Innovative use of capsaicin patch 8% in treating thoracic facet syndrome

Thoracic facet joint pain is a commonly encountered but underresearched condition in spine and pain clinics. Management strategies are often limited, especially in refractory cases. Capsaicin 8% patch (Qutenza) is approved for certain neuropathic pain conditions, but its use in thoracic facet syndrome is novel and undocumented. We present two case reports of patients with chronic thoracic facet joint pain confirmed via diagnostic thoracic facet joint blocks and successful thoracic medial branch radiofrequency ablation. Both patients had persistent mid to lower thoracic mechanical pain despite multiple conservative and pharmacological treatments. Imaging ruled out significant disc pathology or central causes. Each patient underwent two cycles of capsaicin 8% patch application using standard protocols. The initial capsaicin patch application led to substantial pain relief in both patients, with effects lasting approximately 6 months. A second cycle resulted in over 80% pain reduction, with benefits sustained for up to 10 months. No significant adverse effects were reported. Both patients reported improvements in function and quality of life. Capsaicin 8% patches may offer an effective adjunctive therapy for patients with refractory thoracic facet joint pain. These case reports suggest sustained pain relief and functional improvement, warranting further studies to confirm efficacy, clarify mechanisms, and guide optimal use in clinical practice.