Topical capsaicin is one of the more unusual treatments in UK pain medicine. After all, it works by making affected nerves uncomfortable on purpose, so they eventually become less responsive. So it isn’t a quick fix — it takes 1-4 weeks of consistent use for the substance P depletion to translate into less pain. However, for the right patient, it can offer real relief without the systemic side effects of oral medicines.
Where Axsain fits in UK pain management
The UK approach to neuropathic pain follows a stepped path, broadly based on NICE CG173:
Step 1: Identify and treat any underlying cause — diabetes control, vitamin B12 if deficient, alcohol-related neuropathy
Step 2: Lifestyle measures and pain self-management
Axsain sits at Step 5. So it’s a reasonable option for localised neuropathic pain — particularly when oral medicines haven’t fitted the patient or have caused intolerable side effects.
Axsain vs Zacin — the key comparison
Both contain capsaicin, but at different strengths for different conditions:
Zacin 0.025%: lower strength, licensed for osteoarthritis pain
Both made by Ennogen IP Ltd
Both come in 45g aluminium tubes
Both applied 3-4 times daily
Both can cause initial burning, although Axsain’s burning is more intense due to the higher strength
In short, picking the right strength matters. After all, using Zacin for nerve pain usually doesn’t work, and using Axsain for arthritis is unnecessarily strong.
Axsain vs Qutenza
Qutenza is a much stronger capsaicin product:
Qutenza: 8% capsaicin patch (over 100 times stronger than Axsain)
Applied in a clinic, not at home
Single application lasting 30-60 minutes provides relief for up to 3 months
Requires local anaesthetic preparation because of intense burning
Used for severe nerve pain when home capsaicin hasn’t worked
Specialist pain clinic treatment, not a routine prescription
So Axsain is the home-use option, while Qutenza is the specialist clinic version. Most people start with Axsain and only progress to Qutenza if needed.
Axsain vs Versatis
Both are topical treatments for nerve pain, but they work differently:
Versatis 5% lidocaine patches: a local anaesthetic that blocks pain signals directly; quick onset
Axsain 0.075% capsaicin cream: depletes substance P over weeks; gradual buildup of effect
Versatis is specifically licensed for post-herpetic neuralgia
Axsain is licensed for both post-herpetic neuralgia and diabetic nerve pain
Versatis is generally more comfortable to use
Axsain may work where Versatis hasn’t given enough benefit
Many UK pain clinics try Versatis first because of the easier tolerance, then move to Axsain if needed.
Axsain vs oral neuropathic pain medicines
Oral options have stronger evidence overall but more systemic side effects:
Amitriptyline (oral): first-line; effective but can cause drowsiness, dry mouth, weight gain
Duloxetine: first-line; particularly for diabetic neuropathy; nausea and fatigue common
Gabapentin: widely used; drowsiness, weight gain, mood effects possible
Pregabalin: similar to gabapentin; controlled drug status in the UK
Axsain (topical capsaicin): no systemic side effects, but burning sensation and slow onset
In short, topical treatments like Axsain particularly suit people who can’t tolerate oral medicines or who have localised pain rather than widespread neuropathy.
Who Axsain suits well
This cream may suit people who:
Have post-herpetic neuralgia (ongoing pain after shingles)
Have painful diabetic peripheral neuropathy (under hospital consultant guidance)
Have localised rather than widespread neuropathic pain
Couldn’t tolerate oral neuropathic pain medicines
Want to avoid systemic medication where possible
Can commit to 3-4 applications daily for at least 1-4 weeks before judging benefit
Can manage the initial burning sensation
Don’t have asthma severely flared at the time
Have intact skin in the area to be treated
Who might suit other options better
Other options may work better for people who:
Have widespread neuropathic pain — oral medicines may suit better
Have inflammatory pain (arthritis, tendinitis) — Zacin 0.025% or topical NSAIDs apply
Can’t tolerate any burning sensation
Have severe asthma — capsaicin vapour can worsen breathing
Have broken, weeping, or inflamed skin in the application area
Have a known allergy to capsaicin, chilli peppers, or any base ingredient
Are children — Axsain isn’t suitable for under-18s
Are pregnant or breastfeeding — speak to GP first
Need fast pain relief — Axsain works over weeks, not minutes
Need treatment for diabetic neuropathy outside hospital consultant supervision
Courier Pharmacy supply
Axsain Cream 0.075% is a UK Prescription-Only Medicine (POM). So supply only happens after our UK-qualified prescriber reviews your online consultation. In short, if our prescriber decides another approach would suit better — Versatis patches, an oral medicine, or specialist referral — we’ll explain that clearly.
