Time to consider topical capsaicin for acute trauma pain?
Topical capsaicin is more effective than topical piroxicam at reducing pain in acute upper extremity injuries.
PRACTICE CHANGER
Use topical capsaicin gel 0.05% for pain reduction in patients with isolated blunt injuries of the upper extremity without fracture.
STRENGTH OF RECOMMENDATION
B: Based on a single randomized controlled trial (RCT)1
Kocak AO, Dogruyol S, Akbas I, et al. Comparison of topical capsaicin and topical piroxicam in the treatment of acute trauma-induced pain: a randomized double-blind trial. Am J Emerg Med. 2020;38:1767-1771.
Reported adverse effects, such as burning, itching, and rash, were mild and infrequent and showed no significant difference between the treatment groups.
WHAT’S NEW
First study comparing topical capsaicin and a topical NSAID in acute trauma
Although both capsaicin and topical piroxicam have proven efficacy for the treatment of pain, this RCT is the first study to directly compare these agents in the setting of acute upper extremity blunt trauma. Capsaicin is currently more commonly prescribed as a treatment for chronic neuropathic pain.4,9 In this study, capsaicin demonstrated superior results in pain reduction at each assessed time interval and at the primary end point of 72 hours.
CAVEATS
Limited generalizability to lower extremity and truncal trauma
This RCT included a relatively small sample size (136 patients). Researchers evaluated only blunt upper extremity injuries; as such, the generalizability of the effectiveness of topical capsaicin in blunt lower extremity and truncal trauma is limited, especially over larger surface areas.
CHALLENGES TO IMPLEMENTATION
No major challenges found
There are no major challenges to implementing this inexpensive treatment.
