4 min readUpdated: Jun 12, 2026 02:29 PM IST
A compound derived from chilli peppers may have a bigger role in managing diabetic nerve pain than previously recognised, according to a new review published in the Journal of the Association of Physicians of India (JAPI).
The review analysed 22 clinical studies involving more than 1,800 patients and found that topical capsaicin can provide meaningful relief from neuropathic pain, particularly painful diabetic peripheral neuropathy (DPN) and postherpetic neuralgia (PHN). The capsaicin 0.075% cream worked best. This refers to a topical medication (applied to the skin) containing 0.075 grams of the active extract from chili peppers per 100 grams of cream, gel, or lotion.
In some studies, the pain relief achieved with topical capsaicin was comparable to that seen with certain oral medications, but without the systemic side effects associated with those treatments.
The review was led by diabetes specialist and chairman of the Chennai-based Dr Mohan’s Diabetes Specialities Centre, Dr V Mohan, consultant physician and diabetologist at Shilpa Medical Research Center, Mumbai, Dr Mangesh Tiwaskar, orthopaedic surgeon at Mumbai’s Lilavati Hospital, Dr Abhay Nene and medical affairs expert at P&G Health, Dr Sonali Gokhalay, among others.
More than just a pain balm ingredient
Capsaicin is not new. The active component that gives chilli peppers their heat has long been used in pain-relief balms and ointments. What makes the latest review noteworthy, researchers say, is the growing body of evidence supporting its role in neuropathic pain. “What is clinically significant here is the strength and consolidation of evidence specifically for neuropathic pain,” said Dr Mohan. According to him, the review shows that capsaicin is not merely a counter-irritant used in generic pain balms but a mechanism-based therapy that acts on pain-transmitting nerve fibres. Evidence also suggested that the 0.075 per cent formulation may be more effective than lower-strength versions commonly available over the counter.
“Newer delivery formats, including roll-on applications, could improve patient convenience, targeted application and tolerability,” Dr Mohan added.
Could it help other nerve pain conditions?
“The strongest evidence currently exists for diabetic peripheral neuropathy, a form of nerve damage caused by diabetes, and postherpetic neuralgia, lingering nerve pain that can persist after shingles,” said Dr Tiwaskar. However, experts say neuropathic pain, which is triggered by nerve damage, can arise from a wide range of conditions.
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Neuropathic pain may also occur in people with vitamin B deficiencies, thyroid disorders, alcohol-related nerve damage, chemotherapy-induced neuropathy, nerve compression syndromes and other metabolic or neurological disorders. Symptoms can include burning, tingling, numbness, electric shock-like sensations and hypersensitivity.
Because topical capsaicin works locally on pain-sensitive nerve endings, it may have relevance in other forms of localised peripheral neuropathic pain as well.
“Capsaicin acts to desensitise overactive fibres at the site. That action is nerve-specific, not disease-specific. However, treatment suitability should always depend on proper medical diagnosis of the underlying cause,” Dr Tiwaskar added. He also emphasised that stress and anxiety do not directly cause neuropathic pain, although they may worsen pain perception or coexist with chronic pain conditions.
Current treatment options
Experts say neuropathic pain often goes unrecognised or is mistaken for ordinary pain, leading many patients to rely on treatments that may not adequately target the underlying nerve mechanisms. “Conventional muscle pain products or non-specific analgesics may not adequately target nerve-driven pain mechanisms,” said Dr Gokhalay.
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Current treatment approaches include oral medications as well as topical therapies. However, awareness of mechanism-specific treatments such as capsaicin remains inconsistent in routine clinical practice. “This review reinforces that topical capsaicin 0.075 per cent has validated the evidence base and may deserve greater consideration, particularly for patients with localised neuropathic pain, those unable to tolerate systemic therapies, or patients seeking targeted topical management,” Dr Gokhalay said.
