What are the uses, options, and risks of capsaicin pain relief creams? Get a detailed overview of the top 6 capsaicin creams and their key features.

Understanding Capsaicin and Its Pain-Relieving Properties

Capsaicin is the active ingredient in chili peppers and is known for its ability to produce a burning sensation when applied to the skin. However, this same property is also responsible for its potential pain-relieving effects. Capsaicin works by reducing the amount of “substance P,” a chemical that transmits pain signals to the brain. By inhibiting this pain messenger, capsaicin can help alleviate various types of pain, including those associated with osteoarthritis, peripheral neuropathy, and other conditions.

Capsaicin-based pain relief creams are available in both over-the-counter (OTC) and prescription-strength formulations, with concentrations ranging from 0.025% to 8%. While OTC creams typically contain lower concentrations (0.025-0.1%), prescription patches like Qutenza can contain up to 8% capsaicin and are applied in a doctor’s office.

The 6 Best Capsaicin Creams: Evaluating Options for Pain Relief

1. Best for Those with Diabetes: Nervex

Nervex is a capsaicin-based cream formulated specifically for individuals with diabetes, advanced neuropathy, peripheral neuropathy, and fibromyalgia. It contains a concentration of capsaicin that is suitable for those with diabetes and also includes additional ingredients like vitamin B12 and B1, as well as cetyl myristoleate. Some users have reported that Nervex provided better pain relief than oral medications and helped with relaxation when trying to sleep. However, other reviews noted that the cream increased pain and caused a burning sensation.

2. Best Gel Product: Capzasin Quick Relief Gel

Capzasin Quick Relief Gel is a capsaicin-based gel product that may be a good option for those seeking a non-greasy, fast-absorbing formula. The gel texture can make it easier to apply and spread over larger areas of the body. Customer reviews suggest that this product can be effective in providing pain relief, though some users have reported experiencing a burning sensation upon application.

3. Best Whole-Body Cream: Zostrix Maximum Strength

Zostrix Maximum Strength is a capsaicin-based cream that can be used on various parts of the body, including the feet, hands, legs, and toes. The formula is designed to penetrate deep into the skin and absorb quickly. Some users have reported positive experiences with Zostrix in terms of pain relief, while others have noted that the cream can cause a burning sensation, especially on sensitive areas.

4. Best for Sports Injuries: Pure Body Naturals Maximum Strength Hot Cream

Pure Body Naturals Maximum Strength Hot Cream is formulated with capsaicin and other natural ingredients like menthol, camphor, and arnica to provide relief for sports-related injuries and muscle soreness. The “hot” sensation from the cream can help improve blood circulation and reduce inflammation. Users have generally reported positive experiences with this product, though some have noted that the heat sensation can be too intense for certain individuals.

5. Best Value: Rugby Capsaicin Cream

Rugby Capsaicin Cream is a more affordable option that still contains an effective concentration of capsaicin (0.1%) for pain relief. This cream may be a good choice for those on a tighter budget who are seeking a reliable capsaicin-based product. While the price is lower, the quality and effectiveness of the cream seem to be on par with more expensive options, according to customer reviews.

6. Best High Potency: Capzix Cream for Pain Relief

Capzix Cream for Pain Relief is a high-potency capsaicin-based cream containing 0.25% capsaicin, which is considered a “high potency” concentration. This product may be suitable for individuals with more severe or persistent pain who require a stronger formula. Reviews suggest that Capzix can be effective in providing relief, though the higher concentration of capsaicin may also increase the likelihood of experiencing a burning sensation upon application.

Weighing the Risks and Benefits of Capsaicin Creams

While capsaicin-based creams can be effective in providing pain relief, it’s important to be aware of the potential side effects. The most common side effect is a burning or stinging sensation upon application, which can be particularly intense for those with sensitive skin or when using higher-concentration formulas. Some users have also reported increased pain or discomfort in the treated area, especially during the initial use of the product.

It’s recommended to start with a lower-concentration capsaicin cream and gradually increase the potency if needed, as well as to perform a patch test before applying the cream to larger areas. Individuals with certain medical conditions, such as diabetes, should consult with their healthcare provider before using capsaicin-based products to ensure they are suitable and safe for their specific needs.

