What is the efficacy and tolerability of topically applied, high-concentration (8%) capsaicin in chronic neuropathic pain in adults?
Topical Capsaicin, a randomized, double-blind, placebo-controlled trial (Cochrane Database Syst Rev 2017, PMID 28085183) — for postherpetic neuralgia, about 10% more participants reported much or very much improvement with high-concentration capsaicin than 'active' placebo at 8 and 12 weeks (NNT 8.8 and 7.0 respectively. The quality of evidence for efficacy outcomes was downgraded due to sparse data, imprecision, possible effects of imputation methods, and susceptibility to publication bias.
Source: Cochrane Database Syst Rev 2017, PMID 28085183 ↗ · Research map · How Magellan grades evidence · evidence confidence: high
Cochrane Database Syst Rev · 2017 · PMID 28085183 · DOI 10.1002/14651858.CD007393.pub4
High-concentration topical capsaicin offers some pain relief for certain neuropathic conditions, but the overall benefit is modest and the evidence quality is low.
The question
What is the efficacy and tolerability of topically applied, high-concentration (8%) capsaicin in chronic neuropathic pain in adults?
What they tested
High-concentration (8%) capsaicin patches, applied as a single dose, will provide sustained pain relief for chronic neuropathic pain by rapidly desensitizing cutaneous nociceptors, with benefits lasting approximately 12 weeks.
How they did it
This systematic review updated a previous review by searching CENTRAL, MEDLINE, Embase, clinical trials registries, and a pharmaceutical company's website up to June 10, 2016. It included randomized, double-blind, placebo-controlled studies of at least 6 weeks' duration using high-concentration (5% or more) topical capsaicin for neuropathic pain. Two independent reviewers extracted data on efficacy (Patient Global Impression of Change, pain intensity reduction of at least 30% or 50%) and adverse events, and assessed study quality. Pooled analysis used dichotomous data to calculate risk ratio and numbers needed to treat (NNT). The quality of evidence was assessed using GRADE.
What they found
Eight studies involving 2488 participants were included. For postherpetic neuralgia, about 10% more participants reported much or very much improvement with high-concentration capsaicin than 'active' placebo at 8 and 12 weeks (NNT 8.8 and 7.0 respectively; moderate quality evidence). Similarly, about 10% more participants achieved at least 30% or 50% pain intensity reduction (NNT 10-12; very low quality evidence). For painful HIV-neuropathy, one study showed 27% improved with capsaicin vs 10% with 'active' placebo at 12 weeks, and about 10% more participants had at least 30% pain reduction (NNT 11; very low quality evidence). One study on peripheral diabetic neuropathy also reported about 10% more participants improved at 8 and 12 weeks. Local adverse events were common, but serious adverse events were similar between active treatment (3.5%) and control (3.2%).
| Postherpetic Neuralgia (8 weeks) | 10 | |
|---|---|---|
| Postherpetic Neuralgia (12 weeks) | 10 | |
| Painful HIV-Neuropathy (12 weeks) | 17 | |
| Peripheral Diabetic Neuropathy (8 & 12 weeks) | 10 |
Percentage of additional participants reporting 'much or very much improved' with high-concentration capsaicin compared to control.
What it means
High-concentration topical capsaicin provided moderate or substantial pain relief for postherpetic neuralgia, HIV-neuropathy, and painful diabetic neuropathy in a greater proportion of participants compared to control. However, the quality of evidence was moderate to very low, and the additional proportion of beneficiaries was not large. For those who did benefit, improvements in sleep, fatigue, depression, and quality of life were observed.
Limitations
The quality of evidence for efficacy outcomes was downgraded due to sparse data, imprecision, possible effects of imputation methods, and susceptibility to publication bias. Efficacy outcomes were inconsistently reported across studies, leading to incomplete data for most analyses. One study was judged at high risk of bias due to small size.
The paper at a glance
| Title | Topical capsaicin (high concentration) for chronic neuropathic pain in adults |
|---|---|
| Journal | Cochrane Database Syst Rev |
| Year | 2017 |
| PMID | 28085183 ↗ |
| DOI | 10.1002/14651858.CD007393.pub4 ↗ |
| Topic | Pain, nerves & musculoskeletal medicine |
Read the source: PubMed record (authors, abstract, full citation) ↗ · Publisher via doi.org ↗
Where Magellan uses this paper
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Topical Capsaicin
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Capsaicin Pain Relief Cream
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Research describes the compound or intervention studied. It is not a claim about any specific product.
Molecules & mechanisms in this paper
Each of these is named in the paper’s own words above. Open the monograph for the full mechanism and its other citations.
Cite this page
These citations point at this summary. To cite the original paper with its full author list, use the PubMed record or doi.org.
Magellan Longevity. (2026). What is the efficacy and tolerability of topically applied, high-concentration (8%) capsaicin in chronic neuropathic pain in adults? [Plain-English summary of Cochrane Database Syst Rev 2017, PMID 28085183, DOI 10.1002/14651858.CD007393.pub4]. Magellan Longevity. https://magellanlongevity.com/study/capsaicin_np.html@misc{magellan_capsaicin_np,
title = {What is the efficacy and tolerability of topically applied, high-concentration (8%) capsaicin in chronic neuropathic pain in adults?},
author = {{Magellan Longevity}},
year = {2026},
howpublished = {\url{https://magellanlongevity.com/study/capsaicin_np.html}},
note = {Plain-English summary of PubMed PMID 28085183; DOI 10.1002/14651858.CD007393.pub4; Cochrane Database Syst Rev 2017. Reviewed by Gabriel Radu, DO},
urldate = {2026-08-11}
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