Both are second-choice. Capsaicin has the better osteoarthritis data — a moderate effect over four weeks — but roughly one extra user in three gets a burning sensation and a 2024 meta-analysis rates the certainty low to very low. Menthol gives immediate cooling with thin evidence for chronic joint pain. For osteoarthritis, network analyses place a topical NSAID ahead of both.
| Compared on | Capsaicin 0.1% cream | Menthol gel |
|---|---|---|
| Evidence grade | Moderate evidence | Emerging evidence |
| What it is | Capsaicin is the pungent alkaloid responsible for the heat of chili peppers (Capsicum species). Applied to the skin, it binds the transient receptor potential vanilloid 1 (TRPV1) receptor on sensory nerve fibers, triggering release and then depletion of the pain neurotransmitter substance P and,… | Menthol is a naturally occurring organic compound obtained from peppermint and other mint oils, or made synthetically, that is widely used in over-the-counter topical analgesic gels, creams, and patches. |
| Best human evidence | “Capsaicin treatment efficacy (vs. placebo) for change in VAS pain score was moderate, at 0.44 (95% CI 0.25-0.62) over 4 weeks of treatment.” Prog Drug Res 2014 · PMID 24941673 | “These findings suggest that DOMS reduced corticospinal excitability and after the administration of menthol-based topical analgesic, there was a reduction in pain, which was accompanied by…” Med Sci Sports Exerc 2019 · PMID 31157708 |
| Dose / protocol studied | 0.025–0.1% cream 3–4×/day for at least 1–2 weeks (the 8% patch is prescription-only) | Apply gel to the area up to 3–4×/day as needed |
| Typical listed price | $12.00 | $15.99 |
| Who it suits | Someone with osteoarthritis pain who cannot tolerate NSAIDs and is willing to apply it daily for one to two weeks before judging it. | Someone with acute muscle soreness who wants immediate cooling comfort and a low-risk, NSAID-free option. |
| Who should skip it | Anyone who wants fast relief, or who will not tolerate burning — about one extra case per three users in trials, a number needed to harm of 3. | Anyone with chronic joint pain expecting sustained relief — the evidence there is thin and some knee-osteoarthritis data show little advantage over placebo. |
| Key caveat | A burning sensation on application is expected (about 1 extra case per 3 users in trials) and fades with regular use. Evidence is strongest for the prescription 8% patch in nerve pain; OTC creams give modest osteoarthritis relief, and a 2024 meta-analysis rates the certainty as low. Wash hands; keep away from eyes and broken skin. | Relief is mainly immediate cooling comfort, not disease-modifying; trials are small and short, mostly in acute muscle soreness. Menthol gel beat ice in one soreness trial and helped in a migraine study, but evidence for chronic joint pain is thin. NSAID-free and low-risk. |
Menthol gel lists at about 1.3× the price of Capsaicin 0.1% cream. Prices are the typical listed prices in our catalog, not live Amazon prices, and a true cost-per-studied-dose is not shown because our catalog does not record servings per container — we would have to guess, so we don't.
One works slowly by defunctionalising pain fibres; the other works instantly by making the skin feel cold. They are not interchangeable.
Capsaicin, if you cannot use an NSAID. A 2024 meta-analysis of 8 trials found a significant advantage over placebo, and an earlier analysis put the effect on pain score at 0.44 over four weeks. Network analyses place capsaicin behind topical NSAIDs, and reviewers suggest it mainly as a short-term option for people who cannot tolerate NSAIDs.
Menthol. Small randomized trials report modest reductions in pain intensity and pressure-pain sensitivity, and in one delayed-onset-soreness trial menthol gel outperformed ice.
Menthol. Menthol's onset is fast; capsaicin's is slow, often needing one to four weeks of repeated daily application before benefit appears.
Neither — use diclofenac gel. Topical diclofenac is the best-evidenced over-the-counter pain topical on this site, with Cochrane and meta-analysis support in hand and knee osteoarthritis.
A randomized, double-blind, placebo- and active-controlled trial of topical 1% diclofenac with 3% menthol gel for ankle sprain found no significant improvement over placebo, over diclofenac alone, or over 3% menthol gel alone. We include it because leaving out the negative trial is how a comparison page becomes marketing.
Blinding is also genuinely difficult with capsaicin, because the burning gives the treatment away — which is why several reviews rate its efficacy as modest or uncertain.
Each quote below is taken verbatim from the cited paper. Null and negative results are included on purpose — they are the reason a grade means anything.
“Capsaicin treatment efficacy (vs. placebo) for change in VAS pain score was moderate, at 0.44 (95% CI 0.25-0.62) over 4 weeks of treatment.”
“Current evidence indicates that topical NSAIDs and capsaicin in licensed doses may be equally effective for pain relief in OA.”
“High-concentration topical capsaicin used to treat postherpetic neuralgia, HIV-neuropathy, and painful diabetic neuropathy generated more participants with moderate or substantial levels of pain relief than control.”
“These findings suggest that DOMS reduced corticospinal excitability and after the administration of menthol-based topical analgesic, there was a reduction in pain, which was accompanied by increased corticospinal inhibition.”
“A menthol-based topical analgesic increased PPT (decreased pain sensitivity) overall (P = .05; 11.6% [2.4%]; d = 1.05) and PPT was higher (P < .0001; 31.5%-44.2%; d = 1.03-1.8) for lower versus upper body locations.”
“No significant improvement was observed with topical 1% diclofenac/3% menthol gel compared with placebo, 1% diclofenac, or 3% menthol gel in treating pain from ankle sprain.”
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Modestly. A 2024 meta-analysis of 8 trials found a significant advantage over placebo while rating the certainty of evidence low to very low, and an earlier analysis put the effect at 0.44 on pain score over four weeks.
It binds the TRPV1 receptor on sensory nerve fibres, triggering release and then depletion of substance P. The burning is expected — about one extra case per three users in trials — and it fades with regular use.
Not exactly, but the evidence is limited. Small trials show modest reductions in pain intensity and pressure-pain sensitivity and menthol beat ice in one soreness trial, while systematic reviews rate the overall evidence for topical menthol as limited and some chronic-pain data show little advantage over placebo.
Often one to four weeks of repeated daily application. If you judge it after two days you will conclude it does nothing.
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