Choosing the Right Capsaicin Cream for Your Needs

When selecting a capsaicin cream, consider factors such as the concentration of capsaicin, the intended use (e.g., for diabetic neuropathy, sports injuries, or osteoarthritis), and your personal tolerance for the burning sensation. The products highlighted in this article represent a range of options, from low-concentration OTC creams to higher-potency formulations, each with its own strengths and potential drawbacks.

Ultimately, the best capsaicin cream for you will depend on your individual needs, preferences, and responses to the product. It may be helpful to try a few different options to find the one that provides the most effective pain relief with the least amount of discomfort.

Frequently Asked Questions

How does capsaicin work to relieve pain?

Capsaicin works by reducing the amount of “substance P,” a chemical that transmits pain signals to the brain. By inhibiting this pain messenger, capsaicin can help alleviate various types of pain, including those associated with conditions like osteoarthritis, peripheral neuropathy, and other conditions.

Are there any side effects to using capsaicin creams?

The most common side effect of using capsaicin creams is a burning or stinging sensation upon application, which can be particularly intense for those with sensitive skin or when using higher-concentration formulas. Some users have also reported increased pain or discomfort in the treated area, especially during the initial use of the product.

How do I choose the right capsaicin cream for my needs?

When selecting a capsaicin cream, consider factors such as the concentration of capsaicin, the intended use (e.g., for diabetic neuropathy, sports injuries, or osteoarthritis), and your personal tolerance for the burning sensation. It may be helpful to try a few different options to find the one that provides the most effective pain relief with the least amount of discomfort.

Conclusion

Capsaicin-based pain relief creams offer a natural and potentially effective way to manage various types of pain, from osteoarthritis to neuropathic conditions. By understanding the potential benefits and risks associated with these products, individuals can make informed decisions about which capsaicin cream may be the best fit for their specific needs and preferences. Whether you’re seeking relief for sports injuries, diabetic neuropathy, or general muscle and joint pain, exploring the options highlighted in this comprehensive review can help you find the right capsaicin cream for your pain management needs.

The 6 best capsaicin creams: Uses, options, and risks

We include products we think are useful for our readers. If you buy through links on this page, we may earn a small commission Here’s our process.

Medical News Today only shows you brands and products that we stand behind.

Our team thoroughly researches and evaluates the recommendations we make on our site. To establish that the product manufacturers addressed safety and efficacy standards, we:

• Evaluate ingredients and composition: Do they have the potential to cause harm?
• Fact-check all health claims: Do they align with the current body of scientific evidence?
• Assess the brand: Does it operate with integrity and adhere to industry best practices?

We do the research so you can find trusted products for your health and wellness.

Read more about our vetting process.

Was this helpful?

Capsaicin comes from chili peppers, and the heat it produces may help relieve pain associated with osteoarthritis, peripheral neuropathy, and other conditions. Many companies sell creams containing capsaicin for pain relief, but using capsaicin on the skin can have side effects.

This article discusses capsaicin creams in more detail and explores some products that are available to purchase online.

A quick look at the 6 best capsaicin creams

• Best for those with diabetes: Nervex
• Best gel product: Capzasin Quick Relief Gel
• Best whole body cream: Zostrix Maximum Strength
• Best for sports injuries: Pure Body Naturals Maximum Strength Hot Cream
• Best value: Rugby Capsaicin Cream
• Best high potency: Capzix Cream for Pain Relief

Capsaicin is the active ingredient in chili peppers, and it is what makes them hot.

According to the United Kingdom’s National Health Service (NHS), this ingredient can help reduce neuropathic pain by preventing the nerves from transmitting pain signals to the brain. This happens because capsaicin reduces the amount of “substance P” in the body, a chemical neuropeptide that acts as a pain messenger.

Capsaicin comes in two forms — creams and patches.

The cream form is available over the counter (OTC) and they typically contain between 0.025–0.1% capsaicin. Experts consider products with 0.1% capsaicin high potency.

The patches are prescription only, and doctors may prescribe an 8% capsaicin patch known as Qutenza. A Qutenza patch can work for up to 3 months. People have Qutenza patches applied in a doctor’s office if they have conditions such as postherpetic neuralgia and diabetic neuropathy.

Capsaicin cream may have various health benefits.