Key features and specs
Active ingredient: capsaicin 0.075% w/w
Form: white cream
Pack size: 45g aluminium tube
Application: pea-sized amount, 3-4 times daily, at least 4 hours apart
Maximum duration: 8 weeks (no evidence for benefit beyond this)
Age range: adults only; not suitable for children
Apply to: unbroken skin only
Don’t apply: near eyes, on broken skin, or under tight bandages
Important: wash hands immediately after application (unless treating hands)
Avoid: hot baths or showers immediately before or after application
Legal status: Prescription-Only Medicine (POM)
Maker: Ennogen IP Ltd
Storage: below 25°C
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Axsain Cream 0.075% is a topical treatment for nerve pain — particularly post-shingles pain and diabetic nerve pain in the hands and feet. So the active ingredient is capsaicin, the natural compound that makes chilli peppers hot. Applied to the skin, it depletes the pain-signalling chemicals in nearby nerves over a few weeks. Important: an initial burning sensation is normal and often intense, although it usually settles within 1-2 weeks of regular use. This is a UK Prescription-Only Medicine (POM).
At Courier Pharmacy, we believe in treatment that fits the person.
This page covers what Axsain is, who it’s right for, the burning sensation that some people find difficult, and how it compares to other neuropathic pain treatments.
Five key takeaways
Axsain Cream 0.075% is a UK Prescription-Only Medicine (POM). So supply only happens after our UK-qualified prescriber reviews your situation and confirms suitability
Active ingredient is capsaicin 0.075% — the same compound that makes chilli peppers hot. It works by depleting substance P (a pain-signalling chemical) from nerve endings over 1-4 weeks of regular use
Licensed for post-shingles nerve pain (post-herpetic neuralgia) and diabetic nerve pain in the hands and feet. For diabetic nerve pain, the SmPC specifically requires hospital consultant supervision
Apply a pea-sized amount 3-4 times daily, evenly spaced (at least 4 hours apart). The standard treatment period is up to 8 weeks — there’s no clinical trial evidence for benefit beyond this
Important practical points: an initial burning sensation is normal and often strong. So hand washing immediately after application is essential. Avoid hot baths or showers around application time, and never apply near the eyes
Why choose Courier Pharmacy for Axsain Cream
At Courier Pharmacy, our approach starts with a simple idea: treatment should fit the person, not force the person to fit the system.
Dr Ada Jex-Cori
Our service is shaped by the philosophy of Dr Ada Jex-Cori, our brand pharmacist.
Dr Ada represents the spirit of the pharmacy: evidence-led, community-rooted, and willing to challenge the one-size-fits-all approach to medicine. She is named in honour of three pioneering women in science: Ada Lovelace, the mathematician and visionary; Sophia Jex-Blake, the first female doctor in the UK who fought the medical establishment; and Gerty Cori, the biochemist and Nobel Prize winner.
In our fictional world of Etherwell, Dr Ada fights against pharma’s standardised approach to medicine. In the real world, she represents what we stand for. Her view is straightforward: you are not broken. The system is. And we are here to change that.
