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.
A 23-year-old man with no significant past medical history presents to an urgent care center after a fall on his right arm while playing football. He reports a pain level of 6 using the visual analog scale (VAS). Physical exam reveals minor erythema and edema of his forearm with pain to palpation. Range of motion, strength, and sensation are intact. No lacerations are present. His vital signs are normal. No fracture is found on imaging. The physician decides that treatment with a topical analgesic is reasonable for this uncomplicated contusion of the right forearm. Is there a role for topical capsaicin in the treatment of this patient's pain?
Topical nonsteroidal anti-inflammatory drugs (NSAIDs) are effective for the treatment of acute non-low back pain musculoskeletal injuries. (2) They are generally well tolerated and just as effective as oral NSAIDS or acetaminophen for localized injuries. Their ubiquitous availability, affordability, and low adverse effect profile make them an attractive first-line treatment option for acute musculoskeletal pain.
Capsaicin, a topical agent derived from a genus of red peppers, has been used for the treatment of neuropathic and chronic pain via its interactions with substance P, transient receptor potential vanilloid subtype 1 (TRPV1), and nociceptive nerve fibers. (3,4) It has demonstrated effectiveness in the management of diabetic neuropathy, knee...