A 2014 study reviewed the effects of Qutenza, a patch containing 8% capsaicin, in people with peripheral neuropathic pain. The participants used up to four patches for 12 weeks, and the researchers found that this reduced the participants’ pain.

An older review analyzed the effectiveness of herbal therapies in people with lower back pain and found that capsaicin can reduce pain better than a placebo.

Moreover, a 2018 study found that capsaicin cream is as effective as nonsteroidal anti-inflammatory drugs in providing pain relief for people with osteoarthritis.

Medical News Today chooses products that meet the following criteria:

• Price: MNT chooses products available for a wide range of budgets.
• Ingredients: MNT chooses products that clearly list all ingredients.
• Skin concerns: Where appropriate, MNT selects products that target a specific skin concern, such as dryness, oiliness, or aging.
• Safety: MNT chooses products that contain ingredients safe for topical use.
• Reputable: MNT selects products from businesses that adhere to industry best practices.

Was this helpful?

Below, we look at some capsaicin products for a person to consider.

Please note that the writer of this article has not tried these products. All information presented is purely research-based and correct at the time of publication.

Medical News Today follows a strict product selection and vetting process. Learn more here.

Was this helpful?

Best for those living with diabetes: Nervex

According to the manufacturer, Nervex is a pain relief cream suitable for people with diabetes, advanced neuropathy, peripheral neuropathy, and fibromyalgia. People with diabetes should consider the concentration of the capsaicin cream they use, and this cream meets those requirements.

The cream penetrates deep into the skin and absorbs fast. A person can use it on their feet, hands, legs, and toes. Other ingredients include vitamin B12, B1, and cetyl myristoleate, among other ingredients.

The product has a 60-day money-back guarantee.

SHOP NOW

Best gel product: Capzasin Quick Relief Gel

This gel’s design temporarily relieves pain from arthritis, bruises, and back pain. Its active ingredients are capsaicin and menthol.

The manufacturer says it is suitable for ages 18 years and older, is odor-free, and penetrates the skin deeply.

The product comes with a sponge-top applicator to help people use the right amount and massage it into the skin.

SHOP NOW

Best whole body cream: Zostrix Maximum Strength

This capsaicin cream can provide temporary relief of minor pain from arthritis, strains, and sprains, as well as minor back pain.

The manufacturer says that the cream is odor-free, nongreasy, and works for the whole body.

Anyone considering using this product to help with neuralgia should consult a doctor, as it may not suit those 18 years or younger.

SHOP NOW

Best for sports injuries: Pure Body Naturals Maximum Strength Hot Cream

Price	around $13
Pros	customer reports say this product creates a warming sensation and is suitable for those on their feet for long periods and with neck pain.
Cons	other reviews found the cream to be ineffective.

This cream targets muscle soreness, arthritis pain, pain from sports injuries, and inflammation. According to the manufacturer, it also helps with cellulite and deep muscle relaxation.

The company says that the product’s essential oils, including spearmint, eucalyptus, and sweet basil, are responsible for targeting inflammation and muscle tension and supporting blood circulation. These properties help to heal sports injuries.

This product is cruelty-free and contains no parabens, fragrance, sulfates, or harsh chemicals.

SHOP NOW

Best value: Rugby Capsaicin Cream

Price	around $8
Pros	positive customer reviews claim this cream to be the most effective they have tried.
Cons	other reviews claim the product burns sensitive skin.

The cream may provide temporary relief of minor muscle and joint pain. According to the manufacturer, a person needs only a small amount to alleviate pain.

This OTC cream contains purified 0.025 percent capsaicin. Its budget-friendly price and a lower percentage of capsaicin make it an optimal product for first-time users.

The product is listed as the number one doctor- and pharmacist-recommended capsaicin cream.

The cream is also fragrance-free.

SHOP NOW

Best high potency: Capzix Cream for Pain Relief Maximum Strength

This product’s manufacturer says the high-potency formula helps treat the most severe pain points in joints and muscles caused by arthritis, back strains, and sprains.

The 0.1% capsaicin cream formula penetrates through tissue layers and blocks the body’s pain messengers.

It is also described as non-greasy and odor-free.

