(729) Topical vs Systemic Capsaicin for Burning Mouth Syndrome: A Systematic Review of Efficacy and Safety

Introduction: Burning mouth syndrome (BMS) is a chronic idiopathic oral pain condition often involving psychogenic and neuropathic pathways in peri- and post-menopausal women. This study compares pain outcomes and tolerability of topical versus systemic capsaicin, an analgesic that provides relief through neuronal fiber exhaustion.

Methods: A systematic review was conducted in January 2026 to compare pain outcomes measured by the Visual Analog Scale (VAS) in BMS patients. Databases including PubMed, Cochrane, Epistemonikos, and Lens were searched for clinical studies. Three studies met inclusion criteria: two randomized placebo-controlled trials for topical capsaicin and one for systemic formulations. The outcome was mean VAS reduction; the independent variable was the administration route (topical vs. systemic). Data on dosing, sample size, and adverse effects were extracted to evaluate efficacy and safety.

Results: Systemic capsaicin demonstrated a mean VAS reduction of 0.4 points (6.24 pre-treatment to 5.84 post-treatment), but was limited by significant gastrointestinal toxicity, with 32% of patients reporting gastric pain. Topical capsaicin demonstrated a more robust mean VAS reduction of 1.37 points (5.8 pre-treatment to 4.43 post-treatment). While topical delivery showed greater variability in patient response, it maintained a more favorable tolerability profile, with only four total discontinuations due to side effects across all included studies.

Conclusions: Topical capsaicin provides superior pain reduction and better tolerability compared to systemic administration, which offers limited analgesic benefit and high rates of gastrointestinal distress. Although topical delivery is the preferable modality for BMS, the observed variability in response necessitates standardized, large-cohort trials to definitively confirm comparative efficacy.