Topical capsaicin versus topical ibuprofen in acute musculoskeletal injuries: A randomized, double-blind trial

Abstract

Background: Acute musculoskeletal pain is one of the common causes of emergency admissions. Topical analgesics are

an easily tolerated option in the treatment of these pains.

Objective: This study aimed to compare the efficacy of topical capsaicin and topical non-steroidal anti-inflammatory

drugs in acute musculoskeletal injuries.

Methods: In this prospective, randomized, controlled, double-blinded study, patients were allocated to two groups—

the topical non-steroidal anti-inflammatory drug (n=60) and topical capsaicin (n=59). For both groups, the first dose

treatment was applied as a thin layer in the emergency department to a maximum area of 5×5cm. The remaining doses

were administered at home by the patients for 72 h. The initial visual analog scale scores were compared with the 60th

and 120th minute as well as the 24th and 72nd hour values. Differences between the visual analog scale scores, clinical

response to the treatment, and side effects were evaluated.

Results: The proportional reduction in visual analog scale scores for topical capsaicin was significantly higher, especially

at 36 and 72h. These rates were 0.75 (95% confidence interval: 0.77–1.42; p=0.029) and 9.08 (95% confidence interval:

1.02–17.14; p=0.028) at 36h, respectively. At 72h, they were 1.27 (95% confidence interval: 0.48–2.05; p=0.002) and

17.07 (95% confidence interval: 8.39–25.76; p<0.001), respectively. In the topical capsaicin group, the clinical response

to treatment was significantly higher (p=0.001). Treatment-related systemic side effects were experienced only in the

topical non-steroidal anti-inflammatory drug group (1.7%).

Conclusion: Topical capsaicin can be used safely in patients presenting to the emergency department with acute pain

with its high analgesic efficacy and absence of systemic side effects.

Keywords

Musculoskeletal injuries, topical capsaicin, topical ibuprofen