Capsaicin cream

Patient Information Leaflet

Introduction

Welcome to The Dudley Group NHS Foundation Trust. This leaflet will provide you and your relatives with information about using capsaicin cream for the treatment of pain. It includes what capsaicin cream is, what the benefits and risks are and what the treatment involves.

What is capsaicin treatment?

Capsaicin is a substance that is derived from red-hot chilli peppers. It is available as a cream in two different strengths – 0.075% and 0.025%. The stronger cream, also called Axsain, is licensed for use in:

• Post-herpetic neuralgia. This is occurs when the varicella zoster virus – the virus that causes chickenpox and shingles – damages nerves under the skin of the affected area. The cream is used after the rash has healed.
• Painful diabetic neuropathy. This is pain caused by nerves which have been damaged in people who have diabetes.

The weaker cream, also called Zacin, is licensed for use to relieve the pain caused by osteoarthritis.

How does it work?

The capsaicin is thought to work by decreasing the amount of pain signals produced from the area where you are experiencing pain.

Initially, this causes a burning or stinging sensation which some people can find unpleasant. This burning or stinging sensation happens because the capsaicin causes a pain-transmitting chemical to be released into the skin from the nerves and the body senses this as burning or stinging.

It is also thought that the capsaicin is absorbed by nerve cells, is transported all the way to the spinal cord and that this decreases the amount of pain-transmitting chemical that is sent on to the brain.

It takes quite some time for the drug to move to the spinal cord.  Therefore, we recommend that you apply the cream for at least six weeks before deciding to give up, if you are not feeling any benefit from it. If you are getting pain relief from it, you can carry on applying it as long as you like.

What are the benefits?

• It is good for pain which is just in one area of the body.
• It is helpful if you do not want to or cannot take medication.
• It is simple to use as it is just applied to the area where you are having pain.

However, we cannot guarantee that this drug will work for you to improve your pain as everyone is different.

What are the risks?

Unfortunately, there are some side effects. The main one is stinging and/or a burning sensation when you apply it. This tends to be more of a problem for people using the stronger cream.

The sensation does wear off in most people after several weeks of use, and nine out of every 10 people who use it do not feel the stinging/burning after 12 weeks of use. Most other people find it bearable.

Occasionally, people have to stop using the treatment because they find that the stinging sensation is unbearable. Also, some people develop skin irritation. If you get a rash, stop using the cream and contact your GP for advice.

What are the alternatives?

Your pain specialist will discuss alternatives with you in your consultation; these could be medicines, injections or physical therapies.

How do I use the capsaicin cream?

It is really simple to use – you apply it to the area where you are feeling the pain. You need to rub a small amount gently into the painful area. At the beginning, you should apply it four times a day. Applying it less often will tend to make it more uncomfortable on each application. Do not apply the cream to inflamed or broken skin.

Always wash your hands after applying the cream because otherwise, if you rub your eyes, nose or mouth without doing so, it will make them to sting.

What can I do to make the application of the cream more bearable?

The side effects are minor, and many people tolerate them because of the pain relief they get from the cream.

To make the initial application of the stronger cream (Axsain) more bearable, your pain clinic doctor may give you some anaesthetic cream to apply to the area where you are going to apply the capsaicin ointment.

This cream (called EMLA Cream) should be applied for at least one hour before applying the capsaicin cream. You will need to put a dressing over the EMLA Cream for it to work properly, which you take off before applying capsaicin cream.

The EMLA Cream can make the skin where it is applied paler, redder or more swollen. This can become a problem with prolonged use, so normally you are given a two week supply. After this time, hopefully your skin will have become used to the capsaicin cream and you will no longer need the EMLA.

If you have any questions, or if there is anything you do not understand, please contact the Russells Hall Hospital switchboard number on 01384 456111 and ask for the relevant department who issued this leaflet.

If you have any feedback on this patient information leaflet please email dgft.patient.information@nhs.net

This leaflet can be made available in large print, audio version and in other languages, please call 0800 073 0510.

Originator: Ruth Carter, Alifia Tameem. Date reviewed: January 2024. Next review due: October 2026. Version: 3. DGH ref: DGH/PIL/01378.