Painful Diabetic Peripheral Neuropathy of the Feet: Integrating Prescription-Strength Capsaicin into Office Procedures

Figures & data

Infographic: A PDF version of this infographic is available as supplemental material.

Figure 1. Place of capsaicin 8% topical systems in the pharmacological treatment of painful diabetic peripheral neuropathy of the feet.

Based on 2022 guidelines on the treatment of PDPN from the American Association of Clinical Endocrinology [27] and Clinical Compendia American Diabetes Association [28].

*Indicates FDA-approved for PDPN.

PDPN: Painful diabetic peripheral neuropathy.

Figure 2. Mechanism of action of topical capsaicin in pain modulation.

Left panel: Upper black arrows indicate capsaicin-insensitive nerve terminals. Lower black arrows indicate nerve terminal retraction due to mitochondrial dysfunction.

Figure 3. Technology of the capsaicin 8% topical system, showing the transfer of capsaicin into the skin during the application period, enabling long-term (3-month) pain relief.

The topical system consists of a polyester-film backing layer coated with a matrix composed of capsaicin, a DGME-containing solvent, silicone adhesive mixtures, and other ingredients, and covered with a removable polyester-release liner. As DGME is extremely lipophilic, it is easily absorbed into the epidermal and dermal layers but has little affinity for the blood phase. During application, capsaicin is diffused into the skin via the influx of DGME and efflux of water, forming a reservoir of bioavailable capsaicin [20,45].

DGME: Diethylene glycol monomethyl ether.

Figure 4. Summary of the instructions for applying the capsaicin 8% topical system.

Details are based on the US prescribing information [20].

Table 1. Key messages from the case study of a patient presenting with painful diabetic peripheral neuropathy of the feet.

Key message	Comments
Evaluate pain	• Confirm a neuropathic component/mechanism
Consider the use of prescription-strength (8%) capsaicin topical system early in the treatment algorithm	• Capsaicin 8% topical system effectively reduces pain, leading to other health benefits • Capsaicin 8% topical system has a favorable safety profile (e.g., lack of systemic adverse drug reactions and drug–drug interactions) • Capsaicin 8% topical system is a non-opioid treatment option
Keep in mind the instructions for the use of capsaicin 8% topical system	• Review ‘Important Dosage and Administration Instructions’, including ‘Full Instructions for Use’, in the US prescribing information • Be aware that the most common adverse events are application-site reactions including burning sensation, pain and erythema at the application site • Be prepared with local cooling or analgesic medication during and after the procedure
Create a follow-up plan with the patient	• Evaluate changes in pain intensity • Evaluate percent improvement in pain and satisfaction with treatment
Schedule the next application if warranted for pain	• No sooner than 90 days after the previous application

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