The effectiveness of topically applied capsaicin
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To undertake a quantitative overview of trials of topical capsaicin for the treatment of diabetic neuropathy, osteoarthritis, post-herpetic neuralgia, and psoriasis.
A systematic search of the literature using both computerized and manual methods for identifying clinical trials of capsaicin. The trials identified were abstracted for response data, which then were analysed using established meta-analytic methods for both fixed and random effects modelling.
The odds ratio of the response rate of subjects receiving topical capsaicin relative to that of subjects on placebo was used as the main outcome measure. The difference in the response rate was used as the response variable under the random effects model. When dropouts were mentioned and unambiguous assignment could not be made, the analysis was made on the basis of intention to treat.
Capsaicin cream give more pain relief to patients with diabetic neuropathy than placebo did. The odds ratio (OR) and corresponding 95% confidence interval (95% CI) in favour of capsaicin cream were OR=2.74 (95% CI=1.73, 4.32). Using a random effect model the rate difference (RD) in favour of capsaicin cream was RD=0.25 (95% CI=0.15, 0.35).
Capsaicin cream was also better than placebo in providing pain relief in osteoarthritis: OR=4.36 (95% CI=2.77, 6.88) and RD=0.29 (95% CI=0.20, 0.37) and in psoriasis: OR=2.80 (95% CI=1.69, 4.62) and RD=0.35 (95% CI=0.14, 0.56). There was, however, evidence of heterogeneity in the individual RDs in psoriasis, and complete blinding was difficulty because of the initial discomfort associated with topical capsaicin.
In post-herpetic neuralgia the results were even less convincing.
Topical capsaicin appears to be effective in the management of a variety of painful clinical conditions affecting the skin. However, totally blind trials are difficult to conduct with this substance. Future trials will need to address this problem more rigorously if a definitive answer about the effectiveness of capsaicin is to be obtained.
Key wordsCapsaicin Diabetic neuropathy pain relief patients
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- 1.Bernstein JE (1987) Capsaicin in the treatment of dermatologic disease. Cutis 39: 352–353Google Scholar
- 2.Council of Pharmaceutical Society of Great Britain (1952) Martindale — The Extra Pharmacopoeia 23 rd edn, vol 1. Pharmaceutical Press, London, pp 324Google Scholar
- 3.Li Wan Po A (1990) Non prescription drugs, 2nd edn. Blackwell, OxfordGoogle Scholar
- 4.Virus RM, Gebhart GF (1979) Pharmacologic actions of capsaicin: apparent involvement of substance P and serotonin. Life Sci 25: 1273–1284Google Scholar
- 5.Vaught JL (1988) Substance P antagonists and analgesia: a review of the hypothesis. Life Sci 43: 1419–1431Google Scholar
- 6.Payan P (1989) Neuropeptides and inflammation. The role of substance P. Ann Rev Med 40: 341–352Google Scholar
- 7.Nicoll RA, Schenker C, Leeman SE (1980) Substance P as a transmitter candidate. Ann Rev Neurosci 3: 227–268Google Scholar
- 8.Mantel N, Haenszel W (1959) Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst 22: 719–748Google Scholar
- 9.DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Contr Clin Trials 7: 177–188Google Scholar
- 10.Yusuf S, Peto R, Lewis J, Collins R, Sleight P (1985) Beta-blockade during and after myocardial infarction: an overview of the randomised trials. Prog Cardiovasc Dis 27: 335–371Google Scholar
- 11.Chad DA, Aronin N, Lundstrom R, McKeon P, Ross D, Molitch M, Schipper HM, Stall G, Dyess E, Tarsy D (1990) Does capsaicin relieve the pain of diabetic neuropathy. Pain 42: 387–388Google Scholar
- 12.Scheffler NM, Sheitel PL, Lipton MN (1991) Treatment of painful diabetic neuropathy with capsaicin 0.075%. J Am Pediatr Med Assoc 31: 288–293Google Scholar
- 13.The Capsaicin Study Group (1991) Treatment of painful diabetic neuropathy with topical capsaicin — a multicentre, double-blind, vehicle-control study. Arch Intern Med 151: 2225–2229Google Scholar
- 14.Tandan R, Lewis GA, Krusinski PB, Badger GB, Fries TJ (1992) Topical capsaicin in painful diabetic neuropathy — controlled study with long-term follow-up. Diab Care 15: 8–14Google Scholar
- 15.Ross DR, Varipapa RJ (1989) Treatment of painful diabetic neuropathy with topical capsaicin. New Engl J Med 321: 474–475Google Scholar
- 16.Pirart J (1978) Diabetic mellitus and its degenerative complications: a prospective study of 4400 patients observed between 1947 and 1973. Diab Care 1: 168–88, 252–263Google Scholar
- 17.Deal CL, Schnitzer TJ, Lipstein E, Seibold JR, Stevens RM, Levy MD, Albert D, Renold F (1991) Treatment of arthritis with topical capsaicin: a double-blind trial. Clin Ther 13: 383–393Google Scholar
