#225 Topical Capsaicin for Neuropathic and Osteoarthritis Pain: Maybe not so hot?
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- Systematic review [seven Randomized Controlled Trials (RCTs), 1,600 patients, varied neuropathic pain types], 0.075% topical capsaicin versus placebo, 6-12 weeks:1
- Clinical improvement (variably defined): 42% versus 28% (placebo), not statistically different.
- Adverse events:
- Burning, stinging, or erythema: 63% versus 24% (placebo), Number Needed to Harm (NNH)=3.
- Coughing, sneezing: 9% versus 1% (placebo), NNH=13.
- Withdrawal: 15% versus 3% (placebo), NNH=9.
- Two other systematic reviews, 0.075% capsaicin versus placebo, at 4-8 weeks:2,3
- Physician-rated “Much Better” (four RCTs, 309 patients):2 73% versus 49%, Number Needed to Treat (NNT)=5.
- ≥50% pain improvement (10 RCTs, 969 patients):3 NNT~7.
- Adverse events:3
- Local reaction: 58% versus 18%, NNH=3.
- Withdrawal: 16% versus 2%, NNH=8.
- RCT of 33 diabetic neuropathy patients,4 0.025% gel versus placebo:
- Pain score or patients achieving 30% pain reduction: No difference.
- Adverse skin reaction: 15% versus 0% (placebo), NNH=6.
- Two systematic reviews (3-4 RCTs, 301-382 patients, hand osteoarthritis), 0.025%-0.075% topical capsaicin versus placebo at 4-8 weeks:2,5
- Clinical improvement, variably defined:2 45% versus 16%, NNT=4.
- Pain score ~8/100 points lower than placebo.5
- Adverse events not reported.2
- RCT (99 patients, knee osteoarthritis), 0.0125% capsaicin versus placebo over four weeks:6 No improvement.
- Burning or stinging usually receeds after several days of use.7
- 60-gram tube of 0.075% Capsaicin cream costs ~$30 (about 60-day supply based on QID use, depending on area).
- NICE recommends for localized neuropathic pain when oral medications not tolerated8 and as an add-on therapy for knee or hand osteoarthritis pain.9