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Topical capsaicin

The 8% patch eased nerve pain for about 1 extra person in 10 to 13 treated, against a low-strength patch or placebo. Low-strength creams helped osteoarthritis and chronic back pain in pooled trials, while evidence for nerve pain and itch was weak. Burning and pain where applied were very common, and the patch briefly raised blood pressure.

Add to Bio HackChecked 2026-11-14
Status
In the US, capsaicin creams and lotions at low strengths, such as 0.025% to 0.1%, are sold over the counter for temporary relief of minor muscle and joint aches from arthritis, backache, strains and sprains. The 8% capsaicin patch (Qutenza) is a prescription drug applied only by a health professional, FDA-approved in adults for nerve pain after shingles and nerve pain from diabetic neuropathy of the feet.
Also called
capsaicin cream, Zostrix, capsaicin 0.025%, capsaicin 0.075%, capsaicin 0.1%, capsaicin patch, Qutenza, capsaicin 8% patch, high-concentration capsaicin, chili pepper cream, capsicum cream, capsicum plaster, cayenne cream
Taken for
nerve pain after shingles, diabetic nerve pain, nerve pain, arthritis pain, knee pain, back pain, muscle and joint aches, itching, nausea and vomiting from cannabis use

Strong several reviews agree · Moderate one review or consistent trials · Limited one or a few small studies · Untested no study in people, listed with what it rests on

Shown to help6

Reported risks5

What people take it for, and what was found

Shown to help6

Strong

Nerve pain of any cause, with the 8% patch

Shown to give 1 extra person meaningful nerve pain relief for every 10 to 13 treated with the 8% patch, with serious side effects no more common than control.

Compared with placebo or a low-strength 0.04% capsaicin patch [3][4][2]

The numbers and sources
Effect
A 2015 meta-analysis found a number needed to treat of 10.6 (95% CI 7.4 to 19.0) for 50% pain relief with high-concentration capsaicin patches [4]. A 2025 meta-analysis found a number needed to treat of 13.2 (95% CI 7.6 to 50.8) and a number needed to harm, for withdrawal due to side effects, of 1,129.3, on moderate certainty evidence [3]. In HIV nerve pain, about 10% more people had at least 30% pain reduction over weeks 2 to 12 than on control, a number needed to treat of 11 [2].
Population
229 studies of drugs for nerve pain [4]; 313 trials with 48,789 adults [3]; 8 trials with 2,488 adults with postherpetic neuralgia, HIV neuropathy or diabetic neuropathy [2].
Sources
[3], [4], [2]
Caveats
The low-strength control patch is used to keep the burning sensation from revealing treatment, and it may itself have some effect [2]. Both meta-analyses ranked the patch as a second-line option [3][4].
Moderate

Nerve pain after shingles (postherpetic neuralgia)

Shown to ease nerve pain after shingles more than a low-strength control patch, with about 10% more people much improved at 8 and 12 weeks.

Compared with a 0.04% low-strength capsaicin patch used as an active placebo [2][1][5]

The numbers and sources
Effect
About 10% more people reported themselves much or very much improved with the 8% patch than with the low-strength patch, with numbers needed to treat of 8.8 (95% CI 5.3 to 26) and 7.0 (95% CI 4.6 to 15) reported across the 8- and 12-week assessments, on moderate quality evidence [2]. In the two label trials, average pain fell 29% against 18% and 33% against 26% from baseline to week 8 [1]. Pooled patient data across 7 trials found an 8.0% greater fall in pain intensity than control (95% CI 4.6 to 11.5) [5].
Population
4 trials with 1,272 people with postherpetic neuralgia [2]; two 12-week label trials [1]; 1,458 people with postherpetic neuralgia or HIV neuropathy in 7 trials [5].
Sources
[2], [1], [5]
Caveats
The pooled patient data analysis was drawn from the manufacturer's trial database [5]. Efficacy outcomes were inconsistently reported [2].
Limited

Diabetic nerve pain in the feet

One trial found the 8% patch lowered diabetic foot nerve pain by about half a point more than a placebo patch over 12 weeks.

Compared with a placebo patch without capsaicin [1][2]

The numbers and sources
Effect
Average pain fell 30% on the patch and 22% on placebo by week 12. On an 11-point scale, the mean fall was 1.92 against 1.37, a difference of -0.56 (95% CI -0.98 to -0.14) [1]. About 10% more people were much or very much improved at 8 and 12 weeks [2].
Population
369 adults with painful diabetic peripheral neuropathy, one 30-minute application [1][2].
Sources
[1], [2]
Caveats
One trial.
Moderate

Osteoarthritis pain

Shown to ease osteoarthritis pain more than placebo at licensed doses, about as much as topical NSAIDs, though trials were small and varied.