- 18.McCarthy GM, McCarty DL (1992) Effect of topical capsaicin in the therapy of painful osteoarthritis of the hands. J Rheumatol 19: 604–607Google Scholar
- 19.Schinitzer TJ, Morton C, Coker S, Flynn P (1992) Effectiveness of reduced applications of topical capsaicin (0.025%) in osteoarthritis. Arthritis and Rheumatism 35: S132Google Scholar
- 20.Harris ED (1990) Rheumatoid arthritis: pathophysiology and implications for therapy. New Engl J Med 322: 1277–1289Google Scholar
- 21.Lotz M, Carson DA, Vaughan JH (1987) Substance P activation of rheumatoid synoviocytes: neural pathogenesis of arthritis. Science 235: 893–895Google Scholar
- 22.Levine JD, Clark R, Devor M, Helms C, Moskowitz MA, Basbaum AI (1984) Intraneuronal substance P contributes to the severity of experimental arthritis. Science 226: 547–549Google Scholar
- 23.Badlamente MA, Cherney SA (1989) Periosteal and vascular innervation of the human patella in degenerative joints disease. Sem Arthr Rheum 18: 61–66Google Scholar
- 25.Bernstein JE, Korman NJ, Bickers DR, Dahl MV, Milliken LE (1989) Topical capsaicin treatment of chronic postherpetic neuralgia. J Am Acad Dermatol 21: 265–270Google Scholar
- 26.Drake HF, Harris AJ, Gamester RE, Justins D (1990) Randomised double-blind study of topical capsaicin for treatment of postherpetic neuralgia. Pain 5 [Suppl]: S58Google Scholar
- 27.Watson CPN, Evans RJ, Watt VR (1988) Postherpetic neuralgia and topical capsaicin. Can J Neurol Sci 15: 197Google Scholar
- 28.Peikert A, Hentrich M, Ochs G (1991) Topical 0.025% capsaicin in chronic postherpetic neuralgia: efficacy, predictors of response and long-term course. J Neurol 238: 452–456Google Scholar
- 29.Bernstein JE, Bickers DR, Dahl MV, Roshal JY (1987) Treatment of chronic postherpetic neuralgia with topical capsaicin — a preliminary study. J Am Acad Dermatol 17: 93–96Google Scholar
- 30.Fusco BM, Alessandri M (1992) Analgesic effect of capsaicin in idiopathic trigeminal neuralgia. Anesth Analg 74: 375–377Google Scholar
- 31.Hawk RJ, Millikan LE (1988) Treatment of oral postherpetic neuralgia with topical capsaicin. Int J Dermatol 27 (5): 336Google Scholar
- 32.Bucci FA, Gabriels CF, Krohel GB (1988) Successful treatment of postherpetic neuralgia with capsaicin. Am J Ophthalmol 106: 758–759Google Scholar
- 33.Don PC (1988) Topical capsaicin for treatment of neuralgia associated with Herpes zoster infection. J Am Acad Dermatol 18: 135Google Scholar
- 34.Jolleys JV (1989) Treatment of shingles and postherpetic neuralgia. Br Med J 298: 1537–1538Google Scholar
- 35.Arner A, Meyerson BA (1988) Lack of analgesic effect of opiods on neuropathic and idiopathic forms of pain. Pain 33: 11–23Google Scholar
- 36.Bernstein JE, Parish LC, Rapaport M, Rosenbaum MM, Roenigk HH (1986) Effects of topically applied capsaicin on moderate and severe psoriasis vulgaris. J Am Acad Dermatol 15: 504–507Google Scholar
- 37.Kurkcuoglu N, Alaybeyi F (1990) Topical capsaicin for psoriasis. Br J Dermatol 123: 549–550Google Scholar
- 38.Berberian B, Bernstein JE, Dodd WA, Ellis CN, Rumsfield J, Sulica VI (1990) Double-blind evaluation of capsaicin cream in pruritis psoriasis. Clin Res 38: 664 AGoogle Scholar
- 39.Ellis CN, Berberian B, Sulien VI, Dodd WA, Jarratt MT, Katz HI, Prawer S, Krueger G, Rex IH Jr, Wolf JE (1993) A double-blind evaluation of topical capsaicin in pruritic psoriasis. J Am Acad Dermatol 29: 438–442Google Scholar
- 40.Naukkarinen A, Nickoloff BJ, Faber EM (1989) Quantification of cutaneous sensory nerves and their substance P content in psoriasis. J Invest Dermatol 92: 126–129Google Scholar
- 41.Anand P, Springall DR, Blank MA, Sellu D, Polack JM, Bloom SR (1992) Neuropeptides in skin disease: increased VIP in eczema and psoriasis but not axillary hyperhidrosis. Br J Dermatol 124: 547–549Google Scholar
- 42.Granek I, Ashikari P, Foley KM (1984) The postmastectomy pain syndrome: clinical and anatomical correlations. Proc ASCO 3: 122Google Scholar
- 43.Assa J (1974) The intercostobrachial nerve in radical mastectomy. J Surg Oncol 6: 123–26Google Scholar
- 44.Watson CPN, Evans RJ (1992) The postmastectomy pain syndrome and topical capsaicin: a randomized trial. Pain 51: 375–379Google Scholar
- 45.Watson CPN, Evans RJ, Watt UR (1989) The post-mastactomy pain syndrome and the effect of topical capsaicin. Pain 38: 177–186Google Scholar
- 46.Dini D, Bertelli G, Gozza A, Forno GG (1993) Treatment of the post-mastactomy pain syndrome with topical capsaicin. Pain 54: 223–226Google Scholar
- 47.Rayner HC, Atkins RC, Westerman RA (1989) Relief of local stump pain by capsaicin cream. Lancet II: 1276–1277Google Scholar
- 48.Weintraub M, Golik A, Rubio A (1990) Capsaicin for treatment of post-traumatic amputation stump pain. Lancet 336: 1003–1004Google Scholar