Brazilian Journal of Anesthesiology
Brazilian Journal of Anesthesiology
Scientific Article

Capsaicin topical cream (8%) for the treatment of myofascial pain syndrome

Creme tópico de capsaicina (8%) para o tratamento da síndrome da dor miofascial

Valéria Romero, Juliana Rodrigues Lara, Francisco Otero-Espinar, Manoel Henrique Salgado, Norma Sueli Pinheiro Modolo, Guilherme Antonio Moreira de Barros

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Myofascial pain syndrome is a common cause of musculoskeletal pain. The objective of this study was to evaluate the potential analgesic action of 8% capsaicin cream for topical use in patients with myofascial pain syndrome.

Initially, cream formulations of PLA (Placebo) and CPS (Capsaicin 8%) were developed and approved according to the current requirements of the health authority agency. The 40 participating patients were randomly assigned to the PLA and CPS groups in a double‐blind fashion. Before the creams were topically administered, according to the allocation group, the local anesthetic was used for a period of 50 minutes directly in the area of interest. The cream was applied to the area of the skin over the trigger point, represented by the area with pain at palpation, in an amount of 10 g for 30 minutes in a circular area of 24 mm diameter. Subsequently, the cream was removed and the skin tolerability parameters were evaluated. The pain was measured before and during the formulation application, as well as at 1 hour, 7 days, 30 days, and 60 days after the procedure, evaluated using a verbal numerical scale (from 0 to 10: with 0 = no pain and 10 = worst pain imaginable).

No patient in PLA Group had hyperemia or burning sensation at the site of application, while 85% of patients in CPS Group had hyperemia or burning sensation at 15 minutes. These complaints disappeared 24 hours after the cream was removed. The pain score in CPS Group decreased steadily up to the 60th day of evaluation (p < 0.0001).

Application of the formulations did not cause macroscopic acute or chronic skin lesions in patients, and the 8% capsaicin formulation was beneficial and well tolerated.


Capsaicin; Topical route; Trigger points; Myofascial pain syndrome


A síndrome da dor miofascial é uma causa comum de dor musculoesquelética. O objetivo deste estudo foi avaliar a potencial ação analgésica de 8% do creme de capsaicina para uso tópico em pacientes com síndrome da dor miofascial.

Inicialmente, as formulações de creme de PLA (placebo) e CPS (capsaicina 8%) foram desenvolvidas e aprovadas de acordo com os requisitos atuais da agência de autoridade de saúde. Os 40 pacientes participantes foram distribuídos aleatoriamente e de forma duplo‐cega para os grupos PLA e CPS. Antes de os cremes serem administrados topicamente, de acordo com o grupo de alocação, o anestésico local foi usado por um período de 50 minutos diretamente na área de interesse. A administração ocorreu na área da pele sobre o ponto‐gatilho, o qual apresentou a área dolorida à palpação, em uma quantidade de 10 g por 30 minutos em área circular com diâmetro de 24 mm. Posteriormente, o creme foi removido e os parâmetros de tolerabilidade à pele foram avaliados. A dor foi medida antes e durante a aplicação da formulação, bem como uma hora, sete dias, 30 dias e 60 dias após o procedimento avaliado pela escala numérica verbal (0 a 10, com zero sem dor e dez a pior dor imaginável).

Nenhum paciente no grupo PLA experimentou hiperemia ou sensação de queimação no local de aplicação do creme, enquanto 85% dos que experimentaram no grupo CPS apresentaram hiperemia ou sensação de queimação 15 minutos. Essas queixas desapareceram 24 horas após a remoção do creme. O escore de dor no grupo CPS diminui de forma sustentada até o 60° dia de avaliação (p < 0,0001).

A administração das formulações não causou lesões cutâneas agudas ou crônicas macroscópicas nos pacientes e a formulação de 8% de capsaicina foi benéfica e bem tolerada.


Capsaicina; Administração tópica; Pontos‐gatilho; Síndrome de dor miofascial


1 J. Wilke, L. Vogt, D. Niederer, et al. Short‐term efes of acupuntures and stretching on myofascial trigger point pain of the neck: a blinded, placebo‐controlled RCT Complement Ther Med., 22 (2014), pp. 835-841

2 D.C. Ribeiro, A. Belgrave, A. Naden, et al. The prevalence of myofascial trigger points in neck and shoulder‐related disorders: a systematic review of the literature BMC Musculoskelet Disord., 19 (2018), p. 252

3 S.W. Cheatham, M.J. Kolber, G.M. Mokha, et al. Concurrent validation of a pressure pain threshold scale for individuals with myofascial pain syndrome and fibromyalgia J Man Manip Ther., 26 (2018), pp. 25-35

