Systematic review of topical capsaicin for the treatment of chronic pain

doi:10.1136/bmj.38042.506748.EE

BMJ 2004;328:991 (24 April), doi:10.1136/bmj.38042.506748.EE (published 19 March 2004)

Primary care

Systematic review of topical capsaicin for the treatment of chronic pain

Lorna Mason, research associate¹, R Andrew Moore, director of research¹, Sheena Derry, senior researcher¹, Jayne E Edwards, senior researcher¹, Henry J McQuay, professor of pain relief¹

¹ Pain Research and Nuffield Department of Anaesthetics, University of Oxford, Oxford Radcliffe Hospital, Headington, Oxford OX3 7LJ

Correspondence to: R A Moore andrew.moore{at}pru.ox.ac.uk

Objective To determine the efficacy and safety of topicallyapplied capsaicin for chronic pain from neuropathic or musculoskeletaldisorders.

Data sources Cochrane Library, Medline, Embase, PubMed, an in-housedatabase, and contact with manufacturers of topical capsaicin.

Study selection Randomised controlled trials comparing topicallyapplied capsaicin with placebo or another treatment in adultswith chronic pain.

Data extraction Primary outcome was dichotomous informationfor the number of patients with about a 50% reduction in pain.Outcomes were extracted at four weeks for musculoskeletal conditionsand eight weeks for neuropathic conditions. Secondary outcomeswere adverse events and withdrawals due to adverse events.

Data synthesis Six double blind placebo controlled trials (656patients) were pooled for analysis of neuropathic conditions.The relative benefit from topical capsaicin 0.075% comparedwith placebo was 1.4 (95% confidence interval 1.2 to 1.7) andthe number needed to treat was 5.7 (4.0 to 10.0). Three doubleblind placebo controlled trials (368 patients) were pooled foranalysis of musculoskeletal conditions. The relative benefitfrom topical capsaicin 0.025% or plaster compared with placebowas 1.5 (1.1 to 2.0) and the number needed to treat was 8.1(4.6 to 34). Around one third of patients experienced localadverse events with capsaicin, which would not have been thecase with placebo.

Conclusions Although topically applied capsaicin has moderateto poor efficacy in the treatment of chronic musculoskeletalor neuropathic pain, it may be useful as an adjunct or soletherapy for a small number of patients who are unresponsiveto, or intolerant of, other treatments.

Add to CiteULike CiteULike Add to Complore Complore Add to Connotea Connotea Add to Del.icio.us Del.icio.us Add to Digg Digg Add to Reddit Reddit Add to Technorati Technorati What's this?

Topical capsaicin may be a useful adjunct in chronic pain...
BMJ 2004 328: 0. [Full Text]

A commentary on commentaries: Richard Smith
BMJ 2004 328: 0. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

Kissin, I. (2008). Vanilloid-Induced Conduction Analgesia: Selective, Dose-Dependent, Long-Lasting, with a Low Level of Potential Neurotoxicity. Anesth. Analg. 107: 271-281 [Abstract] [Full text]
Barron, M. C., Rubin, B. R. (2007). Managing Osteoarthritic Knee Pain. JAOA: Journal of the American Osteopathic Association 107: ES21-ES27 [Abstract] [Full text]
Wassell, R. W., Adams, N., Kelly, P. J. (2006). The treatment of temporomandibular disorders with stabilizing splints in general dental practice: One-year follow-up.. Journal of the American Dental Association 137: 1089-1098 [Abstract] [Full text]
Rubin, B. R. (2005). Management of Osteoarthritic Knee Pain. JAOA: Journal of the American Osteopathic Association 105: S23-S28 [Abstract] [Full text]
Irving, G. A. (2005). Contemporary assessment and management of neuropathic pain. Neurology 64: S21-S27 [Abstract] [Full text]
Lam, P. M. W., McDonald, J., Lambert, D. G. (2005). Characterization and comparison of recombinant human and rat TRPV1 receptors: effects of exo- and endocannabinoids. Br J Anaesth 94: 649-656 [Abstract] [Full text]
(2004). 23 Apr 2004 to 23 Jul 2004. Evid. Based Nurs. 7: e4-e4 [Full text]
(2004). Other articles noted. Evid. Based Med. 9: e5-e5 [Full text]
Cooper, C., Jordan, K. M (2004). Topical NSAIDs in osteoarthritis. BMJ 329: 304-305 [Full text]
(2004). Topical Capsaicin for Chronic Pain?. Journal Watch Dermatology 2004: 9-9 [Full text]
(2004). Topical Capsaicin for Chronic Pain?. JWatch General 2004: 5-5 [Full text]
Tramer, M. R (2004). It's not just about rubbing--topical capsaicin and topical salicylates may be useful as adjuvants to conventional pain treatment. BMJ 328: 998-998 [Full text]

Rapid Responses:

Read all Rapid Responses

Clear & Consise article on an important subject!: NYB Mark Medical
bmj.com, 24 Apr 2004 [Full text]
External pain control help: John Madura
bmj.com, 25 Apr 2004 [Full text]