Written by Tatjana Djakovic, Staff Writer. Pain was reduced by 25% more in those taking capsaicin.

Lower back pain is a very common problem that interferes with routine daily activities, recreation, and is a leading contributor to missed work and dissatisfaction with quality of life. The prevalence of low back pain is 25-30% in an adult lifespan and an incidence of about 5% per year (1). The total cost (direct and indirect costs) in the US caused by chronic inability to return to work due low back pain amount to about $40-50 billions annually (2).

Most acute back pain is mechanical in nature and occurs as a result of trauma to the lower back or due to a disorder such as arthritis. The symptoms may manifest as muscle ache, shooting or stabbing pain, limited flexibility or decreased range of motion. Chronic back pain is measured as pain that persists for more than 3 months which often becomes progressive and difficult to determine the cause (3).

The drug treatment of choice for most chronic pain is NSAIDs (non steroidal anti-inflammatory), however gastrointestinal problems have been reported (4). An alternative for treatment of the painful condition includes topically applied capsaicin (a major constituent of hot peppers).

A double-blind, randomized, parallel-group study analyzed the effects and safety of a using a topical treatment with capsaicin. The study involved 319 Caucasian patients (137 male and 182 female) between 18 and 75 years of age with chronic back pain for a period of 21 days. Additional treatments which could interfere with the study had to be discontinued at appropriate intervals before enrollment into the study. The patients applied one patch (12 x 18 cm) containing 22 μg/cm2 capsaicin per day in the morning on the site of maximum pain, and were instructed to keep the patch in place for 4 to 8 hours.

After 3 weeks of treatment, current pain had been reduced by 25% more in the capsaicin group compared with the placebo group (p< 0.001). The average pain, worst pain, and disability scores decreased by 12% more in capsaicin group as compared to placebo. Furthermore, the mean reduction of Arhus Back Index, a questionnaire regarding pain, disability and physical impairment on an 11 point scale (0= none, 10= unbearable), was 33% in the capsaicin group as compared to a decrease of 22% in the placebo group (p < 0.001). The majority of participants (74%) rated the efficacy as “excellent” and 36% rated the efficacy as “good.” In addition, 82% of people rated their condition as “symptom-free” while 50% rated it as “improved” after the treatment period of 3 weeks.

The predominant adverse effects that were associated with capsaicin were a local excessively severe sensation of heat and redness of skin. The adverse drug reactions were found in 12 patients (7.5%) with capsaicin and 5 patients (3.1%) in the  placebo group.

Adverse side effects were only associated locally at the site of application as opposed to a whole body reaction (5).

Source: Frerick, Helmut, et al. “Topical treatment of chronic low back pain with a capsicum plaster.” Pain 106.1 (2003): 59-64.

© 2003 Published by Elsevier B.V.

Posted February 5, 2013.

References:

  1. Quittan M., Management of back pain. Disabil Rehabil 2002;24(8): 423-434.
  2. Gatchel RJ, et al., The dominant role of psychosocial risk factors in the development of chronic low back pain disability.  Spine 1995; (20): 2702-2709.
  3. Obtained from National Institute of Neurological Disorders, “Low Back Pain Fact Sheet.”
  4. Lazzaroni, M., and G. Bianchi Porro. “Gastrointestinal side-effects of traditional non-steroidal anti-inflammatory drugs and new formulations.” Alimentary pharmacology & therapeutics 20.s2 (2004): 48-58.
  5. Frerick, Helmut, et al. “Topical treatment of chronic low back pain with a capsicum plaster.” Pain 106.1 (2003): 59-64.