Honest framing about the burning sensation
Many online providers gloss over the initial burning. Courier Pharmacy is different. So we’ll be straight with you:
The burning is real, often intense, and lasts 1-2 weeks at full strength
Some people find this genuinely difficult and stop treatment before benefit develops
Others find it tolerable, especially knowing it settles with time
You need to be ready for this before committing to a course
If you can’t tolerate the burning, other options (Versatis, oral medicines) exist
There’s no shame in deciding the trade-off isn’t right for you
After all, knowing what you’re signing up for matters more than soft-pedalling to make the sale.
When topical fits and when it doesn’t
Topical treatments like Axsain have a clear role, but they aren’t right for everyone:
Best for localised pain (one limb, one area of skin) rather than widespread neuropathy
Best when oral medicines have failed or caused intolerable side effects
Best when you can commit to multiple daily applications for weeks
Less suitable for severe pain where systemic medicines are needed quickly
Less suitable for widespread or migratory pain patterns
Less suitable when scalp, face, or genital areas are affected
Nerve pain and the bigger picture
Nerve pain often connects to wider health patterns. So our pharmacist can discuss:
Diabetes management — blood sugar control affects diabetic neuropathy progression
Vitamin B12 status — deficiency can cause neuropathy that’s reversible with replacement
Sleep and pain — poor sleep worsens pain sensitivity
Mood and pain — depression and anxiety can amplify pain perception
Mast cell activation syndrome (MCAS) and chronic neuropathic symptoms
Shingles vaccination for those at risk of recurrent episodes
Pacing, gentle exercise, and self-management strategies
Sometimes the pain is the visible part of a wider story — and that’s worth talking through.
Pharmacist support before and after purchase
Our pharmacist is here to discuss:
Whether Axsain is the right choice for your situation
How to use it safely (the hand-washing matters)
Managing the initial burning sensation
How to combine with other pain treatments
When to ask for prescriber review
Other options if Axsain doesn’t suit
This is free and on hand before and after purchase.
Trust earned, not claimed
We are GPhC-regulated, and our content is grounded in NICE CG173 on neuropathic pain, the BNF, and the real experience of patients using topical capsaicin.
If Axsain isn’t the right answer for your situation, we’ll tell you honestly. After all, prescribing the right treatment matters more than fulfilling a request.
How to buy Axsain Cream from Courier Pharmacy
Axsain Cream 0.075% is a UK Prescription-Only Medicine (POM). So supply needs a prescription, which our prescriber issues after an online consultation.
How our service works
Add Axsain Cream to your basket and complete the online consultation. The consultation covers your pain history, prior treatments tried, current medicines, allergies, and other relevant medical history
Our UK-qualified prescriber reviews your answers to confirm whether Axsain is suitable. So if extra information is needed, or if a different treatment would suit better, we’ll get in touch
For diabetic neuropathy, our prescriber will check that you have appropriate specialist input, since the SmPC requires this
Once approved, your prescription is dispensed and sent out in plain, unbranded packaging
Free pharmacist and prescriber support is on hand before and after your purchase
When other options might suit better
If Axsain isn’t right, we’ll explain why. Other options may include:
Versatis 5% lidocaine patches: licensed specifically for post-herpetic neuralgia; more comfortable initially
Zacin 0.025% capsaicin cream: for osteoarthritis pain rather than nerve pain
Compounded pain creams: multi-active formulations for treatment-resistant cases
Specialist pain clinic referral: for complex or persistent neuropathic pain
Qutenza 8% patch: clinic-based treatment for severe nerve pain
Shingles vaccination: if recurrent shingles is the underlying issue
Diabetes management review: for diabetic neuropathy
Our community service
Our free fortnightly drop-in clinics at Insomnia, Derby run every other week from 10am to 12pm.
Healthcare shouldn’t only happen when you’re paying for it. So we show up, even when it’s free.
