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The capsicum family includes red peppers, bell peppers, pimento, and paprika, but the most famous medicinal member of this family is the common cayenne pepper.
Cayenne and related peppers have a long history of use as digestive aids in many parts of the world, but the herb's recent popularity has, surprisingly, come through conventional medicine.
What is the Scientific Evidence for Cayenne?
Oral Uses of Cayenne
In a double-blind, placebo-controlled study, 30 individuals with dyspepsia were given either 2.5 g daily of red pepper powder (divided up and taken prior to meals) or placebo for 5 weeks. 1 By the third week of treatment, individuals taking red pepper were experiencing significant improvements in pain, bloating, and nausea as compared to placebo, and these relative improvements lasted through the end of the study.
A placebo-controlled, crossover study failed to find benefit, but it only enrolled 11 participants, far too few to have much chance of identifying a treatment effect. 2
Topical Uses of Cayenne
All double-blind studies of topical capsaicin (or cayenne) suffer from one drawback: It isn’t really possible to hide the burning sensation that occurs during initial use of the treatment. For this reason, such studies probably aren’t truly double-blind. It has been suggested that instead of an inactive placebo, researchers should use some other substance (such as camphor) that causes at least mild burning. However, such treatments might also have therapeutic benefits; they have a long history of use for pain as well.
Because of these complications, the evidence for topical treatments cited below is less meaningful than it might at first appear.
Capsaicin cream is well established as a modestly helpful pain-relieving treatment for post-herpetic neuropathy (the pain that lingers after an attack of shingles), 3 peripheral neuropathy (nerve pain that occurs most commonly as a complication of diabetes , but may occur with HIV as well as other conditions), 4 pain after surgery for cancer surgery 5 6 7 or hernia repair, 8 and osteoarthritis . 9 Weaker evidence supports the use of topical capsaicin for fibromyalgia . 10 Capsaicin instilled into the nose may be helpful for cluster headache . 11 (The fact that this has even been considered a viable treatment option shows how painful cluster headaches can be!)
Actual cayenne rather than capsaicin has been tested for pain as well. A 3-week, double-blind trial of 154 individuals with back pain found that cayenne applied topically as a “plaster” improved pain to a greater extent than placebo. 12
A double-blind, placebo-controlled trial of nearly 200 individuals found that use of topical capsaicin can improve itching as well as overall severity of psoriasis . 13 Benefits were also seen in a smaller double-blind study of topical capsaicin for psoriasis. 14 Topical capsaicin is thought to be helpful for various itchy skin conditions, such as prurigo nodularis, but double-blind studies are lacking. 15 16
Intranasal Uses of Cayenne
One study of 208 patients with idiopathic rhinitis found that using a capsicum nasal spray 3 times daily for 3 days (4 mcg/puff) may reduce symptom frequency. 17
Capsaicin creams are approved over-the-counter drugs and should be used as directed. If the burning sensation that occurs with initial use is too severe, using weaker forms of the cream at first may be advisable.
For treatment of dyspepsia, cayenne may be taken at a dosage of 0.5 to 1.0 g three times daily (prior to meals).
- Bortolotti M, Coccia G, Grossi G, Miglioli M. The treatment of functional dyspepsia with red pepper. Aliment Pharmacol Ther. 16(6):1075-82.
- Rodriguez-Stanley S, Collings KL, Robinson M, Owen W, Miner PB Jr. The effects of capsaicin on reflux, gastric emptying and dyspepsia. Aliment Pharmacol Ther. 14(1):129-34.
- Watson CP, Evans RJ, Watt VR. Post-herpetic neuralgia and topical capsaicin. Pain.1988;33:333-340.
- McCleane G. Topical application of doxepin hydrochloride, capsaicin and a combination of both produces analgesia in chronic human neuropathic pain: a randomized, double-blind, placebo-controlled study. Br J Clin Pharmacol. 49(6):574-9.
- Ellison N, Loprinzi CL, Kugler J, Hatfield AK, Miser A, Sloan JA, Wender DB, Rowland KM, Molina R, Cascino TL, Vukov AM, Dhaliwal HS, Ghosh C. Phase III placebo-controlled trial of capsaicin cream in the management of surgical neuropathic pain in cancer patients. J Clin Oncol. 15(8):2974-80.
- Dini D, Bertelli G, Gozza A, Forno GG. Treatment of the post-mastectomy pain syndrome with topical capsaicin. Pain. 54(2):223-6.
- Watson CP, Evans RJ. The postmastectomy pain syndrome and topical capsaicin: a randomized trial. Pain. 51(3):375-9.
- Aasvang EK, Hansen JB, Malmstrøm J, Asmussen T, Gennevois D, Struys MM, Kehlet H. The effect of wound instillation of a novel purified capsaicin formulation on postherniotomy pain: a double-blind, randomized, placebo-controlled study. Anesth Analg. 107(1):282-91.
- Deal CL, Schnitzer TJ, Lipstein E, Seibold JR, Stevens RM, Levy MD, Albert D, Renold F. Treatment of arthritis with topical capsaicin: a double-blind trial. Clin Ther. 13(3):383-95.
- McCarty DJ, Csuka M, McCarthy, et al. Treatment of pain due to fibromyalgia with topical capsaicin: A pilot study. Semin Arthritis Rheum. 1994;23(suppl 3):41-47.
- Marks DR, Rapoport A, Padla D, Weeks R, Rosum R, Sheftell F, Arrowsmith F. A double-blind placebo-controlled trial of intranasal capsaicin for cluster headache. Cephalalgia. 13(2):114-6.
- Frerick H, Keitel W, Kuhn U, Schmidt S, Bredehorst A, Kuhlmann M. Topical treatment of chronic low back pain with a capsicum plaster. Pain. 106(1-2):59-64.
- Ellis CN, Berberian B, Sulica VI, Dodd WA, Jarratt MT, Katz HI, Prawer S, Krueger G, Rex IH Jr, Wolf JE. A double-blind evaluation of topical capsaicin in pruritic psoriasis. J Am Acad Dermatol. 29(3):438-42.
- Bernstein JE, Parish LC, Rapaport M, Rosenbaum MM, Roenigk HH Jr. Effects of topically applied capsaicin on moderate and severe psoriasis vulgaris. J Am Acad Dermatol. 15(3):504-7.
- Ständer S, Luger T, Metze D. Treatment of prurigo nodularis with topical capsaicin. J Am Acad Dermatol. 44(3):471-8.
- Reimann S, Luger T, Metze D. [Topical administration of capsaicin in dermatology for treatment of itching and pain] Hautarzt. 51(3):164-72.
- Ciabatti PG, D'Ascanio L. Intranasal Capsicum spray in idiopathic rhinitis: a randomized prospective application regimen trial. Acta Otolaryngol. 129(4):367-71.