Topical capsaicin (high concentration) for chronic neuropathic pain in adults - PubMed
- ️Tue Jan 01 2013
Review
Topical capsaicin (high concentration) for chronic neuropathic pain in adults
Sheena Derry et al. Cochrane Database Syst Rev. 2013.
Update in
-
Topical capsaicin (high concentration) for chronic neuropathic pain in adults.
Derry S, Rice AS, Cole P, Tan T, Moore RA. Derry S, et al. Cochrane Database Syst Rev. 2017 Jan 13;1(1):CD007393. doi: 10.1002/14651858.CD007393.pub4. Cochrane Database Syst Rev. 2017. PMID: 28085183 Free PMC article. Review.
Abstract
Background: Topical creams with capsaicin are used to treat peripheral neuropathic pain. Following application to the skin capsaicin causes enhanced sensitivity, followed by a period with reduced sensitivity and, after repeated applications, persistent desensitisation. High-concentration (8%) capsaicin patches were developed to increase the amount of capsaicin delivered; rapid delivery was thought to improve tolerability because cutaneous nociceptors are 'defunctionalised' quickly. The single application avoids noncompliance. 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, normally under 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.
Objectives: To review the evidence from controlled trials on the efficacy and tolerability of topically applied, high-concentration (8%) capsaicin in chronic neuropathic pain in adults.
Search methods: We searched CENTRAL, MEDLINE, EMBASE and clinicaltrials.gov to December 2012.
Selection criteria: Randomised, double-blind, placebo-controlled studies of at least six weeks' duration, using topical capsaicin to treat neuropathic pain.
Data collection and analysis: Two review authors independently assessed trial quality and validity, and extracted data on numbers of participants with pain relief (clinical improvement) after at least six weeks, and with local skin reactions. We calculated risk ratio and numbers needed to treat to benefit (NNT) and harm (NNH). We sought details of definition of pain relief and specific adverse events.Efficacy outcomes reflecting long-duration pain relief after a single drug application were from the patient global impression of change (PGIC) at specific points, usually eight and 12 weeks. We regarded these outcomes as first-tier evidence. We regarded average pain scores over weeks 2 to 8 and 2 to 12 and the number and/or percentage of participants with pain intensity reduction of at least 30% or at least 50% over baseline as second-tier evidence.
Main results: We included six studies, involving 2073 participants; they were of generally good reporting quality; the control was 0.04% topical capsaicin to help maintain blinding. Efficacy outcomes were inconsistently reported between studies, however, resulting in analyses for most outcomes being based on less than complete data.Four studies involved 1272 participants with postherpetic neuralgia. All efficacy outcomes were significantly better than control. At both eight and 12 weeks there was a significant benefit for high-concentration over low-concentration topical capsaicin for participants reporting themselves to be much or very much better, with point estimates of the NNTs of 8.8 (95% confidence interval (CI) 5.3 to 26) and 7.0 (95% CI 4.6 to 15) respectively. More participants had average 2 to 8-week and 2 to 12-week pain intensity reductions over baseline of at least 30% and at least 50% with active treatment than control, with NNT values between 10 and 12.Two studies involved 801 participants with painful HIV-neuropathy. In a single study the NNT at 12 weeks for participants to be much or very much better was 5.8 (95% CI 3.8 to 12). Over both studies more participants had average 2 to 12-week pain intensity reductions over baseline of at least 30% with active treatment than control, with an NNT of 11.Local adverse events were common, but not consistently reported. Serious adverse events were no more common with active treatment (4.1%) than control (3.2%). Adverse event withdrawals did not differ between groups, but lack of efficacy withdrawals were somewhat more common with control than active treatment, based on small numbers of events. No deaths were judged to be related to study medication.
Authors' conclusions: High-concentration topical capsaicin used to treat postherpetic neuralgia and HIV-neuropathy generates more participants with high levels of pain relief than does control treatment using a much lower concentration of capsaicin. The additional proportion who benefit over control is not large, but for those who do obtain high levels of pain relief there are additional improvements in sleep, fatigue, depression and an improved quality of life. High-concentration topical capsaicin is therefore similar to other therapies for chronic pain. In this case, the high cost of single and repeated applications suggest that high-concentration topical capsaicin is likely to be used when other available therapies have failed, and that it should probably not be used repeatedly without substantial documented pain relief. Even when efficacy is established, there are unknown risks, especially on epidermal innervation, of repeated application of long periods.
