• Cesare Bonezzi, Amedeo Costantini, Giorgio Cruccu, Diego M M Fornasari, Vittorio Guardamagna, Vincenzo Palmieri, Enrico Polati, Pierangelo Zini, and Anthony H Dickenson.
• Pain Therapy Unit, Istituti Clinici Scientifici Maugeri , Pavia, Italy.
• Expert Opin Pharmacother. 2020 Aug 1; 21 (11): 1377-1387.

IntroductionNeuropathic pain (NP) is caused by a lesion or disease of the somatosensory system, which can severely impact patients' quality of life. The current-approved treatments for NP comprise of both centrally acting agents and topical drugs, including capsaicin 8% dermal patches, which is approved for the treatment of peripheral NP.Areas CoveredThe authors summarize literature data regarding capsaicin use in patients who suffer from NP and discuss the clinical applications of this topical approach.Expert OpinionOverall, the capsaicin 8% dermal patch is as effective in reducing pain intensity as other centrally active agents (i.e. pregabalin). Some studies have also reported fewer systemic side effects, a faster onset of action and superior treatment satisfaction compared with systemic agents. In our opinion, capsaicin 8% dermal patches also present additional advantages, such as a good systemic tolerability, the scarcity of adverse events, the possibility to combine it with other agents, and a good cost-effective profile. It is important to note that, as the mechanism of action of capsaicin 8% is the 'defunctionalization' of small afferent fibers through interaction with TRPV1 receptors, the peripheral expression of this receptor on nociceptor fibers, is crucial to predict patient's response to treatment.

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