How to Use Capsaicin (Pepper Creams) for Joint Pain

Tips on Controlling Your Arthritis


Theodore R. Fields, MD, FACP

Attending Physician, Hospital for Special Surgery
Professor of Clinical Medicine, Weill Cornell Medical College

The active ingredient in so-called "hot pepper" creams is capsaicin - which indeed comes from hot pepper plants. It is marketed under such brand names as Zostrix and Capzasin-P. It can help people with arthritis-related joint pain in several ways.

Initially, it causes a warm tingling or burning sensation - which distracts you from the underlying pain. Some find this uncomfortable, but some find this lessens their pain. After a few weeks of use, the burning sensation is often less of an issue and deeper pain-relieving benefits grow. Capsaicin appears to reduce a chemical - substance P - that sends pain signals to the brain. It often takes a week or two, therefore, to get maximal benefit.

Here's how to use it:

First, try the mid-strength, which is 0.075% capsaicin.

  • If you find the burning too much to cope with, go for the milder strength, which is 0.025%. With time, as the uncomfortable sensations decrease, you may be able to build back up to the stronger dose

  • If you don't get enough relief with the mid-strength, try the strongest dose, which is 0.25% -- but don't use that dose first.

  • Wash your hands well after use. Make absolutely sure that the cream or fingers that have touched the cream do not touch your eyes, your genitals, or inside your nose - lest you get hit with the same wild burning that would occur if you touched them after chopping up a hot pepper.

  • Apply capsaicin after a work-out or shower rather than before. Warm water or sweat hitting an area of your body where you have used capsaicin may cause a marked increase in burning sensation.

  • Give capsaicin a full trial - three times daily for two weeks. If you don't have an improvement by then - or if you feel worse at any time or just can't stand the burning - just stop using it. However, if the lower dose doesn't work but you tolerate it, a higher dose (see above) may work.
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