Topical capsaicin (high concentration) for chronic neuropathic pain in adults

Sheena Derry; Andrew S C Rice; Peter Cole; Toni Tan; R Andrew Moore

doi:10.1002/14651858.CD007393.pub3

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Figure 1

Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.

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Figure 2

Forest plot of comparison: 1 8% capsaicin versus control (single dose), outcome: 1.1 PGIC much or very much improved at 8 and 12 weeks.

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Figure 3

Forest plot of comparison: 1 8% capsaicin versus control (single dose), outcome: 1.2 PHN ‐ at least 50% pain intensity reduction over weeks 2 to 8.

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Figure 4

Forest plot of comparison: 1 8% capsaicin versus control (single dose), outcome: 1.6 HIVN ‐ at least 30% pain intensity reduction over weeks 2 to 12.

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Figure 5

Skin adverse event rates with capsaicin and control. Yellow symbols are studies recording all events (Group 1). Pink symbols are studies specifying that events are not recorded on the first day after treatment (Group 2). The blue symbol did not specify the period over which events were recorded (Group 2). Size of symbol is proportional to the size of the study

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Figure 6

Forest plot of comparison: 1 8% capsaicin versus control (single dose), outcome: 1.10 Serious adverse events.

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Analysis 1.1

Comparison 1 8% capsaicin versus control (single dose), Outcome 1 PGIC much or very much improved at 8 and 12 weeks.

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Analysis 1.2

Comparison 1 8% capsaicin versus control (single dose), Outcome 2 PHN ‐ at least 50% pain intensity reduction over weeks 2 to 8.

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Analysis 1.3

Comparison 1 8% capsaicin versus control (single dose), Outcome 3 PHN ‐ at least 50% pain intensity reduction over 2 to 12 weeks.

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Analysis 1.4

Comparison 1 8% capsaicin versus control (single dose), Outcome 4 PHN ‐ at least 30% pain intensity reduction over weeks 2 to 8.

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Analysis 1.5

Comparison 1 8% capsaicin versus control (single dose), Outcome 5 PHN ‐ at least 30% pain intensity reduction over weeks 2 to 12.

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Analysis 1.6

Comparison 1 8% capsaicin versus control (single dose), Outcome 6 HIVN ‐ at least 30% pain intensity reduction over weeks 2 to 12.

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Analysis 1.7

Comparison 1 8% capsaicin versus control (single dose), Outcome 7 Local skin reactions ‐ group 1.

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Analysis 1.8

Comparison 1 8% capsaicin versus control (single dose), Outcome 8 Local skin reactions ‐ group 2.

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Analysis 1.9

Comparison 1 8% capsaicin versus control (single dose), Outcome 9 Patch tolerability.

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Analysis 1.10

Comparison 1 8% capsaicin versus control (single dose), Outcome 10 Serious adverse events.

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Analysis 1.11

Comparison 1 8% capsaicin versus control (single dose), Outcome 11 Withdrawals.

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Comparison 1. 8% capsaicin versus control (single dose)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 PGIC much or very much improved at 8 and 12 weeks Show forest plot	2		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

1.1 8 weeks	2	571	Risk Ratio (M‐H, Fixed, 95% CI)	1.42 [1.10, 1.84]
1.2 12 weeks	2	571	Risk Ratio (M‐H, Fixed, 95% CI)	1.55 [1.20, 1.99]
2 PHN ‐ at least 50% pain intensity reduction over weeks 2 to 8 Show forest plot	3	870	Risk Ratio (M‐H, Fixed, 95% CI)	1.44 [1.12, 1.86]

2.1 30‐minute application	1	97	Risk Ratio (M‐H, Fixed, 95% CI)	2.95 [0.73, 11.88]
2.2 60‐minute application	3	674	Risk Ratio (M‐H, Fixed, 95% CI)	1.34 [1.03, 1.75]
2.3 90‐minute application	1	99	Risk Ratio (M‐H, Fixed, 95% CI)	2.02 [0.64, 6.33]
3 PHN ‐ at least 50% pain intensity reduction over 2 to 12 weeks Show forest plot	2	571	Risk Ratio (M‐H, Fixed, 95% CI)	1.31 [1.00, 1.71]

