Is capsicum (capsaicin) helpful with neuropathy?

From the Guidelines

Capsaicin can be a helpful treatment for managing neuropathic pain, particularly for patients with contraindications to oral pharmacotherapy or who prefer topical treatments, as suggested by a recent guideline in 2023 1. When considering treatment options for neuropathy, it's essential to weigh the potential benefits and risks of each therapy.

• Capsaicin works by depleting substance P, a neurotransmitter that sends pain signals, from nerve endings.
• It is available in various forms, including creams, patches, and gels, at different concentrations (0.025%, 0.075%, 0.1%, and 8% patch).
• For neuropathy, starting with a low-concentration cream (0.025% or 0.075%) applied to the painful area 3-4 times daily can be an effective approach.
• The 8% patch (Qutenza) is also effective but requires application by a healthcare provider. Some key points to consider when using capsaicin include:
• Expect an initial burning sensation that typically diminishes with continued use.
• Apply with gloves to avoid transferring to sensitive areas like eyes.
• Results may take several weeks of consistent use, and the treatment should be continued as long as it provides relief. While capsaicin doesn't cure neuropathy, it can significantly reduce pain symptoms for many patients by desensitizing the nerves in the affected area, as supported by studies in 2011 1 and 2019 1. The use of topical capsaicin can be considered, especially for patients who cannot tolerate oral medications or prefer a topical treatment, as recommended by the American Academy of Neurology and the American Diabetes Association 1.

From the FDA Drug Label

Active Ingredient Purpose Capsaicin 0.035% External Analgesic The FDA drug label does not answer the question.

From the Research

Capsicum (Capsaicin) and Neuropathy

• Capsaicin has been studied as a potential treatment for neuropathic pain, with evidence suggesting it can provide relief for some patients 2, 3, 4, 5, 6
• The substance works by desensitizing nerve endings, reducing pain transmission to the brain 6
• Topical capsaicin formulations, such as creams and patches, have been found to be effective in reducing symptoms of diabetic peripheral neuropathy and other neuropathic pain conditions 3, 5, 6

Efficacy of Capsaicin for Neuropathy

• Studies have shown that capsaicin can significantly reduce pain symptoms in patients with diabetic peripheral neuropathy, with some patients experiencing improved sleep quality and reduced pain intensity 3, 5
• The 8% capsaicin patch has been found to be particularly effective, with one study showing a significant reduction in pain symptoms and improvement in nerve fiber density 5
• Capsaicin cream has also been shown to be effective, although the evidence is less consistent, with some studies finding significant pain reduction and others finding no significant difference compared to placebo 3, 6

Safety and Tolerability of Capsaicin

• Capsaicin is generally well-tolerated, with local skin reactions, such as burning and erythema, being the most common adverse events 3, 6
• Systemic adverse effects are rare, and the risk of serious side effects is low 6
• The use of capsaicin for neuropathic pain is considered a potentially beneficial treatment option, although further research is needed to determine the best means of ameliorating side effects and optimizing treatment regimens 3, 5