Capsaicin

How it works

It is an agonist at the TRPV1 receptor on sensory nerves, initially stimulating then desensitising nociceptive fibres and depleting substance P, reducing pain transmission.

Prescribing in practice

• Avoid contact with eyes, mucous membranes and broken or inflamed skin, and ensure hands are washed thoroughly after application to prevent spread.
• A transient local burning sensation is common on application and usually diminishes with continued use.
• High-concentration cutaneous patches must be applied by a trained healthcare professional in an appropriate setting.

Monitoring

Monitor the application site for local skin reactions and assess analgesic response over time.

Counselling the patient

• Apply to intact skin only and wash your hands thoroughly afterwards, or use gloves.
• Expect a burning or stinging sensation at first, which usually eases with regular use.
• Do not apply heat such as a hot bath or heat pad to the treated area.

Evidence & guidelines

Topical capsaicin is recommended in clinical guidance as an option for localised neuropathic pain and osteoarthritis.