SHOP NOW

Capsaicin cream can be applied up to four times a day, according to a 2012 review. The researchers caution that capsaicin creams can cause burning, stinging, or itching but report that these sensations reduce over time.

The NHS recommends rubbing the necessary amount of the cream into the skin until there is none left on the surface and waiting 4 hours between applications.

If applying the cream to the hands, it is a good idea to wash the hands after 30 minutes.

A person might consider using rubber gloves, cotton balls, or a clean tissue to apply the cream. If applying the cream with the fingers, it may help to wash the hands beforehand.

A person may receive a prescription for Qutenza, a skin patch containing a high dose of capsaicin to reduce nerve pain from postherpetic neuralgia.

A healthcare professional applies the patch, then removes it after an hour, but the active ingredients continue working to alleviate the pain, when the treatment is effective.

People should consider these possible effects before making a purchase.

The NHS reports that these creams can cause skin irritation and a burning sensation, and the 2012 review warns against using capsaicin creams on inflamed or broken skin.

According to the NHS, a person should avoid inhaling the cream’s vapor, as doing so can lead to watery eyes, a runny nose, coughing, sneezing, and worsened asthma symptoms, in people with the condition.

If a person experiences any of the following serious side effects, they should receive medical care right away:

• severe pain
• skin swelling
• blistering
• eye irritation or pain
• signs of an allergic reaction, especially swelling of the lips, throat, or tongue

Also, people should avoid prolonged exposure to sunlight when using capsaicin creams, which can increase sensitivity to sunlight.

The following are some of the most common questions about capsaicin cream.

Is capsaicin cream available over the counter?

Yes, the various creams available over the counter contain between 0.025% and 0.1% capsaicin.

Is capsaicin cream an anti-inflammatory?

Yes, capsaicin commonly displays anti-inflammatory properties.

Capsaicin is the ingredient that makes chili peppers hot. From the skin, it can help block pain signals from reaching the brain.

Products containing capsaicin may be beneficial for persons with arthritis, sciatica, and muscle soreness.

Capsaicin creams can have side effects, so following the instructions carefully is key. Anyone who develops side effects should contact a doctor.

The 6 best capsaicin creams: Uses, options, and risks

We include products we think are useful for our readers. If you buy through links on this page, we may earn a small commission Here’s our process.

Medical News Today only shows you brands and products that we stand behind.

Our team thoroughly researches and evaluates the recommendations we make on our site. To establish that the product manufacturers addressed safety and efficacy standards, we:

• Evaluate ingredients and composition: Do they have the potential to cause harm?
• Fact-check all health claims: Do they align with the current body of scientific evidence?
• Assess the brand: Does it operate with integrity and adhere to industry best practices?

We do the research so you can find trusted products for your health and wellness.

Read more about our vetting process.

Was this helpful?

Capsaicin comes from chili peppers, and the heat it produces may help relieve pain associated with osteoarthritis, peripheral neuropathy, and other conditions. Many companies sell creams containing capsaicin for pain relief, but using capsaicin on the skin can have side effects.

This article discusses capsaicin creams in more detail and explores some products that are available to purchase online.

A quick look at the 6 best capsaicin creams

• Best for those with diabetes: Nervex
• Best gel product: Capzasin Quick Relief Gel
• Best whole body cream: Zostrix Maximum Strength
• Best for sports injuries: Pure Body Naturals Maximum Strength Hot Cream
• Best value: Rugby Capsaicin Cream
• Best high potency: Capzix Cream for Pain Relief

Capsaicin is the active ingredient in chili peppers, and it is what makes them hot.

According to the United Kingdom’s National Health Service (NHS), this ingredient can help reduce neuropathic pain by preventing the nerves from transmitting pain signals to the brain. This happens because capsaicin reduces the amount of “substance P” in the body, a chemical neuropeptide that acts as a pain messenger.

Capsaicin comes in two forms — creams and patches.

The cream form is available over the counter (OTC) and they typically contain between 0. 025–0.1% capsaicin. Experts consider products with 0.1% capsaicin high potency.

The patches are prescription only, and doctors may prescribe an 8% capsaicin patch known as Qutenza. A Qutenza patch can work for up to 3 months. People have Qutenza patches applied in a doctor’s office if they have conditions such as postherpetic neuralgia and diabetic neuropathy.

Capsaicin cream may have various health benefits.

