Cayenne (Capsicum annuum, Capsicum frutescens)

Common Names
Capsaicin, capsicum

Botany
Originally from South America, the cayenne plant has spread across the globe both as a food and as a medicine. Cayenne is very closely related to bell peppers, jalapeños, paprika, and other similar peppers. The fruit is used.

Historical or Traditional Use
The potent, hot fruit of cayenne has been used as medicine for centuries. It was considered helpful for various conditions of the gastrointestinal tract, including stomachaches, cramping pains, and gas. 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 and Proposed Mechanism of Action
Cayenne contains a resinous and pungent substance known as capsaicin. This chemical relieves pain and itching by acting on sensory nerves. Capsaicin temporarily stimulates release of various neurotransmitters from these nerves, leading to their depletion. Without the neurotransmitters, pain signals can no longer be sent.¹ The effect is temporary. Capsaicin and other constituents in cayenne have been shown to have several other actions, including reducing platelet stickiness and acting as antioxidants. Numerous double-blind studies have proven topically applied capsaicin creams are helpful for a range of conditions, including nerve pain in diabetes (diabetic neuropathy),^{2 3} postsurgical pain,⁴ psoriasis,⁵ muscle pain due to fibromyalgia,⁶ nerve pain after shingles (postherpetic neuralgia),⁷ osteoarthritis pain,^{8 9} and rheumatoid arthritis pain.¹⁰

With the aid of a health-care professional knowledgeable in nutritional medicine, capsaicin administered via the nose can also be a useful therapy for cluster headaches. This is supported by double-blind studies.¹¹ Weaker scientific support exists for the use of capsaicin for migraines.¹²

Recommended Dosage
Creams containing 0.025–0.075% capsaicin are generally used.¹³ 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. A cayenne tincture can be used in the amount of 0.3–1 ml TID. An infusion can be made by pouring a cup of boiling water onto 1/2–1 tsp of cayenne powder and let set for 10 minutes. A teaspoon of this infusion can be mixed with water and drunk three to four times daily.

Contraindications
Besides causing a mild burning during the first few applications (or severe burning if accidentally placed in sensitive areas, such as the eyes), no side effects accompany the use of cayenne (capsaicin cream).¹⁴ 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 intranasally for headache treatment without professional support.

When consumed as food—one pepper per day for many years—cayenne may increase the risk of stomach cancer, according to one study.¹⁵ A different human study found that people who ate the most cayenne actually had lower rates of stomach cancer.¹⁶ Overall, the current scientific evidence is contradictory; thus, the relationship between cayenne consumption and increased risk of stomach cancer remains unclear.¹⁷ Nevertheless, until more is known, no more than 1 ml of tincture TID should be used. Oral intake of even 1 ml TID can cause burning in the mouth and throat, and can cause the nose to run and eyes to water. Cayenne should be taken in amounts of less than 1 ml tincture TID, or less than 500 mg powder daily, by people with ulcers, heartburn, or gastritis.

References:

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. 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.
6. McCarty DJ et al. Treatment of pain due to fibromyalgia with topical capsaicin: A pilot study. Semin Arth Rhem 1986;23(suppl 3):41–7.
7. Watson CP, Evans RJ, Watt VR, Birkett N. A randomized vehicle-controlled trial of topical capsaicin in the treatment of postherpetic neuralgia. Clin Ther 1993;15:510–23.
8. McCarthy GM, McCarty DJ. Effect of topical capsaicin in the therapy of painful osteoarthritis of the hands. J Rheumatol 1992;19:604–7.
9. Deal CL, Schnitzer TJ, Lipstein E, et al. Treatment of arthritis with topical capsaicin: A double-blind trial. Clin Ther 1991;13(3):383–95.
10. Deal CL, Schnitzer TJ, Lipstein E, et al. Treatment of arthritis with topical capsaicin: A double-blind trial. Clin Ther 1991;13(3):383–95.
11. Marks DR, Rapoport A, et al. A double-blind placebo-controlled trial of intranasal capsaicin for cluster headache. Cephalalgia 1993;13:114–6.
12. Levy RL. Intranasal capsaicin for acute abortive treatment of migraine without aura. Headache 1995;35(5):277[letter].
13. Siften DW, ed. Physicians’ Desk Reference for Nonprescription Drugs. Montvale, NJ: Medical Economics, 1998, 790–1.
14. Siften DW, ed. Physicians’ Desk Reference for Nonprescription Drugs. Montvale, NJ: Medical Economics, 1998, 790–1.
15. Lopez-Carrillo L, Avila M, Dubrow R. Chili pepper consumption and gastric cancer in Mexico: A case-control study. Amer J Epidem 1994;139(3):263–71.
16. 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.
17. 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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