Capsaicin

What Is Capsaicin?

Capsaicin is the natural compound that makes chili peppers hot. When applied to the skin, it initially causes a burning sensation but then reduces pain over time. It's available as over-the-counter creams and prescription patches for various chronic pain conditions.¹

How It Works²

Binds to TRPV1 receptors in pain nerves
Initially activates pain fibers (causes burning)
With repeated use, depletes substance P
Substance P is a pain neurotransmitter
Results in reduced pain signaling
Temporary desensitization of nerve fibers

Available Forms

Over-the-Counter

Creams (0.025% - 0.1%)
Gels and lotions
Patches
Apply 3-4 times daily

Prescription

High-concentration patch (8% - Qutenza)
Applied by healthcare provider
Single application lasts up to 3 months

Conditions Treated³

Postherpetic neuralgia (shingles pain)
Diabetic neuropathy
Osteoarthritis
Rheumatoid arthritis
Musculoskeletal pain
Some other neuropathic conditions

How to Use OTC Capsaicin

Apply thin layer to affected area
Use 3-4 times daily
Wash hands thoroughly after
Or use gloves during application
Avoid eyes, mouth, genitals
Don't cover with bandages unless directed

What to Expect

Initial burning sensation is normal
Burning typically decreases over days
Takes 2-4 weeks for pain relief
Must use consistently
Effect wears off if stopped

Side Effects

Burning, stinging at application site
Redness
Itching
Usually decreases with continued use
Coughing if inhaled

Precautions

Don't apply to broken or irritated skin
Avoid hot showers/baths right after application
Keep away from eyes
Wash hands after handling
Test on small area first

Tips for Success

Start with lower concentration
Apply consistently (don't skip doses)
Give it several weeks to work
Use gloves or applicator
Don't give up due to initial burning

References

Derry S, Rice AS, Cole P, et al. Topical capsaicin (high concentration) for chronic neuropathic pain in adults. Cochrane Database Syst Rev. 2017;1:CD007393.
Anand P, Bley K. Topical capsaicin for pain management: therapeutic potential and mechanisms of action of the new high-concentration capsaicin 8% patch. Br J Anaesth. 2011;107(4):490-502.
Mason L, Moore RA, Derry S, et al. Systematic review of topical capsaicin for the treatment of chronic pain. BMJ. 2004;328(7446):991.