Clonidine applied to the skin for adults with chronic neurop | Figure 1

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Clonidine applied to the skin for adults with chronic neuropathic pain

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Key message

We found no high certainty evidence to support the use of clonidine applied to the skin for painful diabetic neuropathy. We found no evidence for other chronic pain conditions.

What did we do?

To find out how clonidine applied to the skin (topical clonidine) works in people with neuropathic pain, we searched medical databases and references of retrieved papers and registries or clinical trials. We also contacted experts in the field. Two review authors independently screened references for eligibility, extracted data, and assessed risk of bias. When necessary, we contacted trial authors to request additional information.

What did we find?

We identified four studies for inclusion in the review. The studies lasted 8 weeks to 85 days and included a total of 743 participants with painful diabetic neuropathy. Clonidine (0.1% or 0.2%) was applied in gel form to the painful area two to three times daily, and was compared with placebo (dummy treatment) in three studies and with capsaicin applied to the skin in one study.

Limitations in how the studies were conducted and reported and the small amount of evidence available means that our confidence in the results is limited. The evidence suggests that in adults with painful diabetic neuropathy, topical clonidine may provide pain relief in some people. However, topical clonidine was not better than placebo for our other outcomes. We found no evidence of a difference between topical clonidine and capsaicin applied to the skin in painful diabetic neuropathy. The information from clinical trials is not enough to judge about possible long‐term side effects of clonidine applied to the skin; however, we found that during 8 to 12 weeks of treatment there was no evidence of a difference in number of side effects between study groups. We also do not know from the included trials how clonidine works in other chronic neuropathic pain conditions.

How up‐to‐date is this evidence?

The review is current to 27 October 2021.

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