Compared with placebo [8][9][7]; topical NSAIDs, through placebo in a network [9]

The numbers and sources
Effect
Across 8 trials, capsaicin at 0.0125% to 5% lowered osteoarthritis pain more than placebo (SMD -0.84, 95% CI -1.48 to -0.19) at follow-ups up to 3 months [8]. In a network meta-analysis, capsaicin beat placebo only at licensed doses (effect size 0.41, 95% CI 0.17 to 0.64), and did not differ from topical NSAIDs (effect size -0.09, 95% CI -0.34 to 0.16) [9]. In musculoskeletal pain, 0.025% cream or a plaster had a number needed to treat of 8.1 (95% CI 4.6 to 34) [7].
Population
8 trials with 498 people with osteoarthritis [8]; 28 trials with 7,372 people [9]; 3 trials with 368 people with musculoskeletal pain [7].
Sources
[8], [9], [7]
Caveats
Low to very low certainty, short trials and high heterogeneity [8]. No trial compared capsaicin and topical NSAIDs directly [9].
Moderate

Chronic low back pain

Shown to ease chronic low back pain more than placebo with capsicum cream or plaster, on moderate quality evidence, while acute back pain results were unclear.

Compared with placebo cream or plaster [10]; a homeopathic ointment [10]

The numbers and sources
Effect
Capsicum frutescens cream or plaster probably produced more favorable results than placebo in chronic low back pain (3 trials, 755 people, moderate quality). For acute low back pain one trial of 40 people was unclear, and one trial of 161 people found capsicum cream equivalent to a homeopathic ointment, on very low quality evidence [10].
Population
14 trials of herbal medicines with 2,050 adults with low back pain, of which these capsicum trials are a part [10].
Sources
[10]
Caveats
One review, and capsicum preparations are pepper extracts whose capsaicin content may differ from the creams sold as drugs.
Limited

Nausea from cannabis hyperemesis syndrome

One small trial found 0.1% capsaicin cream on the abdomen lowered nausea at 60 minutes, not at 30, compared with placebo cream.

Compared with a placebo cream [11]; no control group in most of the pooled studies [12]

The numbers and sources
Effect
Nausea on a 10 cm scale was 4.1 against 6.1 at 30 minutes (difference -2.0, 95% CI 0.2 to -4.2) and 3.2 against 6.4 at 60 minutes (difference -3.2, 95% CI -0.9 to -5.4). Complete resolution of nausea occurred in 29.4% on capsaicin and 0% on placebo [11]. A pooled analysis of 7 mostly uncontrolled studies reported a mean time to symptom relief of 325 minutes [12].
Population
30 adults with suspected cannabis hyperemesis in the emergency department [11]; 106 patients in 7 studies [12].
Sources
[11], [12]
Caveats
A pilot trial, and the pooled studies were mostly without a comparison group [12].

Mixed results1

Moderate

Nerve pain with low-strength cream

Mixed results: one review found 0.075% cream helped about 1 extra person in 6, while a later review found too few data and no meaningful effect beyond placebo cream.

Compared with placebo cream [7][6][3]

The numbers and sources
Effect
In 2004, pooling 6 trials of 0.075% cream gave a relative benefit of 1.4 (95% CI 1.2 to 1.7) and a number needed to treat of 5.7 (95% CI 4.0 to 10.0) for about 50% pain relief [7]. A 2012 Cochrane review of 0.075% cream trials found substantial heterogeneity, too few data to pool, and concluded the cream was unlikely to have a meaningful effect beyond placebo [6]. A 2025 meta-analysis estimated a number needed to treat of 6.1 (95% CI 3.1 to no limit), on very low certainty evidence [3].
Population
6 trials with 656 people [7]; 6 trials with 389 people, all published before 1996 [6]; trials within 313 [3].
Sources
[7], [6], [3]
Caveats
Blinding is hard to keep because capsaicin burns [6].

Doses studied

The 8% patch contains 179 mg of capsaicin, about 100 times the concentration of creams [1][2]. It is applied by a health professional, up to four patches for 60 minutes for postherpetic neuralgia or 30 minutes on the feet for diabetic neuropathy, no more often than every three months [1]. Cream trials used 0.075% for nerve pain and 0.025% for musculoskeletal pain [7], 0.0125% to 5% in osteoarthritis [8], and 0.1% on the abdomen for cannabis hyperemesis [11]. The over-the-counter 0.025% cream label directs application 3 to 4 times a day and states that the fullest relief typically comes after 2 to 4 weeks of continuous use [13]. How much reaches the blood: after 60-minute applications of the 8% patch, about a third of people had transient capsaicin levels below 5 ng/mL, the highest 4.6 ng/mL right after removal, falling below the limit of measurement within 3 to 6 hours [1].

