingles (herpes zoster) is a viral disease
characterized by a painful skin rash caused by a
return of the chicken pox virus.
3
How Shingles Rash Appears
 Usually starts as painful rash
on one side of the body or
face, clearing up within
2 - 4 weeks1
 Approximately 1 million
cases per year1
1. Weaver BA. J AM Osteopath Assoc. 2009;109(6)(suppl 2):S2-S6.
Images from Harpaz R, et al. MMWR Recomm Rep. 2008;57(RR-5):1-30.
4
Who’s Likely to Get Shingles?
90% of adults in the US are at risk for developing shingles
 Have had chicken pox1
o
Return of the chicken pox virus is the cause of shingles
 Getting older
o
o
More likely to get shingles as we get older1
Symptoms of the condition get worse with age2
 Have immune problems1
o
o
o
o
Cancer
Drugs that depress the immune system
HIV (risk up to 15 times higher in these patients3)
Bone marrow/organ transplant4
1. Centers for Disease Control and Prevention Web site. http://www.cdc.gov/vaccines/vpd-vac/shingles/dis-faqs.htm.
Updated May 19, 2008. Accessed July 28, 2010.
2. Oxman MN. J Am Osteopath Assoc. 2009;109(suppl 2):S13-S17.
3. Stankus SJ, et al. Am Fam Physician. 2000;61(8):2437-2444, 2447-2448.
4. Schmader KE. Clin J Pain. 2002;18(6):350-354.
5
Shingles Vaccine

Zostavax® vaccine can reduce the risk of getting shingles by
50%1

To learn if Zostavax is right for you, talk to your
healthcare provider.

Visit www.zostavax.com
1. Zostavax ® [package insert]. Whitehouse Station, NJ: Merck & Co., Inc.; April 2011.
6
Shingles Vaccine
 Shingles is treated with antiviral medications such as Famvir®,
Valtrex® or Zovirax®. 1-3
o
o
Should be started as soon as possible
For some, antiviral medications may not prevent post-shingles
nerve pain
 Antiviral medications help make shingles go away faster2
o
o
Especially in older people2
People who did not take any antiviral medication during shingles are
more likely to get post-shingles nerve pain4
1. Famvir® [package insert]. East Hanover, NJ: Novartis Pharmaceuticals Corp.; December 2009.
2. Valtrex® [package insert]. Research Triangle Park, NC: GlaxoSmithKline; September 2008.
3. Zovirax® [package insert]. Research Triangle Park, NC: GlaxoSmithKline; November 2007.
4. Parruti G, et al. BMC Med. 2010;8:58.
7
What Is Post-Shingles Nerve Pain?
 The pain that continues after the healing of shingles blisters1
 Also called post herpetic neuralgia (PHN)
 Gets better very slowly – can last indefinitely
1.Berger A, et al. J Pain. 2004;5(3):143-149.
8
What Increases the Risk of Getting
Post-Shingles Nerve Pain?
 Age1
 Severity of rash1
 Severity of pain
during shingles1
1 in 5 people
with a shingles rash will
experience ongoing pain
due to post-shingles nerve
pain1
 Pain before the
start of the rash1
1. Jung BF, et al. Neurology. 2004;62(9):1545-1551.
9
Symptoms of Post-Shingles Nerve Pain
 Pain typically felt in one area
of the body or face
 Feels like1:
o
o
o
o
o
o
o
Burning or stinging
Sensitivity to light touch
Sudden pain
Pressure
Prickling
Increased sensitivity
to minor pain
Numbness
1. Baron R, et al. Pain. 2009;146(1-2):34-40.
10
Medications Commonly Used for Treatment
of Post-Shingles Nerve Pain
Antidepressants & SSNRI1
Narcotic Pain Killers*
Morphine*
Oxycodone*
Methadone*
Levorphanol*
Tramadol*
Anticonvulsants2,3
Topical Anesthetic4
1. Dworkin RH, et al. Pain. 2007;132(3):237-251.
2. Neurontin® [package insert]. New York: Parke-Davis; July 2010.
3. Lyrica® [package insert]. New York: Parke-Davis; April 2011.
4. Lidoderm® [package insert]. Chadds Ford, PA: Endo Pharmaceuticals; March 2010.
*Generic names listed for opioid agonists only.
11
Another Option for Post-Shingles Nerve
Pain Relief
 Prescription patch applied directly to
the site of post-shingles nerve pain
 Delivers medicine to the pain nerves
in the skin at the site of pain, unlike
pills taken by mouth, which need to
travel through your body to work
 Capsaicin – the substance in chili
peppers that gives them their
heat sensation.
12
Patient Testimonial
13
Qutenza® (capsaicin) 8% patch
Qutenza® is a prescription medicine patch
used to relieve pain from damaged nerves
(neuropathic pain) that can occur following
shingles (postherpetic neuralgia, or PHN)
Serious side effects include pain where the patch is applied and temporary increases in blood pressure
during and shortly after application. The most common side effects include a burning feeling and stinging
during patch application and redness, itchiness and small bumps where the patch was applied. These
side effects usually begin to resolve after patch removal but sometimes can last longer.
Qutenza® [package insert]. San Mateo, CA: NeurogesX, Inc.; November 2009.
14
What Is Qutenza® (capsaicin) 8% patch?
 First and only prescriptionstrength capsaicin medicine
 Safe to use with other medicines
(half of patients in clinical studies
were taking other medicines)
A single, one hour
application of
Qutenza® directly to
the site of your pain
can provide pain relief
for 3 months
 Is non-narcotic (non-opioid) and
unlikely to cause systemic drugdrug interactions
Qutenza® [package insert]. San Mateo, CA: NeurogesX, Inc.; November 2009.
15
Applying the Qutenza® Patch
Applied by a healthcare provider only.
Three Simple Steps:
Step 1:
Identify the Painful Area &
Numb Prior to Application
Qutenza ®[package insert]. San Mateo, CA: NeurogesX, Inc.; November 2009.
16
Applying the Qutenza® Patch
Applied by a healthcare provider only.
Three Simple Steps:
Step 1:
Identify and Numbing
Step 2:
Apply
Patch
Qutenza ®[package insert]. San Mateo, CA: NeurogesX, Inc.; November 2009.
17
Applying the Qutenza® Patch
Applied by a healthcare provider only.
Three Simple Steps:
Step 1:
Identify and Numbing
Step 2:
Apply
Qutenza ®[package insert]. San Mateo, CA: NeurogesX, Inc.; November 2009.
Step 3:
Remove Patch and
Cleanse Skin
18
Understand Your Treatment
Before application, talk to your healthcare provider about what to expect:
 Some people experience burning or stinging while the patch is on the
skin and for a while afterwards
 Pain increase that occurs during patch application usually begins to
resolve after patch removal, but in some instances this can last longer
 To lessen possible discomfort your provider may apply a numbing gel
or cream to your skin before applying Qutenza®
 Your blood pressure may be monitored
 If you have any discomfort, you may be treated with a cooling compress
or other pain medicine. If the additional pain medicine makes you drowsy,
you should not drive
Qutenza ® [package insert]. San Mateo, CA: NeurogesX, Inc.; November 2009.
19
Understand Your Treatment
When can you expect a decrease in your pain?
 As early as the first week after treatment
Consider scheduling a follow-up appointment to let your
healthcare provider know:
 How you are feeling and if your pain is decreasing
 If your pain returns or gets worse
 About another treatment with Qutenza® in 3 months, if
your pain returns
Qutenza ® [package insert]. San Mateo, CA: NeurogesX, Inc.; November 2009.
20
Qutenza® (capsaicin) 8% patch
Clinical Study Experience