We cover chronic pain, neuropathy, fibromyalgia, MCAS, CFS, dermatology, eczema, psoriasis, allergies, asthma, hair loss, men’s and women’s health, digestive health, weight management, and whatever else people bring through the door. No appointment needed, no charge, no pressure.
Active ingredients
Each gram of Axsain Cream contains:
Capsaicin 0.075% w/w: the natural compound found in chilli peppers; the active that depletes substance P from nerve endings
Why capsaicin
Capsaicin is the molecule that gives chilli peppers their heat. So that same property — activating heat and pain receptors on nerves — is exactly what makes it useful as a nerve pain treatment:
Activates TRPV1 receptors on pain-sensing nerve endings
Initial activation causes the burning sensation people associate with hot chillies
With repeated use, the nerve endings deplete their stores of substance P
Substance P is the chemical messenger nerves use to send pain signals to the brain
As substance P runs out, the affected nerves can no longer signal pain effectively
The pain-relieving effect builds up gradually over 1-4 weeks of regular use
In short, capsaicin works by overwhelming pain nerves until they exhaust their pain-signalling machinery. After all, the same biology that makes hot food initially uncomfortable can be harnessed to dampen ongoing pain signals.
Why 0.075% specifically
The UK has two different strengths of capsaicin cream. So the choice depends on what's being treated:
025% (Zacin, generic): lower strength, licensed for osteoarthritis pain
075% (Axsain, generic — this product): higher strength, licensed for nerve pain
Nerve pain typically needs the higher strength to deplete substance P effectively
Lower strength is enough for the surface inflammation of arthritis
Using the wrong strength for the wrong condition usually doesn't work well
In addition, an 8% capsaicin patch (Qutenza) exists for severe nerve pain — although that's applied in clinics under specialist supervision rather than at home.
Other ingredients
The full ingredient list:
Purified water
Sorbitol solution
Isopropyl myristate
Cetyl alcohol
White soft paraffin
Glycerol stearate
PEG-100 stearate
Benzyl alcohol (preservative)
The full ingredient list is in the patient information leaflet supplied with the product. So if you have known allergies to any of these, mention them during your consultation.
What is Axsain Cream for?
Axsain Cream 0.075% is for neuropathic pain — that is, pain caused by damaged or dysfunctional nerves rather than by tissue injury or inflammation. So typical uses include post-herpetic neuralgia (the ongoing pain that can follow shingles) and painful diabetic peripheral neuropathy (nerve pain in the hands and feet from long-standing diabetes).
Who is it for?
This cream is for adults with localised nerve pain on intact skin. So it particularly suits people who:
Have ongoing pain after shingles, even after the rash has cleared
Have painful diabetic nerve damage in the hands or feet
Haven't responded fully to oral neuropathic pain medicines
Couldn't tolerate oral medicines because of side effects
Prefer a topical approach to avoid systemic effects
Can manage the initial burning sensation while the treatment takes effect
What does it do?
Capsaicin activates pain-sensing nerves through a specific receptor called TRPV1. So initially, this causes a burning sensation. However, with repeated use over days to weeks, the nerve endings deplete their stores of substance P — a chemical messenger that transmits pain signals. As substance P runs out, pain signals from the treated area become weaker. The effect builds up gradually rather than working immediately.
What it doesn't do
Axsain doesn't treat the underlying cause of nerve damage. So if you have diabetes, ongoing blood sugar control still matters. If you've had shingles, the cream manages residual pain rather than the original viral cause. In addition, Axsain isn't for inflammatory pain like arthritis (Zacin 0.025% has that role). It's also not for tissue injury, muscle pain, or general aches.
How Axsain works
Capsaicin works in a particular way — and understanding it helps explain why the burning sensation eventually gives way to pain relief.
