Cayenne

Also indexed as: Capsaicin

Botanical names: Capsicum annuum, Capsicum frutescens

Parts used and where grown

Originally from South America, the cayenne plant is now used worldwide as a food and spice. Cayenne is very closely related to bell peppers, jalapeños, paprika, and other similar peppers. The fruit is used medicinally.

Cayenne has been used in connection with the following conditions (refer to the individual health concern for complete information):

Science Ratings	Health Concerns
	Neurogenic bladder (administered by urologist) Osteoarthritis (topical, for pain only) Pain (topical use only) Psoriasis (topical) Shingles (herpes zoster)/postherpetic neuralgia (topical, for pain only) Type 1 diabetes Type 2 diabetes (topical for neuropathy)
	Cluster headaches Indigestion and heartburn Itching (anal; pruritus ani) Obesity Rheumatoid arthritis (topical)
	Bursitis Low back pain (topical) Migraine headaches
Reliable and relatively consistent scientific data showing a substantial health benefit. Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit. For a herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.

Historical or traditional use (may or may not be supported by scientific studies)

The potent, hot fruit of cayenne has been used as medicine for centuries. It was considered helpful by herbalists for various conditions of the gastrointestinal tract, including stomach aches, cramping pains, and wind. Cayenne was frequently used to treat diseases of the circulatory system. It is still traditionally used in herbal medicine as a circulatory tonic (a substance believed to improve circulation). Rubbed on the skin, cayenne is a traditional, as well as modern, remedy for rheumatic pains and arthritis due to what is termed a counterirritant effect. A counterirritant is something that causes irritation to a tissue to which it is applied, thus distracting from the original irritation (such as joint pain in the case of arthritis).

Active constituents

Cayenne contains a resinous and pungent substance known as capsaicin. Topical application of capsaicin relieves pain and itching by acting on sensory nerves.¹ Capsaicin temporarily depletes “substance P”, a chemical in nerves that transmits pain sensations. Without substance P, pain signals can no longer be sent. The effect is temporary. Numerous double-blind trials have proven topically applied capsaicin creams are helpful for a range of conditions, including nerve pain in diabetes (diabetic neuropathy),² ³ post-surgical pain,⁴ ⁵ ⁶ psoriasis,⁷ muscle pain due to fibromyalgia,⁸ nerve pain after shingles (postherpetic neuralgia),⁹ ¹⁰ osteoarthritis pain,¹¹ ¹² and rheumatoid arthritis pain.¹³

With the aid of a healthcare professional, capsaicin administered via the nose may also be a potentially useful therapy for cluster headaches. This is supported by a double-blind trial.¹⁴ Weaker scientific support exists for the use of capsaicin for migraines.¹⁵

Injecting capsaicin directly into the urinary bladder has reduced symptoms of one type of bladder dysfunction (neurogenic hyperreflexic bladder)¹⁶ that results from spinal cord and other nerve injuries. Capsaicin is not known to help other bladder conditions, such as chronic bladder pain. The placing of cayenne or capsaicin products into the bladder has only been performed in clinical experiments and should only be done by a urologist.

Modest reductions in appetite have been found in healthy Japanese women and white men when they consumed 10 grams of cayenne pepper along with meals in a double-blind trial.¹⁷ A similar trial found that cayenne could increase metabolism of dietary fats in Japanese women.¹⁸ These trials suggest cayenne may help in the treatment of obesity.

In a double-blind study of people with dyspepsia (heartburn), supplementation with 833 mg of cayenne powder in capsules, three times per day before meals, reduced heartburn symptoms by 48%, compared with a placebo. However, two of 15 individuals receiving cayenne discontinued it because of abdominal pain.¹⁹

How much is usually taken?

Topical creams containing 0.025 to 75% capsaicin are generally used.²⁰ People often apply the cream to the affected area three or four times per day. A burning sensation may occur the first several times the cream is applied. However, this should gradually decrease with each use. The hands must be carefully and thoroughly washed after use, or gloves should be worn, to prevent the cream from accidentally reaching the eyes, nose, or mouth, which would cause a burning sensation. Do not apply the cream to areas of broken skin. For internal use, cayenne tincture (0.3–1 ml) can be taken three times per day. An infusion can be made by pouring 1 cup (250 ml) of boiling water onto 1/2–1 teaspoon (2.5 to 5 grams) of cayenne powder and let set for 10 minutes. A teaspoon of this infusion can be mixed with water and taken three to four times daily. In the treatment of heartburn, researchers have used 833 mg of cayenne powder in capsule form, taken three times per day before meals.²¹

Are there any side effects or interactions?

Besides causing a mild burning during the first few applications (or severe burning if accidentally placed in sensitive areas, such as the eyes), side effects are few with the use of capsaicin cream.²² As with anything applied to the skin, some people may have an allergic reaction to the cream, so the first application should be to a very small area of skin. Do not attempt to use capsaicin cream intra-nasally for headache treatment without professional guidance.