A 2014 study reviewed the effects of Qutenza, a patch containing 8% capsaicin, in people with peripheral neuropathic pain. The participants used up to four patches for 12 weeks, and the researchers found that this reduced the participants’ pain.

An older review analyzed the effectiveness of herbal therapies in people with lower back pain and found that capsaicin can reduce pain better than a placebo.

Moreover, a 2018 study found that capsaicin cream is as effective as nonsteroidal anti-inflammatory drugs in providing pain relief for people with osteoarthritis.

Medical News Today chooses products that meet the following criteria:

• Price: MNT chooses products available for a wide range of budgets.
• Ingredients: MNT chooses products that clearly list all ingredients.
• Skin concerns: Where appropriate, MNT selects products that target a specific skin concern, such as dryness, oiliness, or aging.
• Safety: MNT chooses products that contain ingredients safe for topical use.
• Reputable: MNT selects products from businesses that adhere to industry best practices.

Was this helpful?

Below, we look at some capsaicin products for a person to consider.

Please note that the writer of this article has not tried these products. All information presented is purely research-based and correct at the time of publication.

Medical News Today follows a strict product selection and vetting process. Learn more here.

Was this helpful?

Best for those living with diabetes: Nervex

According to the manufacturer, Nervex is a pain relief cream suitable for people with diabetes, advanced neuropathy, peripheral neuropathy, and fibromyalgia. People with diabetes should consider the concentration of the capsaicin cream they use, and this cream meets those requirements.

The cream penetrates deep into the skin and absorbs fast. A person can use it on their feet, hands, legs, and toes. Other ingredients include vitamin B12, B1, and cetyl myristoleate, among other ingredients.

The product has a 60-day money-back guarantee.

SHOP NOW

Best gel product: Capzasin Quick Relief Gel

This gel’s design temporarily relieves pain from arthritis, bruises, and back pain. Its active ingredients are capsaicin and menthol.

The manufacturer says it is suitable for ages 18 years and older, is odor-free, and penetrates the skin deeply.

The product comes with a sponge-top applicator to help people use the right amount and massage it into the skin.

SHOP NOW

Best whole body cream: Zostrix Maximum Strength

Price	around $17
Pros	customer reviews report the product effectively relieving pain, specifically for those with sciatica and herpetic neuralgia.
Cons	other reviews claim using too much cream can cause a burning sensation that lasts for many days and redness forming on the skin.

This capsaicin cream can provide temporary relief of minor pain from arthritis, strains, and sprains, as well as minor back pain.

The manufacturer says that the cream is odor-free, nongreasy, and works for the whole body.

Anyone considering using this product to help with neuralgia should consult a doctor, as it may not suit those 18 years or younger.

SHOP NOW

Best for sports injuries: Pure Body Naturals Maximum Strength Hot Cream

Price	around $13
Pros	customer reports say this product creates a warming sensation and is suitable for those on their feet for long periods and with neck pain.
Cons	other reviews found the cream to be ineffective.

This cream targets muscle soreness, arthritis pain, pain from sports injuries, and inflammation. According to the manufacturer, it also helps with cellulite and deep muscle relaxation.

The company says that the product’s essential oils, including spearmint, eucalyptus, and sweet basil, are responsible for targeting inflammation and muscle tension and supporting blood circulation. These properties help to heal sports injuries.

This product is cruelty-free and contains no parabens, fragrance, sulfates, or harsh chemicals.

SHOP NOW

Best value: Rugby Capsaicin Cream

The cream may provide temporary relief of minor muscle and joint pain. According to the manufacturer, a person needs only a small amount to alleviate pain.

This OTC cream contains purified 0.025 percent capsaicin. Its budget-friendly price and a lower percentage of capsaicin make it an optimal product for first-time users.

The product is listed as the number one doctor- and pharmacist-recommended capsaicin cream.

The cream is also fragrance-free.

SHOP NOW

Best high potency: Capzix Cream for Pain Relief Maximum Strength

This product’s manufacturer says the high-potency formula helps treat the most severe pain points in joints and muscles caused by arthritis, back strains, and sprains.

The 0.1% capsaicin cream formula penetrates through tissue layers and blocks the body’s pain messengers.

It is also described as non-greasy and odor-free.

