Efficacy of Capsaicin Cream for Neuropathic Pain

Evidence for Capsaicin's Effectiveness

The American College of Physicians recommends capsaicin as a topical treatment for chronic neuropathic pain, with high-quality evidence supporting its use, particularly for HIV-associated peripheral neuropathic pain 1, 2
A single 30-minute application of an 8% dermal patch or cream administered at the site of pain can provide pain relief for at least 12 weeks, with strong, high evidence 1, 2
The FDA has approved capsaicin 8% patch for treatment of pain in diabetic peripheral neuropathy, with high-quality supporting evidence 3
For chemotherapy-induced peripheral neuropathy, capsaicin 8% patch can be considered as a treatment option, with a Grade III, C recommendation 4, 5

Capsaicin works by binding to TRPV1 receptors, leading to decreased release of neurotransmitters such as substance P, which are important chemical mediators in pain transmission, according to the Mayo Clinic Proceedings 6

The Infectious Diseases Society of America strongly recommends capsaicin for HIV-associated neuropathy, with high-quality evidence 1, 2
The American Diabetes Association recommends capsaicin 8% patch as an FDA-approved treatment for diabetic peripheral neuropathy, with high-quality supporting evidence 3
The European Society for Medical Oncology suggests capsaicin 8% patch as a treatment option for chemotherapy-induced peripheral neuropathy, with moderate evidence supporting its use 4, 5

Common side effects of capsaicin include erythema and pain at the application site, according to the Clinical Infectious Diseases journal 1, 2
A 60-minute application of 4% lidocaine can be applied and wiped off before applying capsaicin to reduce side effects, as recommended by the Clinical Infectious Diseases journal 1
Initial burning sensation may limit tolerability for some patients, according to the Journal of Injury Function & Rehabilitation 7

The Clinical Infectious Diseases journal recommends gabapentin as a first-line oral therapy for HIV-associated neuropathic pain, and capsaicin 8% patch as a first-line topical therapy for localized neuropathic pain 1, 8
The Diabetes Care journal suggests using capsaicin when patients prefer topical treatments or have contraindications to oral pharmacotherapy 3