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Written by

Dr Karen H Simpson Dr Karen H Simpson is a consultant in anaesthesia and pain medicine, Leeds, UK

Research update: Effectiveness of the capsaicin 8% patch in the management of peripheral neuropathic pain in European clinical practice

Published 6 September 2017

Pain specialist and joint editor Dr Karen H Simpson reviews the ASCEND trial - an open-label, non-interventional study of patients with non-diabetic peripheral neuropathic pain receiving capsaicin 8% patch treatment

Mankowski C, Poole CD, et al.
Effectiveness of the capsaicin 8% patch in the management of peripheral neuropathic pain in European clinical practice: the ASCEND study
BioMed Central Neurology 2017;17(1):80.

Topical capsaicin formulations have been used for pain management for many years. Acceptable tolerability and modest efficacy of low-concentration capsaicin formulations has been shown but this does require repeated daily self-administration that can be a problem in terms of patient concordance. A high-concentration capsaicin 8% patch can be administered by a single 60-minute application in patients with neuropathic pain. The procedure is unpleasant but has been found to produce effective pain relief for up to 12 weeks.

The mechanism of action of topical capsaicin was historically ascribed to depletion of substance P. However, studies now suggest that the depletion of substance P from nociceptors is only a correlate of capsaicin treatment and has little causative role in analgesia. Topical capsaicin acts to attenuate cutaneous hypersensitivity and reduce pain by ‘defunctionalisation’ of nociceptors. This phenomenon is due to temporary loss of membrane potential, inability to transport neurotrophic factors and reversible retraction of epidermal and dermal nerve fibre terminals.

In randomised studies, the capsaicin 8% patch has shown efficacy for pain relief in patients with peripheral neuropathic pain (PNP) arising from different aetiologies, such as diabetic neuropathy and post-herpetic neuralgia.

ASCEND was an open-label, non-interventional study of patients with non-diabetic PNP. They received capsaicin 8% patch treatment. They were assessed for ≤ 52 weeks. Endpoints were percentage change in the mean numeric pain rating scale (NPRS), average daily pain score from baseline to the average of weeks 2 and 8 following first treatment and median time from first to second treatment. Health-related quality of life (HRQoL, using EQ-5D), Patient Global Impression of Change (PGIC) and tolerability were also noted.

Following first capsaicin 8% patch treatment, patients experienced a 27% (95% CI: 23.6, 29.62; n=412) reduction in mean NPRS score from baseline to weeks 2 and 8. Forty-four percent of all patients were responders (≥30% reduction in NPRS score from baseline to weeks 2 and 8) following first treatment, and of this 44%, 86.9% (n=159/183) remained successfully treated at week 12. The median time from first to second treatment was 191 days (95% CI: 147, 235; n=181).

Analgesia was seen until week 52, with a 37% (95% CI: 31.3, 42.7; n=176) reduction in mean NPRS score from baseline. Patients with the shortest duration of pain had a better response to treatment. Mean EQ-5D index score improved from baseline to week 2 and was maintained until week 52. Most patients reported improvements in PGIC at week 2 and at all follow-up assessments regardless of number of treatments received. Adverse events were primarily mild or moderate reversible application site reactions.

Therefore, the capsaicin 8% patch provided effective and sustained pain relief, substantially improved HRQoL, enhanced overall health status and was generally well tolerated in a heterogeneous PNP population.


  • Dr Karen H Simpson is a consultant in anaesthesia and pain medicine, Leeds, UK

Date of preparation: September 2017; MINT/PAEU-17042