SHOP NOW

Capsaicin cream can be applied up to four times a day, according to a 2012 review. The researchers caution that capsaicin creams can cause burning, stinging, or itching but report that these sensations reduce over time.

The NHS recommends rubbing the necessary amount of the cream into the skin until there is none left on the surface and waiting 4 hours between applications.

If applying the cream to the hands, it is a good idea to wash the hands after 30 minutes.

A person might consider using rubber gloves, cotton balls, or a clean tissue to apply the cream. If applying the cream with the fingers, it may help to wash the hands beforehand.

A person may receive a prescription for Qutenza, a skin patch containing a high dose of capsaicin to reduce nerve pain from postherpetic neuralgia.

A healthcare professional applies the patch, then removes it after an hour, but the active ingredients continue working to alleviate the pain, when the treatment is effective.

People should consider these possible effects before making a purchase.

The NHS reports that these creams can cause skin irritation and a burning sensation, and the 2012 review warns against using capsaicin creams on inflamed or broken skin.

According to the NHS, a person should avoid inhaling the cream’s vapor, as doing so can lead to watery eyes, a runny nose, coughing, sneezing, and worsened asthma symptoms, in people with the condition.

If a person experiences any of the following serious side effects, they should receive medical care right away:

• severe pain
• skin swelling
• blistering
• eye irritation or pain
• signs of an allergic reaction, especially swelling of the lips, throat, or tongue

Also, people should avoid prolonged exposure to sunlight when using capsaicin creams, which can increase sensitivity to sunlight.

The following are some of the most common questions about capsaicin cream.

Is capsaicin cream available over the counter?

Yes, the various creams available over the counter contain between 0.025% and 0.1% capsaicin.

Is capsaicin cream an anti-inflammatory?

Yes, capsaicin commonly displays anti-inflammatory properties.

Capsaicin is the ingredient that makes chili peppers hot. From the skin, it can help block pain signals from reaching the brain.

Products containing capsaicin may be beneficial for persons with arthritis, sciatica, and muscle soreness.

Capsaicin creams can have side effects, so following the instructions carefully is key. Anyone who develops side effects should contact a doctor.

Capsaicin in the complex therapy of the pain form of diabetic neuropathy

11/12/2017

PDF article

According to the International Diabetes Federation, the number of patients with diabetes mellitus (DM) aged 20 to 79 years worldwide is 415 million (8. 8% of the world population), and this figure continues to increase steadily. It is predicted that by 2040 the number of patients with diabetes in the world will reach 642 million (IDF Diabetes Atlas, 7 ^th Edition revision, 2015). The costs of treating diabetes and its complications account for 12% of all global healthcare costs.

A common complication of DM is peripheral neuropathy, which in many patients is accompanied by pain that is difficult to treat. According to population studies, neuropathy of peripheral nerves is observed in 60-70% of patients with DM (R.C. Eastman, 1995), however, there are publications about the presence of this pathology in 100% of patients with DM (M. Janghorbani et al., 2006).

Three clinical forms of diabetic peripheral neuropathy are known: painless, acute and chronic pain forms. The painless form is characterized by gradual development and a long (years) course. Painful neuropathy lasting up to 6 months is acute, and more than 6 months is chronic. At the same time, “positive” (burning sensation, tingling and tingling, dagger pains, lumbago, hyperalgesia, allodynia) and “negative” (instability while walking, stiffness, numbness) pain symptoms are distinguished (A.S. Ametov, E.V. Sokareva, 2012). In many cases (more than 70%) neuropathy is distal symmetrical sensorimotor in nature; patients are concerned about severe pain, paresthesia, hyperesthesia, proprioception disorders, loss of sensitivity, muscle weakness and atrophy (R.C. Eastman, 1995). M. Harris et al. (1993) report that the symptoms of sensory neuropathy are detected in more than 40% of patients with diabetes.

A characteristic sign of neuropathy of diabetic origin is the appearance of pain at night or at rest (B.N. Mankovsky). According to P.B. Dyck, P.J. Dyck (1999) distinguishes the following diagnostic criteria for diabetic polyneuropathy: diagnosed diabetes mellitus, prolonged chronic hyperglycemia, the presence of distal symmetric sensorimotor polyneuropathy and the exclusion of its other causes, the presence of nephro- or retinopathy similar in severity to polyneuropathy.

