We’ve all seen the "heat creams" at the chemist. But for a manual therapist, the difference between a supermarket rub and a clinical-grade tool is the difference between a happy patient and one who doesn't book back in.
At MWax, we’re obsessed with the science of what actually works on the table. That’s why we’ve been looking closely at Capsaicin, the active "heat" compound in chilli peppers. The research for its use in localised, neuropathic, and osteoarthritic pain is getting stronger every day.
Here is what you need to know about using this powerhouse in your clinic.
Capsaicin as a Topical Treatment for Pain Relief: Mechanisms and Evidence
Capsaicin, the active compound in chilli peppers, has gained clinical relevance as a topical analgesic for various chronic pain conditions. Its unique mechanism of action and favourable safety profile make it a valuable non-systemic option for patients with localised pain, particularly when oral medications are contraindicated or poorly tolerated.
Mechanism of Action
Capsaicin isn't just "hot." It’s a tactical strike on pain. Capsaicin exerts its analgesic effects by binding to the transient receptor potential vanilloid 1 (TRPV1) receptor on nociceptive neurons. This receptor is responsible for detecting noxious heat and chemical stimuli.
Upon activation, capsaicin causes an influx of calcium ions, leading to an initial burning sensation followed by defunctionalisation of the nociceptor and depletion of substance P, a neuropeptide involved in pain transmission ((https://onlinelibrary.wiley.com/doi/full/10.1002/ptr.8223)
Repeated application results in desensitisation of the sensory neurons, reducing the transmission of pain signals to the central nervous system. You’re essentially "turning down the volume" on the patient's pain.
Clinical Applications
1. Neuropathic Pain
Topical capsaicin has demonstrated efficacy in treating postherpetic neuralgia (PHN), diabetic peripheral neuropathy (DPN), and radiculopathy. In a randomized controlled trial involving patients with PHN, 0.075% capsaicin applied 3–4 times daily for six weeks resulted in a ≥40% reduction in pain in nearly half of the participants, compared to only 6% in the placebo group (https://pubmed.ncbi.nlm.nih.gov/2768576/)
2. Osteoarthritis
Capsaicin cream (0.025%–0.075%) is recommended in several clinical guidelines for the management of knee and hand osteoarthritis, particularly for patients with mild to moderate symptoms or those unable to tolerate NSAIDs. A systematic review of guidelines concluded that capsaicin is effective as a short-term adjunct to core treatments such as exercise and weight management (https://onlinelibrary.wiley.com/doi/full/10.1002/ptr.8223)
3. Other Musculoskeletal Conditions
Capsaicin is also used for myofascial pain, muscle strains, and localised soft tissue pain, offering a non-invasive alternative to systemic analgesics.
What Formulations and Dosages have been researched
- Low-concentration creams (0.025%–0.075%): Applied 3–4 times daily for several weeks.
- High-concentration patches (8% capsaicin, e.g., Qutenza®): Applied under medical supervision for 30–60 minutes, with effects lasting up to 12 weeks.
- Hotspot is measured at 0.06%, fitting with the low concentration creams.
Adverse Effects and Considerations
The most common side effect is a transient burning or stinging sensation at the application site, particularly during the first few days of use. This typically subsides with continued application. Patients should be advised to wash their hands thoroughly after use and avoid contact with eyes or mucous membranes.
Putting Research Into Practice: Clinical Use
As a single use topical application, MWax Hotspot will provide a warming effect (sometimes quite hot for a short period) that ‘reactivates’ with certain environments (like clothing covering or showers) for up to 24 - 48 hours. Patient feedback varies from marked changes in localised pain to small reductions.
It is the repetitive use of MWax Hotspot that shows longer lasting changes in pain perception. To achieve the results seen in the clinical literature, patients should apply Hotspot up to 3 times per day for 2-4 weeks. This obviously involves the patient purchasing the product and applying it at home.
Imagine your patient leaving the clinic not just feeling better, but carrying the "cure" in their pocket. By recommending Hotspot for home use, you are giving them a professional-grade tool to manage their recovery between visits.
The MWax Difference
At the end of the day, your reputation is built on the results your patients see. We created Hotspot to be the tool we couldn't find elsewhere. A premium, therapist-made formula that provides the traction you need on the table and the relief your patients need at home.
If you’re looking to add a reliable, evidence-based "heat" tool to your kit, we’d love for you to give Hotspot a try.
References
Capsaicin treatment in neuropathic pain: axon reflex vasodilatation after 4 weeks correlates with pain reduction
Sendel, Manon*; Dunst, Andreas
Proteomic and phosphoproteomic analyses reveal the biological perturbations caused by capsaicin treatment
panelZicang Li a, Meining Xing a, Wenhao Hou a, Zhan Yue a, Ying Jiang a, Wantao Ying a
https://www.sciencedirect.com/science/article/abs/pii/S0963996925002194
A Comprehensive Review of Capsaicin and Its Role in Cancer Prevention and Treatment
Govardhan Katta Radhakrishna , Damodar Nayak Ammunje, et al
https://www.thieme-connect.com/products/ejournals/html/10.1055/a-2309-5581
Beneficial Effects of Capsaicin in Disorders of the Central Nervous System
by Michał Pasierski andBartłomiej Szulczyk *
https://www.mdpi.com/1420-3049/27/8/2484
Topical Capsaicin for the Treatment of Neuropathic Pain
By Adiba Sultana, Rajeev K. Singla, Xuefei He, Yan Sun, Md. S. Alam and Bairong Shen
https://www.benthamdirect.com/content/journals/cdm/10.2174/1389200221999201116143701
Topical Capsaicin for the Management of Painful Diabetic Neuropathy: A Narrative Systematic Review
Brandon GoodwinORCID Icon,Maanas Chiplunkar,Ryan Salerno,Kylon Coombs,Umar Sannoh,Vrushank Shah
https://www.tandfonline.com/doi/abs/10.2217/pmt-2023-0006
The role of topical capsaicin gel in pain management during microfocused ultrasound treatment for neck laxity
Vasanop Vachiramon, Pansakorn Tanratana, Tanaporn Anuntrangsee, Pasita Palakornkitti, Nitina Yeesibsean, Pintusorn Kungvalpivat, Sabrina Fabi
https://onlinelibrary.wiley.com/doi/full/10.1111/srt.13240
Efficacy and safety of topical capsaicin in the treatment of osteoarthritis pain: A systematic review and meta-analysis
Gyem Tshering, Pawel Posadzki,
https://onlinelibrary.wiley.com/doi/full/10.1002/ptr.8223