Clinical question
How effective is topical, high-concentration (8%) capsaicin for chronic neuropathic pain in adults?
Bottom line
High-concentration topical capsaicin (applied by slow-release patch) was better than very low-concentration capsaicin in adults with postherpetic neuralgia. Good pain relief (moderate or substantial benefit for 2–12 weeks) was achieved by about 10% more people with high-concentration capsaicin than with control, after a single application (NNT* 6–9). There was limited evidence that a similar proportion of people benefited in painful diabetic neuropathy and HIV-neuropathy. Serious adverse events were no more common with active treatment than control.
*NNT = number needed to treat to benefit 1 individual.
Caveat
These results should be interpreted with caution as the quality of the evidence was moderate or very low. It was not clear how well repeated applications worked, as the therapy needs to be repeated several times a year.
Context
Only the 8% patch formulation of capsaicin is available, with a capsaicin concentration about 100 times greater than conventional creams. High-concentration topical capsaicin is given as a single patch application to the affected part. It must be applied under highly controlled conditions, often following local anaesthetic, due to the initial intense burning sensation it causes. The benefits are expected to last for about 12 weeks, when another application might be made.
Cochrane Systematic Review
Derry S et al. Topical capsaicin (high concentration) for chronic neuropathic pain in adults. Cochrane Reviews, 2017, Issue 1. Art. No.: CD007393.DOI: 10.1002/14651858. CD007393.pub4. This review contains 8 studies involving 2488 participants. It is an update of a Cochrane Review published in February 2013, and includes 2 new studies with 413 participants.
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