The TRPV1 mechanism
Capsaicin works at a specific receptor on nerve endings called TRPV1:
Applied cream brings capsaicin into contact with sensory nerve endings in the skin
Capsaicin binds to TRPV1 receptors — the same receptors that detect heat above 43°C
This activation triggers nerves to send pain and heat signals to the brain
That's why the initial application feels burning or hot
With repeated activation, the nerve endings gradually release their stores of substance P
Substance P is the main chemical messenger nerves use to signal pain to the spinal cord and brain
Once depleted, the nerve has less ability to send new pain signals
Over weeks of regular use, the treated nerves become less able to transmit ongoing pain
Importantly, this isn't damage to the nerve — it's depletion of its pain-signalling chemicals. So if treatment stops, substance P levels rebuild over time and the original pain may return.
Why the initial burning settles
The burning sensation isn't a side effect — it's the treatment working. Specifically:
As substance P depletes, the nerves become less responsive to capsaicin too
By 1-2 weeks, most users find the burning much less intense
By 2-4 weeks, the burning has usually faded substantially
In the same time-frame, pain relief starts to become noticeable
In short, the burning and the eventual pain relief come from the same biological process. After all, you have to push through the early discomfort to get to the benefit on the other side.
Why the 8-week maximum
The 8-week course limit isn't arbitrary:
Clinical trials supporting Axsain ran for up to 8 weeks
There's no published evidence of additional benefit beyond 8 weeks
Continuous long-term use hasn't been formally studied
Some people use further courses after a break, although this is individual
If 8 weeks of Axsain doesn't help, a different approach is usually more productive than continuing
How to use Axsain Cream
This summary is for reference only. The definitive guide is the patient information leaflet supplied with the cream. So if anything isn't clear, contact our pharmacist or prescriber.
Standard application
How to apply Axsain effectively:
Wash your hands thoroughly with soap and water before applying
Make sure the application area is clean, dry, and intact (no broken skin)
Squeeze a pea-sized amount onto your fingers
Gently rub into the affected area until no cream is visible on the surface
Wash your hands immediately afterwards — soap and water, scrubbing under nails
Use a cotton bud or glove if you're applying to a small or awkward area
Apply 3-4 times daily, with at least 4 hours between applications
Continue for the full prescribed course (typically up to 8 weeks)
If you're treating your hands
Special considerations for hand neuropathy:
You can't easily wash your hands after applying to your hands
So consider using disposable gloves to apply the cream, then dispose carefully
Or apply to one hand at a time, washing the other hand carefully afterwards
Avoid touching your face, eyes, or any sensitive areas for several hours after application
Wear gloves for food preparation, contact with children, and handling pets afterwards
Crucial application warnings
Some specific things to avoid:
Don't apply more than 4 times daily — this increases burning without improving benefit
Don't apply immediately before or after hot baths or showers — heat increases burning significantly
Don't apply under tight bandages, occlusive dressings, or tight clothing — this concentrates capsaicin and intensifies effects
Don't apply near the eyes, nose, mouth, or genitals
Don't apply to broken, damaged, irritated, or recently sun-exposed skin
Don't share the tube between household members
Hand washing matters — really
This is the safety point most often missed. So:
Capsaicin transfers easily from hands to anything you touch afterwards
Contact with eyes causes severe burning
Touching the face after applying can cause significant discomfort
Wash hands with plenty of soap and water for at least 30 seconds
Pay particular attention to under fingernails and around cuticles
Even after washing, residue can remain — so be cautious around eyes and face for several hours
When you should see improvement
Capsaicin takes time:
Week 1: intense burning, no obvious pain relief yet
Week 2: burning starts to settle; pain relief may begin
Weeks 2-4: noticeable reduction in pain for most responders
Weeks 4-8: peak benefit usually reached
If no improvement by 4-6 weeks, contact our prescriber for review
Stopping early because of the burning misses the relief that comes later
If you miss an application
Don't worry. Just apply at the next scheduled time and continue normally. So don't double up. However, consistent application matters because the substance P depletion only builds up with regular use.