Given that severe pain syndrome, which negatively affects the ability to work and the quality of life of patients, is observed in 20-30% of patients with peripheral diabetic neuropathy, the role of effective treatment of neuropathic pain in DM cannot be overestimated (A.S. Ametov, E.V. Sokareva , 2012). Among the main modern directions in the treatment of diabetic neuropathy, pathogenetic (restoration of nerve function, control of glycemia) and symptomatic therapy (pain relief) should be noted. Lifestyle changes are important, including optimization of physical activity, diet therapy and body weight correction. It is possible to use non-pharmacological methods of treatment, such as magnetic therapy, electrical stimulation of the spinal cord and transcutaneous electrical nerve stimulation for 3-4 weeks, acupuncture, organization of psychological support (D. Ziegler, 2009).

During pathogenetic therapy, α-lipoic acid preparations are prescribed, as well as B vitamins (B ₁ , B ₆ , B ₁₂ ), which improve the metabolism of affected nerve fibers. Non-steroidal anti-inflammatory drugs (NSAIDs), antidepressants, and anticonvulsants are used to treat pain in diffuse or focal diabetic neuropathy. It is possible to prescribe opioids when other drugs and local anesthetics are ineffective, and a positive effect of isosorbide dinitrate in the form of a spray is also expected. It is known that the constant use of NSAIDs, antidepressants and other drugs that have an analgesic effect is limited due to numerous side effects. As a rule, these drugs are prescribed for course therapy, but even during administration, their effectiveness in some cases is insufficient, which necessitates combined treatment with the inclusion of topical agents. For the purpose of local action in painful diabetic neuropathy, irritants are locally prescribed, for example, capsaicin, an alkaloid obtained from capsicum (Capsicum annuum, Capsicum genus, Solanaceae family). Locally, capsaicin is used in the form of a cream or ointment, which is applied to painful areas with a thin layer 3 times a day and rubbed (I. I. Dedov, G.A. Melnichenko, 2009). Similar data on the topical use of this substance is published in the 2011 Toronto Expert Panel on Diabetic Neuropathy Consensus for the Diagnosis, Evaluation and Management of Painful Diabetic Neuropathy, which recommends the application of 0.075% capsaicin cream 3-4 times a day. Later M.K. Aswar and V.R. Patil in A Systematic Review on Neuropathy (2016) also noted that topical capsaicin is effective in peripheral neuropathy. In addition, recommendations for the use of topical agents with capsaicin in diabetic neuropathy are also reflected in the recommendations of the European Federation of Neurological Societies (EFNS) on the pharmacological treatment of neuropathic pain (2010), as well as in the 2011 general report of the American Association of Neuromuscular and electrodiagnostic medicine and the American Academy of Physical Medicine and Rehabilitation (American Academy of Neurology, the American Association of Neuromuscular and Electrodiagnostic Medicine; the American Academy of Physical Medicine and Rehabilitation).

It is believed that the therapeutic effect of capsaicin in the treatment of the painful form of diabetic neuropathy is realized due to the depletion of pain impulses. The action of capsaicin is associated with a significant decrease in the reserves in the sensory fiber terminals of substance P, a neuropeptide, which is the main neurotransmitter for the transmission of pain impulses from the peripheral to the central nervous system. Among the most common side effects of capsaicin are itching, burning sensation and erythema at the site of application of the cream or ointment. It should also be noted that after the first application of the drug, pain may increase (A.A. Zusman et al., 2011), and with regular repeated use – a decrease, since neurons lose sensitivity over time.

The therapeutic effects of capsaicin have been studied in a number of studies. Of interest is a double-blind, placebo-controlled, 8-week study of capsaicin cream in 277 patients with painful peripheral polyneuropathy and/or radiculopathy treated at 12 clinical centers (Capsaicin Study Group, 1992). The analysis included individuals with fasting glucose <10 mmol/l or glycosylated hemoglobin ≤11%. In the group of patients who applied a cream containing capsaicin to the painful areas, a significant improvement was obtained in terms of pain status (p=0.012) and functional state: walking (p=0.029), work (p=0.019), sleep (p=0.036) and recreational activity (p=0.037). The researchers concluded that the topical application of capsaicin cream effectively relieves pain in patients with painful diabetic neuropathy, with a subsequent improvement in daily activity of patients and an increase in their quality of life.

