The effectiveness of topically applied capsaicin

A meta-analysis


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.

This is a preview of subscription content, log in to check access.


  1. 1.

    Bernstein JE (1987) Capsaicin in the treatment of dermatologic disease. Cutis 39: 352–353

    Google Scholar 

  2. 2.

    Council of Pharmaceutical Society of Great Britain (1952) Martindale — The Extra Pharmacopoeia 23 rd edn, vol 1. Pharmaceutical Press, London, pp 324

    Google Scholar 

  3. 3.

    Li Wan Po A (1990) Non prescription drugs, 2nd edn. Blackwell, Oxford

    Google Scholar 

  4. 4.

    Virus RM, Gebhart GF (1979) Pharmacologic actions of capsaicin: apparent involvement of substance P and serotonin. Life Sci 25: 1273–1284

    Google Scholar 

  5. 5.

    Vaught JL (1988) Substance P antagonists and analgesia: a review of the hypothesis. Life Sci 43: 1419–1431

    Google Scholar 

  6. 6.

    Payan P (1989) Neuropeptides and inflammation. The role of substance P. Ann Rev Med 40: 341–352

    Google Scholar 

  7. 7.

    Nicoll RA, Schenker C, Leeman SE (1980) Substance P as a transmitter candidate. Ann Rev Neurosci 3: 227–268

    Google Scholar 

  8. 8.

    Mantel N, Haenszel W (1959) Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst 22: 719–748

    Google Scholar 

  9. 9.

    DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Contr Clin Trials 7: 177–188

    Google Scholar 

  10. 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: 335–371

    Google Scholar 

  11. 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: 387–388

    Google Scholar 

  12. 12.

    Scheffler NM, Sheitel PL, Lipton MN (1991) Treatment of painful diabetic neuropathy with capsaicin 0.075%. J Am Pediatr Med Assoc 31: 288–293

    Google Scholar 

  13. 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: 2225–2229

    Google Scholar 

  14. 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: 8–14

    Google Scholar 

  15. 15.

    Ross DR, Varipapa RJ (1989) Treatment of painful diabetic neuropathy with topical capsaicin. New Engl J Med 321: 474–475

    Google Scholar 

  16. 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, 252–263

    Google Scholar 

  17. 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: 383–393

    Google Scholar 

  18. 18.

    McCarthy GM, McCarty DL (1992) Effect of topical capsaicin in the therapy of painful osteoarthritis of the hands. J Rheumatol 19: 604–607

    Google Scholar 

  19. 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: S132

  20. 20.

    Harris ED (1990) Rheumatoid arthritis: pathophysiology and implications for therapy. New Engl J Med 322: 1277–1289

    Google Scholar 

  21. 21.

    Lotz M, Carson DA, Vaughan JH (1987) Substance P activation of rheumatoid synoviocytes: neural pathogenesis of arthritis. Science 235: 893–895

    Google Scholar 

  22. 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: 547–549

    Google Scholar 

  23. 23.

    Badlamente MA, Cherney SA (1989) Periosteal and vascular innervation of the human patella in degenerative joints disease. Sem Arthr Rheum 18: 61–66

    Google Scholar 

  24. 24.

    Fitzgerald M (1983) Capsaicin and sensory neurons — a review. Pain 15: 109–130

    Article  CAS  PubMed  Google Scholar 

  25. 25.

    Bernstein JE, Korman NJ, Bickers DR, Dahl MV, Milliken LE (1989) Topical capsaicin treatment of chronic postherpetic neuralgia. J Am Acad Dermatol 21: 265–270

    Google Scholar 

  26. 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]: S58

  27. 27.

    Watson CPN, Evans RJ, Watt VR (1988) Postherpetic neuralgia and topical capsaicin. Can J Neurol Sci 15: 197

    Google Scholar 

  28. 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: 452–456

    Google Scholar 

  29. 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: 93–96

    Google Scholar 

  30. 30.

    Fusco BM, Alessandri M (1992) Analgesic effect of capsaicin in idiopathic trigeminal neuralgia. Anesth Analg 74: 375–377

    Google Scholar 

  31. 31.

    Hawk RJ, Millikan LE (1988) Treatment of oral postherpetic neuralgia with topical capsaicin. Int J Dermatol 27 (5): 336

    Google Scholar 

  32. 32.

    Bucci FA, Gabriels CF, Krohel GB (1988) Successful treatment of postherpetic neuralgia with capsaicin. Am J Ophthalmol 106: 758–759

    Google Scholar 

  33. 33.

    Don PC (1988) Topical capsaicin for treatment of neuralgia associated with Herpes zoster infection. J Am Acad Dermatol 18: 135

    Google Scholar 

  34. 34.

    Jolleys JV (1989) Treatment of shingles and postherpetic neuralgia. Br Med J 298: 1537–1538

    Google Scholar 

  35. 35.

    Arner A, Meyerson BA (1988) Lack of analgesic effect of opiods on neuropathic and idiopathic forms of pain. Pain 33: 11–23

    Google Scholar 

  36. 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: 504–507

    Google Scholar 

  37. 37.

    Kurkcuoglu N, Alaybeyi F (1990) Topical capsaicin for psoriasis. Br J Dermatol 123: 549–550

    Google Scholar 

  38. 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 A

  39. 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: 438–442

    Google Scholar 

  40. 40.

    Naukkarinen A, Nickoloff BJ, Faber EM (1989) Quantification of cutaneous sensory nerves and their substance P content in psoriasis. J Invest Dermatol 92: 126–129

    Google Scholar 

  41. 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: 547–549

    Google Scholar 

  42. 42.

    Granek I, Ashikari P, Foley KM (1984) The postmastectomy pain syndrome: clinical and anatomical correlations. Proc ASCO 3: 122

    Google Scholar 

  43. 43.

    Assa J (1974) The intercostobrachial nerve in radical mastectomy. J Surg Oncol 6: 123–26

    Google Scholar 

  44. 44.

    Watson CPN, Evans RJ (1992) The postmastectomy pain syndrome and topical capsaicin: a randomized trial. Pain 51: 375–379

    Google Scholar 

  45. 45.

    Watson CPN, Evans RJ, Watt UR (1989) The post-mastactomy pain syndrome and the effect of topical capsaicin. Pain 38: 177–186

    Google Scholar 

  46. 46.

    Dini D, Bertelli G, Gozza A, Forno GG (1993) Treatment of the post-mastactomy pain syndrome with topical capsaicin. Pain 54: 223–226

    Google Scholar 

  47. 47.

    Rayner HC, Atkins RC, Westerman RA (1989) Relief of local stump pain by capsaicin cream. Lancet II: 1276–1277

    Google Scholar 

  48. 48.

    Weintraub M, Golik A, Rubio A (1990) Capsaicin for treatment of post-traumatic amputation stump pain. Lancet 336: 1003–1004

    Google Scholar 

Download references

Author information



Corresponding author

Correspondence to A. Li Wan Po.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Zhang, W.Y., Li Wan Po, A. The effectiveness of topically applied capsaicin. Eur J Clin Pharmacol 46, 517–522 (1994).

Download citation

Key words

  • Capsaicin
  • Diabetic neuropathy
  • pain relief
  • patients