Capsaicin Cream for Pain: What the Evidence Says

Chili-pepper chemistry, straight into the skin! Capsaicin—the compound that makes peppers hot—binds pain-sensing nerve fibers, triggers an initial release of the pain neurotransmitter substance P, then depletes the supply until the signal quiets. First it burns. Then it goes quiet.

So does a 0.1% over-the-counter cream like Capzasin-HP actually ease minor musculoskeletal and arthritis pain? Yes, for some people—modestly, and with effects that vary from person to person.

How it works

Capsaicin, the compound that makes chili peppers hot, works by binding to pain-sensing nerve fibers in the skin. This triggers an initial release of the pain neurotransmitter substance P, followed by depletion of substance P and a reversible desensitization of the pain-signaling nerves with repeated use.

Evidence for pain relief

Studies show topical capsaicin can provide moderate pain relief for osteoarthritis. A 2014 review found capsaicin treatment resulted in a 0.44 point greater reduction in pain score compared to placebo over 4 weeks. Individual responses can vary - a 2021 study found 59% of people with knee osteoarthritis had a greater response to either capsaicin cream or ibuprofen gel. Overall, a 2004 review calculated that 8 people would need to be treated with capsaicin for one person to experience pain relief.

For chronic neuropathic pain conditions like postherpetic neuralgia and diabetic neuropathy, high-concentration (8%) capsaicin patches applied by a doctor have shown substantial pain relief in more participants than a control treatment, according to a 2017 review. However, low-concentration creams like 0.1% capsaicin are not typically used for neuropathic pain. Educational, not medical advice.