Based on an 8-week study by R. Biesbroeck et al. (1995), conducted with the participation of 235 patients with painful diabetic neuropathy, topical use of capsaicin-containing drugs is comparable in effectiveness to oral administration of amitriptyline, but is safer due to the absence of drowsiness, as well as side effects from the cardiovascular system and neuromuscular complications (46. 9and 23%, respectively, in the amitriptyline group). Later, J. Kiani et al. (2015) proved equivalent efficacy of topical capsaicin-containing creams and amitriptyline in a 12-week, randomized, double-blind study that included 102 patients with painful diabetic neuropathy.

Also interesting are the results of a study by J.Y. Moon et al. (2017), which evaluated the efficacy and safety of topical capsaicin preparations. The authors came to the conclusion about the statistically significant effectiveness of patches and cream when used in the treatment of pain for 6 weeks in patients with peripheral neuropathy. C. Mankowski et al. in 2017, published the results of a randomized trial, which indicate the high efficacy of topical application of capsaicin in peripheral neuropathic pain and good tolerability of such treatment.

Traditionally, capsaicin products are used topically at a concentration of 0.025 to 0.075% (N. Uceyler, C. Sommer, 2014). However, at present, the issues of studying the effectiveness and safety of using high concentration capsaicin-containing products (≥5%) are relevant. The history of their use began in 2009, when a transdermal 8% capsaicin patch was introduced into the practice of treating pain syndromes in peripheral neuropathy (N. Uceyler, C. Sommer, 2014). In 2016 A.I. Vinik et al. published the results of a study on the safety and tolerability of topical application of a patch containing a drug with 8% capsaicin content. The trial lasted 52 weeks, 468 patients were randomized into 2 groups. The first included patients with painful diabetic peripheral neuropathy who received standard treatment in combination with a patch, and the second included those who received only standard therapy. Based on the results of the study, it was concluded that long-term combination therapy, which included a patch with capsaicin, was well tolerated; at the same time, there were no significant adverse effects of a functional or neurological nature in comparison with standard treatment. A similar conclusion was reached several years earlier by researchers from Germany (T. Wagner et al., 2013), who conducted a retrospective analysis of the local use of capsaicin-containing patches, which contributed to a long-term and sustainable reduction of neuropathic pain. In the review of R.W. Hurley et al. (2013), devoted to recommendations and data accumulated in the field of neuropathic pain treatment (Neuropathic pain: treatment guidelines and updates), noted the possibility of using a capsaicin patch in the treatment of peripheral diabetic neuropathy. M. Haanpaa and R.D. Treede (2012), analyzing the results of three randomized trials, concluded that the use of patches with a high concentration of capsaicin is effective and provides tolerance comparable to that of low-dose topical agents in patients with peripheral neuropathic pain.

Summarizing the above, it should be noted that the local use of capsaicin-containing drugs in the complex treatment of the pain form of diabetic neuropathy is appropriate, given the evidence of their effectiveness and safety. On the Ukrainian market there is a cream with a capsaicin content of 0.05% Capsagamma Cream (Woerwag Pharma, Germany), which is produced in tubes of 40 mg. Local application of capsaicin cream will increase the effectiveness of symptomatic therapy in patients with diabetic neuropathy without increasing the risk of significant side effects, which is important for diabetic patients who usually take a large number of different drugs. This approach will improve the safety profile of complex patient care, reduce the risk of polypharmacy, and improve compliance.

Prepared by Ilona Dyudina

• Number:
• Thematic issue “Neurology, Psychiatry, Psychotherapy” No. 3 (42), February 2017

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M02AB Capsaicin and similar agents (Capsaicin and Similar Agents) is included in the group

Anatomo-Therapeutic-Chemical (ATC) classification system (ATC)

ATC code:
M02AB

Part of the group:
M02A-
Topical preparations for joint and muscle pain

Name:
Capsaicin and similar preparations

Latin name:
Capsaicin and Similar Agents

Preparations of group

Descriptions of drugs with inactive reg. beats or not supplied to the Russian market