When consumed as food—one pepper per day for many years—cayenne may increase the risk of stomach cancer, according to one study.²³ A different human study found that people who ate the most cayenne actually had lower rates of stomach cancer.²⁴ Overall, the current scientific evidence is contradictory. Thus, the relationship between cayenne consumption and increased risk of stomach cancer remains unclear.²⁵ Oral intake of even 1 ml of tincture three times per day can cause burning in the mouth and throat, and can cause the nose to run and eyes to water. People with ulcers, heartburn, or gastritis should use any cayenne-containing product cautiously as it may worsen their condition.

Are there any drug interactions?
Certain medicines may interact with cayenne. Refer to drug interactions for a list of those medicines.

References
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1. Lynn B. Capsaicin. Actions on nociceptive C-fibers and therapeutic potential. Pain 1990;41:61–9.

2. Capsaicin study group. Treatment of painful diabetic neuropathy with topical capsaicin. A multicenter, double-blind, vehicle-controlled study. The capsaicin study group. Arch Int Med 1991;151:2225–9.

3. Capsaicin study group. Effect of treatment with capsaicin on daily activities of patients with painful diabetic neuropathy. The capsaicin study group. Diabet Care 1992;15:159–65.

4. Ellison N, Loprinzi CL, Kugler J, et al. Phase III placebo-controlled trial of capsaicin cream in the management of surgical neuropathic pain in cancer patients. J Clin Oncol 1997;15:2974–80.

5. Watson CPN, Evans RJ, Watt VR. The postmastectomy pain syndrome and the effect of topical capsaicin. Pain 1989;38:177–86.

6. Watson CPN, Evans RJ. The postmastectomy pain syndrome and topical capsaicin: a randomized trial. Pain 1992;51:375–9.

7. Bernstein JE, Parish LC, Rapaport M, et al. Effects of topically applied capsaicin on moderate and severe psoriasis vulgaris. J Am Acad Dermatol 1986;15:504–7.

8. McCarty DJ, Csuka M, McCarthy G, et al. Treatment of pain due to fibromyalgia with topical capsaicin: A pilot study. Semin Arth Rhem 1994;23:41–7.

9. Watson CP, Tyler KL, Bickers DR, et al. A randomized vehicle-controlled trial of topical capsaicin in the treatment of postherpetic neuralgia. Clin Ther 1993;15:510–26.

10. Watson CP, Evans RJ, Watt VR. Postherpetic neuralgia and topical capsaicin. Pain 1988;33:333–40.

11. McCarthy GM, McCarty DJ. Effect of topical capsaicin in the therapy of painful osteoarthritis of the hands. J Rheumatol 1992;19:604–7.

12. Deal CL, Schnitzer TJ, Lipstein E, et al. Treatment of arthritis with topical capsaicin: A double-blind trial. Clin Ther 1991;13:383–95.

13. Deal CL, Schnitzer TJ, Lipstein E, et al. Treatment of arthritis with topical capsaicin: A double-blind trial. Clin Ther 1991;13:383–95.

14. Marks DR, Rapoport A, Padla D, et al. A double-blind placebo-controlled trial of intranasal capsaicin for cluster headache. Cephalalgia 1993;13:114–6.

15. Levy RL. Intranasal capsaicin for acute abortive treatment of migraine without aura. Headache 1995;35:277 [letter].

16. de Seze M, Wiart L, Ferrier JM, et al. Intravesical instillation of capsaicin in urology: A review of the literature. Eur Urol 1999;36:267–77 [review].

17. Yoshioka M, St-Pierre S, Drapeau V, et al. Effects of red pepper on appetite and energy intake. Br J Nutr 1999;82:115–23.

18. Yoshioka M, St-Pierre S, Suzuki M, Tremblay A. Effects of red pepper added to high-fat and high-carbohydrate meals on energy metabolism and substrate utilization in Japanese women. Br J Nutr 1998;80:503–10.

19. Bortolotti M, Coccia G, Grossi G. Red pepper and functional dyspepsia. N Engl J Med 2002;346:947–8 [letter].

20. Siften DW (ed). Physicians’ Desk Reference for Nonprescription Drugs. Montvale, NJ: Medical Economics, 1998, 790–1.

21. Bortolotti M, Coccia G, Grossi G. Red pepper and functional dyspepsia. N Engl J Med 2002;346:947-8 [letter].

22. Siften DW (ed). Physicians’ Desk Reference for Nonprescription Drugs. Montvale, NJ: Medical Economics, 1998, 790–1.

23. Lopez-Carrillo L, Avila M, Dubrow R. Chili pepper consumption and gastric cancer in Mexico: A case-control study. Amer J Epidem 1994;139:263–71.

24. Buiatti E, Palli D, Decarli A, et al. A case-control study of gastric cancer and diet in Italy. Int J Cancer 1989;44:611–6.

25. Surh YJ, Lee SS. Capsaicin in hot chili pepper: Carcinogen, co-carcinogen or anticarcinogen? Food Chem Toxic 1996;34:313–6.

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The information presented in Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or chemist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires March 2007.