4 F. Wolfe, D.J. Clauw, M.A. Fitzcharles, et al. 2016 Revisions to the 2010/2011 fibromyalgia diagnostic criteria Semin Arthritis Rheum., 46 (2016), pp. 319-329

5 J. Fleckenstein, D. Zaps, L.J. Rüger, et al. Discrepancy between prevalence and perceived effectiveness of treatment methods in myofascial pain syndrome: results of a cross‐sectional, nationwide survey BMC Musculoskelet Disord., 11 (2010), p. 32

6 P. Peng Medical management of chronic pain Can Urol Assoc J., 12 (2018), p. 155

7 J. Graham, M. Barberio, G.S. Wang Capsaicin Cream for Treatment of Cannabinoid Hyperemesis Syndrome in Adolescents: A Case Series Pediatrics, 140 (2017), p. 20163795

8 European Medicines Agency. qutenza® (capsaicin) 179 mg cutaneous patch: summary of product characteristics [online] 2011. Available from:‐combined‐h909en.pdf.[Acesso 14/06/2012].

9 S. Steinke, M. Gutknecht, C. Zeidler, et al. Cost‐effectiveness of an 8% cap‐saicin patch in the treatment of brachioradial pruritus and notalgiaparaesthetica, two forms of neuropathic pruritus Acta Derm Venereol., 97 (2017), pp. 71-76

10 European Medicines Agency. qutenza® (capsaicin) 179 mg cutaneous patch: summary of product characteristics [online] 2011. Disponível em:‐combined‐h909en.pdf.[Acesso 14/06/2012].

11 C.E. Argoff A review of the use of topical analgesics for myofascial pain Curr Pain Headache Rep., 6 (2002), pp. 375-378

12 Y. Nasirzadeh, S. Ahmed, S. Monteiro, et al. A survey of healthcare practitioners on myofascial pain criteria Pain Practic., 18 (2018), pp. 631-640

13 M.L. Andersson, B. Svensson, S. Bergman Chronic widespread pain in patients with rheumatoid arthritis and the relation between pain and disease activity measures over the first 5 years J Rheumatol. (2013), p. 130493

14 L.V. Magri, V.A. Carvalho, F.C.C. Rodrigues, et al. Effectiveness of low‐level laser therapy on pain intensity, pressure pain threshold, and SF‐MPQ indexes of women with myofascial pain Lasers Med Sci., 32 (2017), pp. 419-428

15 M.P. Flores, A.P.C.R. de Castro, J.D.S. Nascimento Analgésicos tópicos Rev Bras Anestesiol. (2012), pp. 244-252

16 L. Mason, R.A. Moore, S. Derry, et al. Systematic review of topical capsaicin for the treatment of chronic pain Bmj., 328 (2004), pp. 7446-7991

17 E. Singer, R. Dionne A controlled evaluation of ibuprofen and diazepam for chronic orofacial muscle pain J Orofac Pain., 11 (1997), p. 2

18 X.J. Luo, J. Peng, Y.J. Li Recent advances in the study on capsaicinoids and capsinoids Eur J Pharmacol., 650 (2011), pp. 1-7

19 R.V. Contri, T. Katzer, A.R. Pohlmann Chitosan hydrogel containing capsaicinoids‐loaded nanocapsules: an innovative formulation for topical delivery Soft Mater., 8 (2010), pp. 370-385

20 S. Derry, R.A. Moore Topical capsaicin (low concentration) for chronic neuropathic pain in adults Cochrane Database Syst Rev. (2012), p. CD010111

21 W.D. Rollyson, C.A. Stover, K.C. Brown, et al. Bioavailability of capsaicin and its implications for drug delivery J Control Release., 196 (2014), pp. 96-105

22 T.R. Paulsen, S. Stiller, K. Weber, et al. A 90‐day toxicity and genotoxicity study with high‐purity phenylcapsaicin., 2 (2018) 2397847318773060

23 S. Haroutounian, N.B. Finnerup Recommendations for pharmacologic therapy of neuropathic pain Essent Pain Medic. (2018), pp. 445-456

24 V. Fattori, M. Hohmann, A. Rossaneis Capsaicin: current understanding of its mechanisms and therapy of pain and other pre‐clinical and clinical uses Molecules., 21 (2016), p. 844

25 A. Chang, S. Bhimji Capsaicin (2017)

26 W.R. Kennedy, G.F. Vanhove, S.-P. Lu, et al. A randomized, controlled, open‐label study of the long‐term efects of NGX‐4010, a high‐concentration capsaicin patch, on epidermal nerve fber density and sensory function in healthy volunteers J Pain., 1 (2010), pp. 579-587

27 G. Baranidharan, S. Das, A. Bhaskar review of the high‐concentration capsaicin patch and experience in its use in the management of neuropathic pain Ther Adv Neurol Disord., 6 (2013), pp. 287-297

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