Topical application of capsaicin has been associated with mild to severe adverse effects, including dermatitis and cough. 19 Studies of caspaicin-induced apoptosis in glioma cells found inhibition of autophagy to be a likely contributor. 15,16,18 Alternatively, the co-carcinogenic effect of capsaicin on chemically induced skin carcinogenesis is mediated via epidermal growth factor receptor. 26Ĭapsaicin exerts chemopreventive effects by causing cell-cycle arrest and inducing apoptosis, by generating reactive oxygen species and depolarizing mitochondrial membranes, and through caspase activation. 24 Also, capsaicin activates transient receptor potential vanilloid subfamily member 1 (TRPV1, referred to as a capsaicin receptor), 25 resulting in selective and reversible defunctionalization of cutaneous sensory nerve endings expressing TRPV1. 23 This results in an initial increase in pain, but after repeated exposures, pain subsides due to the eventual depletion of substance P at afferent neurons. Mechanistic studies revealed that the analgesic effects of capsaicin are due to depolarization of C-fiber polymodal nociceptors, 21,22 which causes the release of substance P, a neurotransmitter that relays pain signals to the brain. 20 More research is needed to evaluate the role of capsaicin in cancer symptom relief. However, long-term topical application of capsaicin was shown to increase skin carcinogenesis in mice treated with a tumor promoter, 19 although such effects may be dose-dependent. 02), with reductions also observed after 12 weeks (P =. Patients with a low sensitivity to neurotoxic agents had higher pain reduction after 8 days (P =. In another study of 18 patients with oxaliplatin-induced neuropathy, a single application of 8% capsaicin patch decreased pain. However, it was also associated with significant skin burning, skin redness, and cough In a crossover study of 99 patients with cancer who had postsurgical neuropathic pain, a capsaicin (0.075%) cream, applied at the pain site 4 times daily, produced substantial pain relief (P =. RockefellerĬhair in Integrative Medicine and Chief of GUEST EDITOR Integrative Oncology is guest edited by Jun J. 10 Additional case series indicate that topical capsaicin (0.025%) may also be effective for cannabis-associated hyperemesis. The reduction in endoscopic swallowing scores in the capsaicin group was significantly greater than in the placebo group 30 and 60 minutes after treatment (P <. 9Īlso, preliminary findings suggest the utility of topical capsaicin (0.025%), applied to the external auditory canal, for improving swallowing function in a study of elderly patients with dysphagia (n = 20). 02) and global subjective improvement (P =. In a randomized study (n = 30), topical capsaicin (0.075%) applied 3 times daily for 6 weeks (used along with standard treatment) yielded significant improvements in myalgic score (P =. 8Ĭapsaicin has been shown to have short-term benefits in patients with fibromyalgia as well. 7Ī meta-analysis of 25 randomized trials reported the capsaicin patch to be as effective as oral agents such as duloxetine and gabapentin for painful diabetic peripheral neuropathy without the adverse effects associated with these agents. In a phase IV multicenter study involving 420 patients with nondiabetic peripheral neuropathic pain, the capsaicin patch produced rapid, sustained pain relief and improved health-related quality of life (half of all patients achieved a clinically important ≥ 30% reduction in mean numerical pain rating scores ‘average pain’ by weeks 2 and 8 after the first treatment, which was sustained in patients who received retreatment). Furthermore, the reductions in pain were maintained with repeated administrations over 1 year. A 4-week randomized trial of 44 patients with postherpetic neuralgia found a single 60-minute application to be safe and effective in reducing the numerical pain rating scores compared with the control (P =. 5Ī high-concentration dermal patch containing 8% capsaicin has also been investigated for its benefits. 3 Topical capsaicin is also included in the American College of Rheumatology recommendations for osteoarthritis, 4 but its effectiveness for rheumatoid arthritis remains inconclusive. Gubili is Editor, Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York.Ĭlinical data indicate the benefits of topical formulations containing low-concentration capsaicin (0.025%) for psoriasis 1 (0.025%–0.3%) for prurigo nodularis 2 and (0.006%) for pruritus ani. Latte-Naor is Director, Mind-Body Medicine, and Assistant Attending Physician, Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York.
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