Capsaicin, derived from the chilli pepper plant, is available in high concentration (8%) patches to provide topical therapy for neuropathic pain. Its analgesic effects relate to defunctionalisation and nerve terminal retraction of predominantly C fibres in the dermis and epidermis. Systematic reviews and meta-analysis support its use for the management of post-herpetic neuralgia and HIV neuropathy with some evidence for use in painful peripheral diabetic neuropathy. The article concludes with advice on the practicalities of running a topical 8% capsaicin clinic for peripheral neuropathic pain.
SchumacherMA. Transient receptor potential channels in pain and inflammation: therapeutic opportunities. Pain Pract2010; 10(3): 185–200.
2.
SzallasiABlumbergPM. Vanilloid (Capsaicin) receptors and mechanisms. Pharmacol Rev1999; 51(2): 159–212.
3.
DerrySMooreRA. Topical capsaicin (low concentration) for chronic neuropathic pain in adults. Cochrane Database Syst Rev2012; 9: CD010111.
4.
FinnerupNBAttalNHaroutounianS, et al. Pharmacology for neuropathic pain in adults: a systematic review and meta-analysis. The Lancet Neurology2015; 14(2): 162–173.
5.
AnandPBleyK. Topical capsaicin for pain management: therapeutic potential and mechanisms of action of the new high-concentration capsaicin 8% patch. Br J Anaesth2011; 107(4): 490–502.
6.
JensenTSBaronRHaanpääM, et al. A new definition of neuropathic pain. Pain2011; 152(10): 2204–2205.
AttalNLanteri-MinetMLaurentB, et al. The specific disease burden of neuropathic pain: results of a French nationwide survey. Pain2011; 152(12): 2836–2843.
9.
FinnerupNBAttalNHaroutounianS, et al. Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet Neurol2015; 14(2): 162–173.
10.
O’NeillJBrockCOlesenAE, et al. Unravelling the mystery of capsaicin: a tool to understand and treat pain. Pharmacol Rev2012; 64(4): 939–971.
11.
IlieMCaruntuCTampaM, et al. Capsaicin: physicochemical properties, cutaneous reactions and potential applications in painful and inflammatory conditions (Review). Exp Ther Med2019; 18: 916–925.
12.
GeberCFondelRKramerHH, et al. Psychophysics, flare, and neurosecretory function in human pain models: capsaicin versus electrically evoked pain. J Pain2007; 8(6): 503–514.
13.
FriasBMerighiA. Capsaicin, nociception and pain. Molecules2016; 21(6): E797.
14.
HolzerP. The pharmacological challenge to tame the transient receptor potential vanilloid-1 (TRPV1) nocisensor. Br J Pharmacol2008; 155(8): 1145–1162.
15.
ChandaSBashirMBabbarS, et al. In vitro hepatic and skin metabolism of capsaicin. Drug Metab Dispos2008; 36(4): 670–675.
WohlrabJNeubertRHHHeskampM-L, et al. Cutaneous drug delivery of capsaicin after in vitro administration of the 8% capsaicin dermal patch system. Skin Pharmacol Physiol2015; 28(2): 65–74.
18.
SimpsonDMRobinson-PappJVanJ, et al. Capsaicin 8% patch in painful diabetic peripheral neuropathy: a randomized, double-blind, placebo-controlled study. J Pain2017; 18(1): 42–53.
19.
HaanpääMCruccuGNurmikkoTJ, et al. Capsaicin 8% patch versus oral pregabalin in patients with peripheral neuropathic pain. Eur J Pain2016; 20(2): 316–328.
20.
CruccuGNurmikkoTJErnaultE, et al. Superiority of capsaicin 8% patch versus oral pregabalin on dynamic mechanical allodynia in patients with peripheral neuropathic pain. Eur J Pain2018; 22(4): 700–706.
21.
GalvezRNavezMLMoyleG, et al. Capsaicin 8% patch repeat treatment in nondiabetic peripheral neuropathic pain. Clin J Pain2017; 33(10): 921–931.
22.
MankowskiCPooleCDErnaultE, et al. Effectiveness of the capsaicin 8% patch in the management of peripheral neuropathic pain in European clinical practice: the ASCEND study. BMC Neurol2017; 17(1): 80–11.
23.
VinikAIPerrotSVinikEJ, et al. Capsaicin 8% patch repeat treatment plus standard of care (SOC) versus SOC alone in painful diabetic peripheral neuropathy: a randomised, 52-week, open-label, safety study. BMC Neurol2016; 16(1): 251–214.
24.
HanssonPJensenTSKvarsteinG, et al. Pain-relieving effectiveness, quality of life and tolerability of repeated capsaicin 8% patch treatment of peripheral neuropathic pain in Scandinavian clinical practice. Eur J Pain2018; 22(5): 941–950.
25.
Filipczak-BryniarskaIKrzyzewskiRMKucharzJ, et al. High-dose 8% capsaicin patch in treatment of chemotherapy-induced peripheral neuropathy: single-center experience. Med Oncol2017; 34(9): 162–165.
26.
Lanteri-MinetMPerrotS. QAPSA: post-marketing surveillance of capsaicin 8% patch for long-term use in patients with peripheral neuropathic pain in France. Curr Med Res Opin2019; 35(3): 417–426.
27.
BlairHA. Capsaicin 8% dermal patch: a review in peripheral neuropathic pain. Drugs2018; 78(14): 1489–1500.
KnolleEZadrazilMKovacsGG, et al. Comparison of cooling and EMLA to reduce the burning pain during capsaicin 8% patch application: a randomized, double-blind, placebo-controlled study. Pain2013; 154(12): 2729–2736.
30.
LaycockHThomasSEGoodallI, et al. A single centre experience of capsaicin 8% patch efficacy. Does diagnosis predict pain outcome? In: Proceedings of the 11th congress of the European Pain Federation EFIC, Valencia, 4–7 September 2019.
