I found the recent article “Treatment Options in Knee Osteoarthritis”1 quite informative, particularly because it addressed a practical patient management issue. However, one key finding was discordant with my own experience managing this disease: in my practice, few patients have been willing to try treatment with capsaicin cream, and none has continued using it on a long-term basis. There are many barriers to the use of capsaicin: many patients prefer pills, 4 times daily dosing is difficult to comply with (this frequency is recommended for the first 2 weeks of use, as opposed to the 3 times daily “utility” the authors selected), and the cream burns (apparently ignored by the authors). It is my unscientific impression that my patients generally prefer treatment with acetaminophen (and cyclooxygenase-2 inhibitors before the recent troubles for this class of drugs) for their osteoarthritis.
Reinharth D. Capsaicin Cream Unpopular With Patients. Arch Intern Med. 2005;165(6):702. doi:10.1001/archinte.165.6.702