![]() ![]() Itching was greater with capsaicin compared to amitriptyline or clonidine statistical significance was not reported. There was no statistically significant difference in headache events with capsaicin compared to pregabalin, gabapentin, or duloxetine. Capsaicin was associated with dermatological complications (application site pain, erythema, itching, and burning sensation) whereas pregabalin, gabapentin, and duloxetine were associated with somnolence, dizziness, and nausea. These comprised one systematic review with NMA and three RCTs (two being non-inferiority trials). One randomized controlled trial involving patients with acute back and neck pain suggested greater efficacy with capsaicin (0.075%) compared with diclofenac, statistical significance was not reported.įour publications reported on safety outcomes (related to adverse events). One systematic review with NMA involving patients with pain due to osteoarthritis, reported similar efficacy with capsaicin (0.0125% or 0.025%) compared to topical non-steroidal anti-inflammatory drugs. For neuropathic pain, similar or non-inferior efficacy was reported for capsaicin (8%) patch compared to oral drugs (pregabalin, gabapentin, and duloxetine), and capsaicin (0.75%) cream compared to topical drugs (amitriptyline and clonidine). Four publications reported on neuropathic pain (peripheral neuropathic pain or painful diabetic neuropathy ) these comprised one systematic review with network analysis (NMA) (with comparators: pregabalin, gabapentin, and duloxetine) and three non-inferiority randomized controlled trials (with comparators: pregabalin, amitriptyline, or clonidine one each). Six publications reported on clinical efficacy (related to pain relief) of capsaicin compared to other drugs. The eight relevant publications identified comprised two systematic reviews with network meta-analysis (NMA), four randomized controlled trials (RCTs) and two economic evaluations. The purpose of this report is to review the clinical effectiveness, safety and cost-effectiveness of capsaicin products for the treatment of acute and chronic non-cancer pain. Two guidelines recommended the use of capsaicin (8%) patch as second line therapy for NP. There was variability in the recommendations for use of capsaicin for the management of pain due to OA. 8Ī recent CADTH rapid response report, 9 presented a summary and critical appraisal of evidence-based guidelines regarding capsaicin products for the treatment of acute and chronic non-cancer pain. 7 There appears to be some uncertainty regarding the therapeutic efficacy of capsaicin for the management of pain. According to a report dated 2018, capsaicin is available in Canada as a cream (0.025%, 0.05%, and 0.075%), gel (0.025%), and patch (0.025%), as well as in creams, gels, or lotions (0.025% or 0.035%) in combination with other active ingredients. 4 – 6 Several capsaicin products are available over-the-counter in Canada. 5 It is available as low concentration (e.g., 0.025%, 0.075%, and 0.25%) and high concentration (e.g., 8%) product. 4 – 6 There are various formulations for capsaicin: cream, gel, lotion and patch. This binding initially results in depolarization, initiation of action potential, and pain signal transmission to the spinal cord, and subsequently causes desensitization of the sensory axons and inhibition of pain transmission. 4 It is a transient receptor potential vanilloid 1 receptor (TRPV1) agonist it binds to nociceptors (sensory receptors responsible for sending signals that cause the perception of pain) in the skin, specifically to the TRVP1 receptor. 1, 3 Capsaicin, which is found in chili peppers, has been used as a topical agent to relieve pain. A variety of pharmacological options such as non-steroidal anti-inflammatory drugs (NSAIDs), local anesthetics, tricyclic antidepressants, and capsaicin have been used for pain management. There are several treatment options for managing pain both pharmacological and non-pharmacological options. 2 Pain is associated with reduced quality of life, absenteeism from work, and substantial healthcare costs. 1 According to the Canadian Community Health Survey of individuals during the period 2007 to 2008, the prevalence of chronic pain in adults over the age of 18 years was 18.9% in Canada, and ranged between 16% and 22% for the different provinces. ![]() Chronic pain includes pain associated with osteoarthritis (OA), neuropathic pain (NP), and back pain. 1 Acute pain includes pain from sprains, strains, and tendonitis and muscle aches. Generally, acute pain is defined as lasting less than three months, and chronic pain is defined as pain lasting three months or longer.
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