Comparison of topical capsaicin and topical piroxicam in the treatment of acute trauma-induced pain: A randomized double-blind trial



      This study aimed to compare the analgesic efficacy of topical capsaicin and topical piroxicam in acute musculoskeletal injuries.


      This is a prospective, randomized, controlled, double-blinded study. The data for the 67 patients in the piroxicam group and the 69 in the capsaicin group were examined. The initial visual analog scale (VAS) scores were compared with the 60th and 120th minute as well as the 24th and 72nd hour values. Differences between the VAS scores, clinical effectiveness of the treatment and side effects were evaluated.


      In the capsaicin group, the mean difference in the delta VAS scores was significantly higher at each measurement time. The mean of the percentage of reduction in the VAS scores of the topical capsaicin group was significantly higher than that in the topical piroxicam group. The highest difference in terms of both outcomes was determined at the 72nd hour VAS change. Mean differences were 1.53 (95% CI: 0.85–2.221) and 19.7 (95% CI: 12.4–27.2) respectively (p < 0.001). In the capsaicin group, the clinical effect of the treatment was found significantly higher (p < 0.01). The difference between the clinical effectiveness of the groups regarding the treatment outcomes was also statistically significant (p < 0.001). There was no significant difference between the patient groups regarding the presence of side effects.


      Topical capsaicin can be used as an alternative to topical piroxicam initially and at follow-up in patients presenting to the emergency department with acute pain as there were no observable differences in side-effects between the two groups.
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        • Anand P.
        • Bley K.
        Topical capsaicin for pain management: therapeutic potential and mechanisms of action of the new high-concentration capsaicin 8% patch.
        Br J Anaesth. 2011; 107: 490-502
        • Chrubasik S.
        • Weiser T.
        • Beime B.
        Effectiveness and safety of topical capsaicin cream in the treatment of chronic soft tissue pain.
        Phytother Res. 2010; 24: 1877-1885
        • Bjerring P.
        • Arendt-Nielsen L.
        Use of a new argon laser technique to evaluate changes in sensory and pain thresholds in human skin following topical capsaicin treatment.
        Skin Pharmacol Physiol. 1989; 2: 162-167
        • Persson M.S.M.
        • Stocks J.
        • Walsh D.A.
        • Doherty M.
        • Zhang W.
        The relative efficacy of topical non-steroidal anti-inflammatory drugs and capsaicin in osteoarthritis: a network meta-analysis of randomised controlled trials.
        Osteoarthr Cartil. 2018; 26: 1575-1582
        • Simpson D.M.
        • Robinson-Papp J.
        • Van J.
        • Stoker M.
        • Jacobs H.
        • Snijder R.J.
        • et al.
        Capsaicin 8% patch in painful diabetic peripheral neuropathy: a randomized, double-blind, placebo-controlled study.
        J Pain. 2017; 18: 42-53
        • Aslan F.E.
        • Sarıyıldız D.
        • Gürkan A.
        • Aygin D.
        Pain severity and analgesia approaches in adult trauma patients.
        Agri. 2008; 20: 13-18
        • Brogden R.N.
        • Heel R.C.
        • Speight T.M.
        • Avery G.S.
        Piroxicam: a review of its pharmacological properties and therapeutic efficacy.
        Drugs. 1981; 22: 165-187
        • Zeng C.
        • Wei J.
        • Persson M.S.M.
        • Sarmanova A.
        • Doherty M.
        • Xie D.
        • et al.
        Relative efficacy and safety of topical non-steroidal anti-inflammatory drugs for osteoarthritis: a systematic review and network meta-analysis of randomised controlled trials and observational studies.
        Br J Sports Med. 2018; 52: 642e50
        • Price D.D.
        • McGrath P.A.
        • Rafii A.
        • Buckingham B.
        The validation of visual analogue scales as ratio scale measures for chronic and experimental pain.
        Pain. 1983; 17: 45-56
        • Kulkantrakorn K.
        • Lorsuwansiri C.
        • Meesawatsom P.
        0.025% capsaicin gel for the treatment of painful diabetic neuropathy: a randomized, double-blind, crossover, placebo-controlled trial.
        Pain Pract. 2013; 13: 497-503
        • Kocak A.O.
        • Ahiskalioglu A.
        • Sengun E.
        • Gur S.T.A.
        • Akbas I.
        (2019). Comparison of intravenous NSAIDs and trigger point injection for low back pain in ED: a prospective randomized study.
        Am J Emerg Med. 2019; 37: 1927-1931
        • Predel H.G.
        • Ebel-Bitoun C.
        • Peil B.
        • Weiser T.W.
        • Lange R.
        Efficacy and safety of diclofenac + capsaicin gel in patients with acute back/neck pain: a multicenter randomized controlled study.
        Pain Ther. 2020 Mar.;
        • Derry S.
        • Moore R.A.
        Topical capsaicin (low concentration) for chronic neuropathic pain in adults.
        Cochrane Database Syst Rev. 2012; 9 (Sep 12): CD010111
        • Derry S.
        • Rice A.S.
        • Cole P.
        • Tan T.
        • Moore R.A.
        Topical capsaicin (high concentration) for chronic neuropathic pain in adults.
        Cochrane Database Syst Rev. 2017; 1 (2017 Jan 13): CD007393
        • Zhang W.Y.
        • Li Wan P.A.
        The effectiveness of topically applied capsaicin. A meta-analysis.
        Eur J Clin Pharmacol. 1994; 46: 517-522
        • Jones V.M.
        • Moore K.A.
        • Peterson D.M.
        Capsaicin 8% topical patch (Qutenza) — a review of the evidence.
        J Pain. 2011; 25: 32-41
        • McNeill S.C.
        • Potts R.O.
        • Francoeur M.L.
        Local enhanced topical delivery (LETD) of drugs: does it truly exist?.
        Pharm Res. 1992; 9: 1422-1427
        • O'Hanlon J.J.
        • McCleane G.
        • Muldoon T.
        Preoperative application of piroxicam gel compared to a local anaesthetic field block for postoperative analgesia.
        Acta Anaesthesiol Scand. 1996; 40: 715-718
        • Russell A.L.
        Piroxicam 0.5% topical gel compared to placebo in the treatment of acute soft tissue injuries: a double-blind study comparing efficacy and safety.
        Clin Invest Med. 1991; 14: 35-43
        • Kroll M.P.
        • Wiseman R.L.
        • Guttadauria M.
        A clinical evaluation of piroxicam gel: an open comparative trial with diclofenac gel in the treatment of acute musculoskeletal disorders.
        Clin Ther. 1989; 11: 382-391
        • Browning R.C.
        • Johson K.
        Reducing the dose of oral NSAIDs by use of Feldene Gel: an open study in elderly patients with osteoarthritis.
        Adv Ther. 1994; 11: 198-207
        • Pisko E.J.
        • Rahman M.A.
        • Turner R.A.
        • Agudelo C.A.
        Long term efficacy and safety of piroxicam in the treatment of rheumatoid arthritis.
        Curr Ther Res. 1980; 27: 852-859