4 PHN ‐ at least 30% pain intensity reduction over weeks 2 to 8 Show forest plot	4	1268	Risk Ratio (M‐H, Fixed, 95% CI)	1.31 [1.13, 1.52]

4.1 30‐minute application	1	97	Risk Ratio (M‐H, Fixed, 95% CI)	1.34 [0.67, 2.69]
4.2 60‐minute application	4	1072	Risk Ratio (M‐H, Fixed, 95% CI)	1.30 [1.12, 1.52]
4.3 90‐minute application	1	99	Risk Ratio (M‐H, Fixed, 95% CI)	1.48 [0.74, 2.95]
5 PHN ‐ at least 30% pain intensity reduction over weeks 2 to 12 Show forest plot	3	973	Risk Ratio (M‐H, Fixed, 95% CI)	1.25 [1.07, 1.45]

6 HIVN ‐ at least 30% pain intensity reduction over weeks 2 to 12 Show forest plot	2	801	Risk Ratio (M‐H, Fixed, 95% CI)	1.35 [1.09, 1.68]

6.1 30‐minute application	2	340	Risk Ratio (M‐H, Fixed, 95% CI)	1.67 [1.14, 2.46]
6.2 60‐minute application	2	359	Risk Ratio (M‐H, Fixed, 95% CI)	1.10 [0.84, 1.44]
6.3 90‐minute application	1	102	Risk Ratio (M‐H, Fixed, 95% CI)	1.94 [0.83, 4.53]
7 Local skin reactions ‐ group 1 Show forest plot	3		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

7.1 Erythema	3	1312	Risk Ratio (M‐H, Fixed, 95% CI)	1.40 [1.30, 1.52]
7.2 Pain	3	1312	Risk Ratio (M‐H, Fixed, 95% CI)	2.28 [1.99, 2.62]
7.3 Papules	3	1312	Risk Ratio (M‐H, Fixed, 95% CI)	3.58 [1.87, 6.85]
7.4 Pruritus	3	1312	Risk Ratio (M‐H, Fixed, 95% CI)	1.99 [0.98, 4.03]
7.5 Oedema	3	1312	Risk Ratio (M‐H, Fixed, 95% CI)	2.98 [1.44, 6.18]
8 Local skin reactions ‐ group 2 Show forest plot	3		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

8.1 Erythema	1	129	Risk Ratio (M‐H, Fixed, 95% CI)	6.31 [0.35, 114.82]
8.2 Pain	3	735	Risk Ratio (M‐H, Fixed, 95% CI)	1.85 [0.99, 3.47]
8.3 Papules	3	735	Risk Ratio (M‐H, Fixed, 95% CI)	1.58 [0.59, 4.24]
8.4 Pruritus	3	735	Risk Ratio (M‐H, Fixed, 95% CI)	1.57 [0.98, 2.50]
8.5 Oedema	3	735	Risk Ratio (M‐H, Fixed, 95% CI)	1.34 [0.75, 2.39]
9 Patch tolerability Show forest plot	6		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

9.1 < 90% of application time	6	2074	Risk Ratio (M‐H, Fixed, 95% CI)	3.27 [1.17, 9.15]
9.2 Dermal irritation score > 2 at 2 h	3	1065	Risk Ratio (M‐H, Fixed, 95% CI)	11.80 [4.04, 34.48]
9.3 Dermal irritation score > 0 at 2 h	2	606	Risk Ratio (M‐H, Fixed, 95% CI)	2.28 [1.60, 3.26]
9.4 Rescue medication 0 to 5 d	6	2073	Risk Ratio (M‐H, Fixed, 95% CI)	2.47 [2.13, 2.87]
10 Serious adverse events Show forest plot	5	1579	Risk Ratio (M‐H, Fixed, 95% CI)	1.41 [0.82, 2.41]

11 Withdrawals Show forest plot	6		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

11.1 Adverse events	6	2073	Risk Ratio (M‐H, Fixed, 95% CI)	0.87 [0.37, 2.00]
11.2 Lack of efficacy	6	2073	Risk Ratio (M‐H, Fixed, 95% CI)	0.57 [0.32, 1.02]

Comparison 1. 8% capsaicin versus control (single dose)

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