Treatment of Neuropathic Pain

Kristen Jefferies, Pharm.D.


Semin Neurol. 2010;30(4):425-432. 

In This Article

Topical Capsaicin

Capsaicin depletes substance P. Reviews of six studies (389 patients) of capsaicin 0.075% cream versus placebo, and two studies (709 patients) of a single application of a capsaicin 8% transdermal patch versus placebo revealed the following: The NNT with capsaicin 0.075% cream for 6 to 8 weeks was 6.6 (95% CI 4.1–17) to achieve any pain relief. The NNT with the capsaicin patch to achieve >30% pain reduction at 12 weeks was 12 (95% CI 6.4 to 70). However, it was noted that the data used to calculate the NNT was not robust due to the small study sizes and differences in outcomes used. The most common side effects reported were local skin irritation (burning, stinging, erythema, rash, itching), which typically improved after 1 to 2 weeks. Topical capsaicin is generally recommended as a third-line treatment option when other medications are ineffective or not tolerated. Various topical formulations of low concentration capsaicin are available without a prescription in the United States. In November 2009, capsaicin 8% patch was approved by the FDA for the treatment of PHN. It is administered for 1 hour every 3 months and professional training is required.[17]


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