Risks

Reported risks5

StrongVery common

Burning, pain and redness where applied

Shown to cause burning or pain where applied far more than placebo, with 1 extra person affected for every 2 to 3 using creams.

The numbers and sources
How common
Very common: more than 1 in 10 people.
Effect
With the 8% patch for postherpetic neuralgia, application site pain occurred in 42% against 21% on the low-strength patch, and redness in 63% against 54%. On the feet in diabetic neuropathy, burning occurred in 14% against 3% on placebo and site pain in 10% against 2% [1]. With low-strength cream, the number needed to harm for local skin reactions was 2.5 (95% CI 2.1 to 3.1), usually tolerable and fading with time [6]. In osteoarthritis, capsaicin raised burning at the site (RR 5.56, 95% CI 1.75 to 17.69, number needed to harm 3) [8]. About a third of patients in chronic pain trials had local side effects on capsaicin [7].
Population
622 on the patch and 495 on control in postherpetic neuralgia, 186 and 183 in diabetic neuropathy [1]; 6 trials with 389 people [6]; 5 osteoarthritis trials [8]; trials in chronic pain [7].
Sources
[1], [6], [8], [7]
Caveats
Pain on the treatment day usually returned to baseline by the end of the day with the patch [1].
ModerateCommon

Nausea, cough and other whole-body effects with the patch

Shown to raise nausea slightly with the 8% patch, 5% against 2% on control, with small rises in vomiting, cough and nasal symptoms.

The numbers and sources
How common
Common: between 1 in 100 and 1 in 10 people.
Effect
In postherpetic neuralgia trials, nausea occurred in 5% against 2%, vomiting in 3% against 1%, nasopharyngitis in 4% against 2% and sinusitis in 3% against 1%. In diabetic neuropathy, upper respiratory infection occurred in 4% against under 1% and cough in 2% against under 1% [1]. Serious adverse events were 3.5% on the patch and 3.2% on control [2].
Population
622 on the patch and 495 on control, and 186 and 183, in label trials [1]; 8 trials with 2,488 adults [2].
Sources
[1], [2]
Caveats
The label lists events regardless of cause [1].
LimitedCommon

Blood pressure rise during patch treatment

The label reports blood pressure rose briefly during or after the 8% patch, by under 10 mm Hg on average, tied to treatment pain.

The numbers and sources
How common
Common: between 1 in 100 and 1 in 10 people.
Effect
Transient increases averaged under 10 mm Hg, were larger in some patients and lasted about two hours after removal. They tracked treatment-related pain rather than starting blood pressure. Hypertension was reported in 2% on the patch against 1% on control in postherpetic neuralgia and 2% against under 1% in diabetic neuropathy. The label notes possible higher risk with unstable blood pressure or a recent heart attack or stroke [1].
Population
Label clinical trials [1].
Sources
[1]
Caveats
Reported on the label without a pooled analysis.
LimitedHow often is not known

Severe burns and accidental exposure

The label reports second- and third-degree burns after the 8% patch, some needing skin grafts, and severe eye and airway irritation from accidental exposure.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
Postmarketing reports include deep partial-thickness and full-thickness burns and scarring, some requiring hospitalization and grafting, in patients treated for unapproved uses or more often than directed, at sites with prior skin injury. Unintended contact can severely irritate eyes, mucous membranes, airways and skin, and removing the patch too fast can put capsaicin in the air, causing coughing and sneezing [1]. The over-the-counter cream label warns against heat, tight bandaging and inhaling dried residue, and to stop if blistering or trouble breathing occurs [13].
Population
Postmarketing reports [1]; labeling statement [13].
Sources
[1], [13]
Caveats
Spontaneous reports give no rate.
LimitedHow often is not known

Reduced skin sensation

The label reports minor, temporary loss of sensation after the 8% patch, and fewer nerve fibers in the skin that recovered fully in volunteers.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
Reductions in sensory function, generally minor and temporary, have been reported, including to heat and other harmful stimuli. In healthy volunteers, nerve fiber density in the skin and heat and sharp sensation fell one week after the patch and fully recovered [1].
Population
Patients after treatment and healthy volunteers in two studies [1].
Sources
[1]
Caveats
The label gives no rate.

Possible, not studied in people2

Untested

Use in pregnancy

Not studied in people. Rat and rabbit studies of skin-applied capsaicin found no birth defects at 11 to 37 times the maximum patch dose.

No study in people. This rests on animal studies.