More than 1600 patients received Qutenza® in the
clinical studies used by the FDA to approve Qutenza®

Nearly half of patients responded to Qutenza® with meaningful
pain reduction of 30% or greater that lasted for 3 months1,2

98% of patients completed the Qutenza® treatment
Qutenza ® [package insert]. San Mateo, CA: NeurogesX, Inc.; November 2009.
1. Backonja M, et al. Lancet Neurol. 2008;7(12):1106-1112.
2. Irving G, et al. Pain Med. 2011;12(1):99-109.
21
Coverage for Qutenza®
When medically reasonable and necessary, Qutenza® is covered by
Medicare and many private insurance companies for post-shingles
nerve pain.
22
Important Safety Information to Consider
Most Common Adverse Reactions*
1% of patients
treated with Qutenza®
discontinued
from clinical studies
prematurely due to
adverse reactions




Application Site Redness
Application Site Pain
Application Site Itchiness
Application Site Small Bumps
Warnings and Precautions
 Avoid eye and mucous membrane exposure
 Capsaicin may get into the air and cause
you to cough or sneeze
 Placement of the patch on the skin may
be painful
 May cause temporary increases in
blood pressure
Serious Adverse Reactions
 Application site-related pain
 Temporary increases in blood pressure
* ≥5% in Qutenza® (capsaicin) 8% patch treated patients and at an incidence greater than in control
Qutenza ® [package insert]. San Mateo, CA: NeurogesX, Inc.; November 2009.
23
Qutenza® Call Center
For more information about Qutenza ® please call
1-877-900-6479
24
Want to Learn More?
Talk to your healthcare provider,
or let us help you find one in your area.
25