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Topical capsaicin helps severe fibromyalgia pain; depletes pain-signaling substance P in local nerve endings

  [ 24 votes ]   [ 5 Comments ] • August 3, 2012

Short-term efficacy of topical capsaicin therapy in severely affected fibromyalgia patients
- Source: Rheumatology International, Jul 28, 2012

By Benigno Casanueva, et al.

[Note: capsaicin is the active component in chili peppers that causes a burning sensation where it touches tissues. It is thought to work by temporarily depleting or interfering with substance P in local nerve endings. Substance P is a protein involved in transmitting pain impulses to the brain, and its level in the cerebrospinal fluid of fibromyalgia patients is known to be 3 to 4 times normal. Many capsaicin-containing prescription and over-the-counter products for external application are available in a variety of forms and concentrations including 1% capsaicin (strong), and more-frequent 0.075%, generally for neuropathic pain, or 0.025%, generally for musculoskeletal pain. See for basic information about topical capsaicin.]

The purpose of this study was to evaluate the short-term efficacy of topical capsaicin treatment in patients severely affected by fibromyalgia.

One hundred and thirty fibromyalgia patients were randomly divided into two groups.

• The control group, 56 women and 4 men who continued their medical treatment,

• And the capsaicin group, 70 women who apart from continuing their medical treatment, also underwent topical capsaicin 0.075% 3 times daily for 6 weeks.

At the beginning of the program, there were no significant differences between the two groups in any of the analyzed parameters.

At the end of the treatment, there were significant improvements in the capsaicin group in the myalgic [pain] score (5.21 vs 3.8, p = 0.02) and global subjective improvement (22.8% vs 5%, p = 0.001). [Note: The myalgic score was determined by how much pressure could be applied to a tender point before the patient experienced pain, so a higher score indicates higher pain threshold.]

Six weeks after the end of the treatment, the experimental group showed significant differences in Visual Analogue Scale of depression (5.63 vs 7.35, p = 0.02), Fibromyalgia Impact Questionnaire (67.89 vs 77.7, p = 0.02), role limitations due to emotional problems (36.17 vs 17.2, p = 0.05), Fatigue Severity Scale (6.2 vs 6.6, p = 0.04), myalgic score (3.94 vs 2.66, p = 0.02) and pressure pain threshold (79.25 vs 56.71, p = 0.004).

In conclusion, patients severely affected by fibromyalgia can obtain short-term improvements following topical capsaicin 0.075% treatment three times daily for 6 weeks.

Source: Rheumatology International, Jul 28, 2012. DOI: 10.1007/s00296-012-2490-5, by Casanueva B, Rodero B, Quintial C, Llorca J, Gonzalez-Gay MA. Rheumatology Service, Specialist Clinic of Cantabria; Rodero Center, Neurophysiology Service, Santa Clotilde Hospital; Dept. of Epidemiology and Computational Biology, University of Cantabria; Rheumatology Service, Hospital Universitario Marques de Valdecilla, Santander, Cantabria, Spain. [Email:]

Please Discuss This Article:   Post a Comment 

Posted by: roge
Aug 4, 2012
Oh but I thought FM was only a central sensitization issue - hogwash - it also has a peripheral component as well - peripheral nerves as well as dysfunctional facia and muscles - but for whatever reason, researchers dont want to focus on these perhiperal areas - wake up please.
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Peripheral - skin!
Posted by: KerryK
Aug 4, 2012
It continues to mystify me that the most obvious peripheral source of the pain of FM, the place that the capsaicin cream was applied to, the skin, is always ignored as the source of our troubles. This, too, in the face of discoveries on the action of capsaicin against the trpv1 nerve receptors on c-fibers in skin, the overpresence of mast cells and the potential role of keratinocytes in pain generation. I note that the skin is the most sensitive organ system. Why do we want to believe so hard that muscle and fascia are the source, even given the notable absence of evidence for muscle, fascia involvement.
Reply Reply

Posted by: roge
Aug 5, 2012
kerryk, true and good point about the skin, that said there are some studies showing abnoral and dysfunctional facia and muscle, please do some research before completely discountng this. a recent study show inflamed facia (just google " fibromyalgia facia inlamed" and other studies have shown red ragged fibres in muscles and a host of other muscle abnormalities pointing to hypoxia. As Im sure you know, the main complaint of those with FM is muscle and facia pain and especially after repetitive use so there quite obviously is in addition to central hypersensitivty dysfunction at the muscle and connective tissue level.
Reply Reply

Posted by: KerryK
Aug 6, 2012
Rogue. I apologize for seemingly offending you. That was not my intent. However, I did google as you suggested and the connection of FM to fascia is only barely not conjecture. The connection to muscle appears to be primarily faith. It is notable that the research community has pretty much abandoned the "muscle pain" hypothesis. Further, I have done a hell of a lot of research. It appears to me that patients report muscle pain as their symptom because, in a way, I guess, FMS sort of feels like muscle pain. Further, there have been armies of physiotherapists, acupuncturists, massages therapists, and doctors who want to get rid of you telling us for decades that it is just "muscle pain". It is a meme that somehow became a truth by repetition. I feel strongly that the breezy dismissal of our problems as muscle pain, with poor evidence, has distracted research and delayed progress on our illness. It is now that the illness is treated as we would neuropathy that progress is finally being made. Finally, I suppose that if inflamed fascia were the cause of FM, it would more properly be called fasciiitis.


Horrible Reaction To Capsaicin - Beware!
Posted by: jhampton
Aug 17, 2012
I suffer from Undifferenciated Connective Tissue Disease, Systemic Fibromyalgia, Chronic Fatigue Syndrome....just to name a few. A few months ago my Rhematologist encouraged me to try Capsacian on my elbows for muscle and joint pain. I have developed Neuropathy and Tennis Elbow along with everything else. I had started Physical Therapy and decided I had better give the Capsaicin a try. I also applied it on my toes because they hurt so bad. Holy Cow!!! By the second day I was in so much pain from the burning from this stuff I just about checked myself in to the Hospital! It burned so horribly bad I thought....something is not right. I had a horrible reaction to Capsaicin! If your skin is very sensitive...DON'T USE IT! I thought I would try Benadryl and a Cortisone Ointment to try to get the "burning and pain" to stop. The next day I was feeling better but it took several days to recover. When I searched the Web to find out information about Capsaicin I couldn't believe all the people who suffer "Burns" from this stuff! I had no idea what was in it or I wouldn't have used it at all! very careful! I would NEVER use this stuff! People with AutoImmune Diseases and Fibromyalgia have very Sensitive Skin. I encourage people to not use Capsaicin. I did use BioFreeze and it works quite well,and,without getting burned! Be Very Careful!
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