Update of
-
Topical capsaicin for chronic neuropathic pain in adults.
Derry S, Lloyd R, Moore RA, McQuay HJ. Derry S, et al. Cochrane Database Syst Rev. 2009 Oct 7;(4):CD007393. doi: 10.1002/14651858.CD007393.pub2. Cochrane Database Syst Rev. 2009. PMID: 19821411 Free PMC article. Updated. Review.
Similar articles
-
Topical capsaicin (high concentration) for chronic neuropathic pain in adults.
Derry S, Rice AS, Cole P, Tan T, Moore RA. Derry S, et al. Cochrane Database Syst Rev. 2017 Jan 13;1(1):CD007393. doi: 10.1002/14651858.CD007393.pub4. Cochrane Database Syst Rev. 2017. PMID: 28085183 Free PMC article. Review.
-
Oxycodone for neuropathic pain and fibromyalgia in adults.
Gaskell H, Moore RA, Derry S, Stannard C. Gaskell H, et al. Cochrane Database Syst Rev. 2014 Jun 23;(6):CD010692. doi: 10.1002/14651858.CD010692.pub2. Cochrane Database Syst Rev. 2014. PMID: 24956205 Updated. Review.
-
Gabapentin for chronic neuropathic pain and fibromyalgia in adults.
Moore RA, Wiffen PJ, Derry S, Toelle T, Rice AS. Moore RA, et al. Cochrane Database Syst Rev. 2014 Apr 27;2014(4):CD007938. doi: 10.1002/14651858.CD007938.pub3. Cochrane Database Syst Rev. 2014. PMID: 24771480 Free PMC article. Updated. Review.
-
Gabapentin for chronic neuropathic pain in adults.
Wiffen PJ, Derry S, Bell RF, Rice AS, Tölle TR, Phillips T, Moore RA. Wiffen PJ, et al. Cochrane Database Syst Rev. 2017 Jun 9;6(6):CD007938. doi: 10.1002/14651858.CD007938.pub4. Cochrane Database Syst Rev. 2017. PMID: 28597471 Free PMC article. Review.
-
Tramadol for neuropathic pain in adults.
Duehmke RM, Derry S, Wiffen PJ, Bell RF, Aldington D, Moore RA. Duehmke RM, et al. Cochrane Database Syst Rev. 2017 Jun 15;6(6):CD003726. doi: 10.1002/14651858.CD003726.pub4. Cochrane Database Syst Rev. 2017. PMID: 28616956 Free PMC article. Review.
Cited by
-
Hydromorphone for neuropathic pain in adults.
Stannard C, Gaskell H, Derry S, Aldington D, Cole P, Cooper TE, Knaggs R, Wiffen PJ, Moore RA. Stannard C, et al. Cochrane Database Syst Rev. 2016 May 24;2016(5):CD011604. doi: 10.1002/14651858.CD011604.pub2. Cochrane Database Syst Rev. 2016. PMID: 27216018 Free PMC article. Review.
-
Erythromelalgia: a cutaneous manifestation of neuropathy?
Leroux MB. Leroux MB. An Bras Dermatol. 2018 Jan-Feb;93(1):86-94. doi: 10.1590/abd1806-4841.20187535. An Bras Dermatol. 2018. PMID: 29641704 Free PMC article. Review.
-
Mitochondrial fission augments capsaicin-induced axonal degeneration.
Chiang H, Ohno N, Hsieh YL, Mahad DJ, Kikuchi S, Komuro H, Hsieh ST, Trapp BD. Chiang H, et al. Acta Neuropathol. 2015 Jan;129(1):81-96. doi: 10.1007/s00401-014-1354-3. Epub 2014 Oct 17. Acta Neuropathol. 2015. PMID: 25322817 Free PMC article.
-
Acupuncture for neuropathic pain in adults.
Ju ZY, Wang K, Cui HS, Yao Y, Liu SM, Zhou J, Chen TY, Xia J. Ju ZY, et al. Cochrane Database Syst Rev. 2017 Dec 2;12(12):CD012057. doi: 10.1002/14651858.CD012057.pub2. Cochrane Database Syst Rev. 2017. PMID: 29197180 Free PMC article. Review.
-
Ma XL, Zhang FX, Dong F, Bao L, Zhang X. Ma XL, et al. Mol Pain. 2015 Apr 22;11:22. doi: 10.1186/s12990-015-0019-0. Mol Pain. 2015. PMID: 25896608 Free PMC article.
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Other Literature Sources