Food, drink, and lifestyle
Axsain is for external use only:
Avoid hot baths or showers around application time — heat increases capsaicin's effect
Loose cotton clothing over the treated area is more comfortable than tight or synthetic fabric
Avoid sunbed use over treated areas
Spicy food doesn't interact with the cream, although capsaicin sensitivity can vary
Alcohol doesn't interact directly
Storage
Store below 25°C
Replace the cap securely after use
Keep the tube upright if possible
Keep out of sight and reach of children
Don't share the tube between household members
Don't use after the expiry date
Warnings and precautions
Don't use Axsain if you
Don't use Axsain if you:
Have a known allergy to capsaicin, chilli peppers, or any base ingredient
Are under 18 — this cream isn't licensed for children
Have severe asthma actively flared — capsaicin vapour can trigger breathing problems
Have broken, weeping, infected, or severely inflamed skin in the application area
Have recent sunburn or sun-damaged skin where you plan to apply
Use with care if you
Talk to our prescriber before using if you:
Have asthma or other airway conditions — capsaicin vapour can occasionally worsen these
Have very sensitive skin or eczema
Are pregnant, planning pregnancy, or breastfeeding
Have diabetic neuropathy — the SmPC specifies hospital consultant supervision for this use
Are using other topical treatments in the same area
Have allergies to other plant-derived compounds
The asthma consideration
This is an important practical point:
Capsaicin can vaporise slightly from skin or hands after application
Inhaling capsaicin vapour can cause coughing, sneezing, runny eyes
In people with asthma, this can trigger wheezing or worsen symptoms
Apply in well-ventilated areas
Avoid leaning closely over treated skin while it's still drying
If you develop breathing difficulty after applying, stop using the cream and seek medical advice
The eye contact warning
Capsaicin in eyes is very painful. So if accidental contact happens:
Rinse the eye thoroughly with cool water for at least 15 minutes
Don't rub the eye
Don't use eye drops to try to wash it out
If significant pain or redness persists, seek medical advice urgently
The pain usually settles within 30-60 minutes once thoroughly rinsed
Diabetic neuropathy and consultant supervision
This deserves specific mention:
The Axsain SmPC specifies that patients using Axsain for diabetic peripheral polyneuropathy should only do so under direct hospital consultant supervision
This is because diabetic neuropathy treatment usually fits within wider diabetic care management
Specialist pain clinic or diabetes specialist involvement matters for this group
Our prescriber will assess whether you have appropriate specialist input before prescribing for diabetic neuropathy
For post-shingles pain, consultant supervision isn't a specific requirement
Use in older adults
Older adults can use Axsain. However:
Skin can be more fragile, so apply gently
Reduced sensation can make it harder to judge how much burning is too much
Polypharmacy makes interactions worth checking, although topical capsaicin has few
Diabetic neuropathy is more common in older adults — specialist supervision applies
Use in children
Axsain isn't licensed for under-18s. So children with neuropathic pain need specialist paediatric pain assessment rather than this product.
Use in pregnancy and breastfeeding
Talk to your GP first:
Safety in pregnancy and breastfeeding hasn't been formally established
However, transdermal absorption of capsaicin is very low
Dietary capsaicin intake (from chilli-containing foods) is typically much higher than what's absorbed from the cream
If breastfeeding, don't apply to the breast area
Alternatives may be preferred during pregnancy if practical
Driving and machinery
Axsain has no effect on driving or operating machinery.
Side effects
Most Axsain side effects relate directly to its mechanism. So burning is expected and usually settles.