The numbers and sources
Effect
The label states capsaicin is negligibly absorbed from the 8% patch and maternal use is not expected to expose the fetus. Rats and rabbits given topical capsaicin during organogenesis at up to 11 and 37 times the maximum human dose showed no malformations, and capsaicin was measured in rat milk [1].
Population
Pregnant rats and rabbits (animal) [1].
Sources
[1]
Caveats
Animal studies do not show what happens in human pregnancy.
Untested

Sperm motility in animals

Not studied in people. Male rats given the 8% patch daily for about 7 weeks had lower sperm motility and, at higher doses, lower sperm counts.

No study in people. This rests on animal studies.

The numbers and sources
Effect
In a rat fertility study with 3 hours a day of exposure for about 49 days, sperm motility fell in all dose groups and sperm counts fell at the two higher doses, at 13 to 28 times the exposure from the maximum human dose [1].
Population
Male rats (animal) [1].
Sources
[1]
Caveats
Rats were exposed daily for weeks, unlike the single human application every three months.

Claims tested and not found

  1. That capsaicin cream relieves itch. A systematic review of 6 randomized trials in dialysis itch, anal itch, notalgia paresthetica and brachioradial pruritus found no convincing evidence for capsaicin in any condition [14].

Sources

  1. FDA label (DailyMed). Qutenza (capsaicin) topical system 8%. Averitas Pharma Inc. 2026. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=3ffbbcb0-ad93-4f15-bb38-5da76a71c735
  2. Derry S, Rice AS, Cole P, Tan T, Moore RA. Topical capsaicin (high concentration) for chronic neuropathic pain in adults. Cochrane Database of Systematic Reviews. 2017. https://doi.org/10.1002/14651858.cd007393.pub4
  3. Soliman N, Moisset X, Ferraro MC, et al. Pharmacotherapy and non-invasive neuromodulation for neuropathic pain: a systematic review and meta-analysis. The Lancet Neurology. 2025. https://doi.org/10.1016/s1474-4422(25)00068-7
  4. Finnerup NB, Attal N, Haroutounian S, et al. Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. The Lancet Neurology. 2015. https://doi.org/10.1016/s1474-4422(14)70251-0
  5. Mou J, Paillard F, Turnbull B, Trudeau J, Stoker M, Katz NP. Efficacy of Qutenza (capsaicin) 8% patch for neuropathic pain: a meta-analysis of the Qutenza Clinical Trials Database. Pain. 2013. https://doi.org/10.1016/j.pain.2013.04.044
  6. Derry S, Moore RA. Topical capsaicin (low concentration) for chronic neuropathic pain in adults. Cochrane Database of Systematic Reviews. 2012. https://doi.org/10.1002/14651858.cd010111
  7. Mason L, Moore RA, Derry S, Edwards JE, McQuay HJ. Systematic review of topical capsaicin for the treatment of chronic pain. BMJ. 2004. https://doi.org/10.1136/bmj.38042.506748.ee
  8. Tshering G, Posadzki P, Kongkaew C. Efficacy and safety of topical capsaicin in the treatment of osteoarthritis pain: A systematic review and meta-analysis. Phytotherapy Research. 2024. https://doi.org/10.1002/ptr.8223
  9. Persson MSM, Stocks J, Walsh DA, Doherty M, Zhang W. The relative efficacy of topical non-steroidal anti-inflammatory drugs and capsaicin in osteoarthritis: a network meta-analysis of randomised controlled trials. Osteoarthritis and Cartilage. 2018. https://doi.org/10.1016/j.joca.2018.08.008
  10. Oltean H, Robbins C, van Tulder MW, Berman BM, Bombardier C, Gagnier JJ. Herbal medicine for low-back pain. Cochrane Database of Systematic Reviews. 2014. https://doi.org/10.1002/14651858.cd004504.pub4
  11. Dean DJ, Sabagha N, Rose K, et al. A Pilot Trial of Topical Capsaicin Cream for Treatment of Cannabinoid Hyperemesis Syndrome. Academic Emergency Medicine. 2020. https://doi.org/10.1111/acem.14062
  12. Pourmand A, Esmailian G, Mazer-Amirshahi M, Lee-Park O, Tran QK. Topical capsaicin for the treatment of cannabinoid hyperemesis syndrome, a systematic review and meta-analysis. The American Journal of Emergency Medicine. 2021. https://doi.org/10.1016/j.ajem.2021.01.004
  13. FDA label (DailyMed). Zostrix Original Strength (capsaicin 0.025%) cream, Drug Facts. Akorn Consumer Health. 2020. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0eb78397-d6a1-4086-9d6c-02b45b3b9424
  14. Gooding SM, Canter PH, Coelho HF, Boddy K, Ernst E. Systematic review of topical capsaicin in the treatment of pruritus. International Journal of Dermatology. 2010. https://doi.org/10.1111/j.1365-4632.2010.04537.x

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