SupplementStrong evidenceImmunity

Capsaicin topical

Cochrane-supported high-dose 8% patch for neuropathic pain; lower-strength creams have separate evidence in OA.

Why

Capsaicin is the principal pungent compound in chilli pepper (Capsicum frutescens). Two distinct evidence streams matter clinically. Low-strength creams (0.025–0.075%) have an older RCT base in painful diabetic neuropathy, post-herpetic neuralgia and knee/hand osteoarthritis. The high-strength 8% patch (Qutenza) is a prescription-only single-application treatment with Cochrane-supported NNT of 7–11 for moderate pain relief in post-herpetic neuralgia and HIV-associated neuropathy.

How it works

Activates and then desensitises TRPV1 receptors on small unmyelinated C-fibre and Aδ-fibre nociceptors, producing initial burning followed by sustained reduction in pain signal transmission. Repeated low-dose application leads to depletion of substance P from cutaneous nerve terminals.

Expected onset · Low-strength cream: pain reduction over 2–4 weeks of consistent application. High-strength patch: effect over 1–2 weeks lasting up to 3 months.

How to take

Dosage

Low-strength cream (0.025–0.075%): apply to affected area 3–4 times daily. High-strength 8% patch (Qutenza): single 30–60 min application by trained clinician, repeatable at ≥3-month intervals.

Timing

Low-strength: 3–4 times daily; high-strength patch: single clinical application

On the label

Low-strength: Zacin 0.025%, Axsain 0.075%. High-strength: Qutenza 8% patch (prescription-only).

Ideal for

Adults with painful diabetic neuropathy, post-herpetic neuralgia, or localised musculoskeletal pain when oral analgesics are limited.

Safety

Initial burning, stinging, erythema are universal. These settle with repeated use. Wash hands thoroughly after application; do not apply near eyes, mucous membranes, or broken skin. High-strength patch requires clinical setting due to acute pain on application. Cough and bronchospasm possible if aerosolised. Pregnancy: avoid high-strength; low-strength culinary use is unrestricted.

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Evidence

At a glance

Cochrane 2017 SR on the 8% capsaicin patch in chronic neuropathic pain: NNT of 7–11 for moderate (≥30%) pain relief at 8–12 weeks in PHN and HIV neuropathy. Cochrane 2012 SR on low-strength creams: less clear signal but improvement vs placebo in painful diabetic neuropathy and OA across older trials. Effect specific to small-fibre neuropathic pain.

Where to get it

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