Common side effects
Burning or stinging sensation at the application site — especially in the first 1-2 weeks
Skin redness or warmth in the treated area
Sneezing, coughing, or runny eyes from vapour
Local skin irritation, dryness, or itching
Less common side effects
Persistent burning beyond the expected adjustment period
Skin blistering or significant irritation (usually from too much cream or applying after heat exposure)
Worsening of asthma symptoms
Contact dermatitis (allergic reaction)
Eye, nose, or throat irritation from vapour
Rare but serious side effects
Severe allergic reactions (swelling of face, lips, tongue, throat; breathing difficulty) — medical emergency
Significant asthma worsening or breathing difficulty
Wheezing or chest tightness
Severe skin reactions with blistering or peeling
Stop and seek urgent medical help if
You develop signs of severe allergic reaction
Significant breathing difficulty or wheezing develops
Severe skin reaction with blistering develops
Asthma symptoms worsen and don't settle
Severe eye contact happens and pain persists after rinsing
Yellow Card reporting
If you notice any side effects, please report them through the MHRA Yellow Card scheme at https://yellowcard.mhra.gov.uk/, or talk to our pharmacist.
Drug interactions
Axsain is for external use only with low systemic absorption. So significant drug interactions are unusual.
Skin-related considerations
The main interactions are with other topical products:
Other topical pain treatments (lidocaine patches, NSAID gels, compounded creams): don't apply to the same area at the same time
Heat-applying products (rubefacient creams, deep heat sprays): avoid combining — could intensify burning significantly
Topical steroids: usually fine, but apply at separate times
Emollients: can be used to surrounding skin, but apply at separate times
Sunscreens: apply to surrounding skin, not the Axsain-treated area
Not relevant interactions
Generally no interactions with:
Most oral medications, including for diabetes, blood pressure, depression
Antihistamines
Common over-the-counter cold and flu treatments
Alcohol in moderation
Spicy food (although personal capsaicin sensitivity varies)
Frequently asked questions
Why does the cream burn so much?
The burning is the treatment working. Specifically:
Capsaicin activates the same nerve receptors that detect heat above 43°C
Initial activation feels like burning, even though the skin isn't actually hot
With repeated applications, the nerves become less responsive
By 1-2 weeks, most people find the burning much less intense
By 2-4 weeks, the burning has usually faded substantially
If burning remains intolerable after 2 weeks, talk to our prescriber about alternatives
How quickly will it relieve my pain?
Capsaicin builds up effect over weeks:
Week 1: intense burning, no obvious pain relief
Week 2: burning settling; pain relief may start
Weeks 2-4: noticeable pain reduction for responders
Weeks 4-8: peak benefit usually reached
If no improvement by 4-6 weeks, contact our prescriber
Why is the course only 8 weeks?
Clinical trial limitation. So:
Trials supporting Axsain ran up to 8 weeks
No formal evidence supports benefit beyond 8 weeks of continuous use
Some people use further courses after a break
Continuous indefinite use hasn't been formally studied
If 8 weeks doesn't help, alternative approaches are usually more productive
Why can't I use it for diabetic neuropathy without seeing a consultant?
The SmPC requires this. After all, diabetic neuropathy is part of wider diabetic management, and pain treatment should fit alongside that. Our prescriber will check that you have specialist diabetic or pain clinic input before prescribing Axsain for diabetic nerve pain. For post-shingles pain, no such requirement exists.
Can I use it for arthritis?
No — use Zacin 0.025% for that. So Axsain 0.075% is licensed for nerve pain. Arthritis pain is inflammatory rather than neuropathic, and Zacin's lower strength is enough for arthritis. Using Axsain for arthritis would cause unnecessarily intense burning without proportional benefit.
Can I use it on my face or eyelids?
No. Specifically:
Don't apply near eyes, nose, mouth, or genitals
Facial skin is more sensitive and more vulnerable to burning
Risk of accidental eye transfer is much higher with face application
Trigeminal neuralgia (facial nerve pain) usually needs specialist input rather than topical capsaicin
Can I use it after a shower?
Wait. So:
Hot showers or baths increase capsaicin's burning effect significantly
Wait at least 1-2 hours after a hot shower before applying
Wait at least 1-2 hours after applying before bathing
Lukewarm showers are less of an issue than hot ones
Cool water immediately after application can cause skin reactions too
Will it stain my clothes?
