From the Guidelines
Capsaicin is a recommended treatment option for polyneuropathy, particularly for pain management, due to its effectiveness and minimal side effects. The most effective form is high-concentration capsaicin patches (8%), which can provide pain relief for up to 12 weeks with a single application, as supported by a recent guideline 1. For daily use, over-the-counter topical creams containing 0.075% capsaicin can be applied to painful areas, with the option to consider an 8% patch for patients with contraindications to oral pharmacotherapy or who prefer topical treatments.
When applying capsaicin, it is essential to wear gloves to avoid transferring it to sensitive areas, and expect a burning sensation during initial applications that typically diminishes with continued use. The treatment works by depleting substance P, a neurotransmitter involved in pain signaling, from nerve endings and desensitizing TRPV1 receptors. Capsaicin is particularly useful for diabetic neuropathy, HIV-associated neuropathy, and postherpetic neuralgia, offering a non-systemic alternative with minimal side effects compared to oral medications, making it suitable for patients who cannot tolerate or prefer to avoid oral neuropathic pain medications 1.
Some key points to consider when using capsaicin for polyneuropathy include:
- High-concentration capsaicin patches (8%) can provide pain relief for up to 12 weeks with a single application
- Topical creams containing 0.075% capsaicin can be applied daily to painful areas
- Wear gloves when applying capsaicin to avoid transferring it to sensitive areas
- Expect a burning sensation during initial applications that typically diminishes with continued use
- Capsaicin is a useful alternative for patients who cannot tolerate or prefer to avoid oral neuropathic pain medications, as supported by recent studies 1.
From the Research
Treatment Options for Polyneuropathy
- First-line treatments for polyneuropathy include calcium-channel anticonvulsants such as gabapentin and pregabalin, as well as antidepressants like duloxetine and amitriptyline 2
- Topical therapeutics, such as a topical capsaicin patch, can be used for localized disorders 3, 4
- Second-line treatments include opioids and other antidepressants or anticonvulsants 2
- Exercise and physiotherapy can also be beneficial in managing polyneuropathy and its associated pain 4, 5
Capsaicin for Polyneuropathy
- A topical capsaicin patch is a treatment option for polyneuropathy, particularly for localized pain 3, 4
- The US Food and Drug Administration (FDA) has approved a topical capsaicin patch for the treatment of postherpetic neuralgia and painful diabetic neuropathy 4
Management of Polyneuropathy
- Management of polyneuropathy should follow a multimodal concept, including treatment of other symptoms and consideration of comorbidities, patient age, and adverse events 2
- A timely diagnosis of the cause of polyneuropathy is crucial for initiating appropriate specific treatment 5
- Treatment is often limited due to adverse events, which can affect the central nervous system 2