Possibly slightly. So:
Capsaicin can leave a faint yellow tinge on light-coloured fabrics
Let the cream fully absorb before dressing
Loose cotton clothing is better than tight or synthetic fabrics
Don't apply under tight elastic, waistbands, or bra straps
Wash treated clothing separately from white loads to be safe
Can I use Axsain with my other pain medicines?
Usually yes. So:
Oral neuropathic pain medicines (amitriptyline, gabapentin, pregabalin, duloxetine): can be used alongside
Paracetamol: no interaction
NSAIDs (ibuprofen, naproxen): no interaction
Opioids: no interaction
Other topical treatments to the same area: avoid combining
Talk to our pharmacist about any combination to be safe
Can I use it during pregnancy?
Talk to your GP first. So safety in pregnancy hasn't been formally established. However, very little capsaicin is absorbed through the skin — dietary intake from chilli foods is typically much higher. The benefit-risk balance depends on your individual situation, which is why GP consultation matters.
Can I use it on broken skin?
No. So:
Application to broken skin causes severe burning
Increased absorption raises the risk of systemic effects
Wait until skin is fully healed before applying
If your nerve pain is in an area with ongoing skin damage, talk to our prescriber about alternatives
Does the cream contain real chilli?
Yes, in essence. So capsaicin is the same compound that makes chilli peppers hot, although it's purified and standardised for medical use rather than extracted directly from peppers. People with severe chilli sensitivity may want to start cautiously.
What if I get the cream in my eyes?
Don't panic — it's painful but settles. So:
Rinse the eye thoroughly with cool water for at least 15 minutes
Don't rub the eye
Don't use eye drops to try to flush it out
Severe pain usually settles within 30-60 minutes once thoroughly rinsed
If significant pain or redness persists, seek medical advice
How should I store Axsain?
Storage:
Below 25°C
Don't refrigerate
Replace the cap securely after use
Keep out of sight and reach of children
Don't use after the expiry date
How do I order from Courier Pharmacy?
Add Axsain Cream to your basket on courierpharmacy.co.uk and complete the online consultation. Our prescriber will review and confirm whether Axsain is suitable for your situation. For diabetic neuropathy, we'll check appropriate specialist input. Your order goes out in plain, unbranded packaging.
More than a prescription: our community
Healthcare shouldn't only happen when you're paying for it.
Every fortnight we run free drop-in talks and clinics at Insomnia, Derby, from 10am to 12pm. So we show up, even when it's free.
Bring a question, bring a friend, bring a stack of bewildering letters from another clinic. We'll sit with you.
We cover chronic pain, neuropathy, fibromyalgia, MCAS, CFS, dermatology, eczema, psoriasis, allergies, asthma, hair loss, men's and women's health, digestive health, weight management, and whatever else people bring through the door. No appointment. No cost. No pressure. Just real support and treatment that fits.
This article is for information only and isn't a substitute for personal medical advice. Always speak to a qualified prescriber before starting or changing treatment for chronic pain. Patients using Axsain for diabetic peripheral polyneuropathy should be under hospital consultant supervision as specified in the Summary of Product Characteristics.
How this content was created
Written by the Courier Pharmacy editorial team and reviewed by a GPhC-registered pharmacist.
The content is grounded in the latest Ennogen IP Ltd Summary of Product Characteristics for Axsain Cream 0.075%, NICE guidance (CG173 on neuropathic pain), the BNF entry for capsaicin, and the real experience of patients using topical capsaicin treatments. In addition, it draws on the real questions patients bring to our drop-in clinics in Derby.
[2] National Institute for Health and Care Excellence (2020) Neuropathic pain in adults: pharmacological management in non-specialist settings — NICE guideline CG173. Available at: https://www.nice.org.uk/guidance/cg173
