Cayenne's therapeutic uses

• DEFINITION: Natural plant product used to treat specific health conditions.
• PRINCIPAL PROPOSED USES:
• OTHER PROPOSED USES:

Overview

Cayenne and related peppers have a long history of use as digestive aids in many parts of the world, but the herb’s popularity came through conventional medicine. The capsicum family includes red peppers, bell peppers, pimento, and paprika, but this family's most famous medicinal member is the common cayenne pepper.

Requirements and Sources

Many people think that hot peppers cause tissue inflammation and that this is the source of the classic hot pepper sensation. However, hot peppers do not actually have any damaging effect; they merely simulate the sensations produced by damage. (Herbs such as garlic, ginger, horseradish, and mustard can actually cause tissue damage.)

Therapeutic Dosages

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. To treat dyspepsia, cayenne may be taken at a dosage of 0.5 to 1.0 gram (g) three times daily (before meals).

Therapeutic Uses

All hot peppers contain a substance called capsaicin. When applied to tissues, capsaicin causes the release of a chemical called substance P. Substance P is ordinarily released when tissues are damaged, and it is part of the system the body uses to detect injury. When hot peppers artificially elicit the release of substance P, they trick the nervous system into thinking that an injury has occurred. The result: a sensation of burning pain.

When capsaicin is applied regularly to a part of the body, substance P becomes depleted in that location. This is why individuals who consume a lot of hot peppers gradually build up a tolerance. It is also the basis for several medical uses of capsaicin. When levels of substance P are reduced in an area, all pain in that area is somewhat reduced. Because of this effect, capsaicin cream is widely used to treat various painful conditions.

Under the brand name Zostrix, a cream containing concentrated capsaicin was approved by the US Food and Drug Administration for the treatment of post-herpetic neuralgia, the pain that often lingers after an attack of shingles. There is also relatively good evidence that topical capsaicin can modestly decrease the pain of diabetic peripheral neuropathy, other forms of peripheral neuropathy nerve pain following cancer surgery, as well as the pain of arthritis. Capsaicin cream may also be helpful for other forms of pain, including musculoskeletal pain, fibromyalgia, back pain, and cluster headaches. However, the benefits seen with capsaicin are seldom dramatic. In many cases, other pain-relieving treatments are used simultaneously. Besides pain-related conditions, some evidence indicates that topical capsaicin may be helpful for psoriasis and possibly other skin conditions (especially those involving itching).

Cayenne can be taken internally as well. It appears that oral use of cayenne might reduce the pain of minor indigestion (dyspepsia). This may seem like an odd use of the herb; intuitively, it seems that hot peppers should be hard on the stomach. However, remember that hot peppers do not actually damage tissues; they merely produce sensations similar to those caused by actual damage. Apparently, by depleting substance P in the stomach, they reduce sensations of discomfort. In fact, some evidence suggests that oral use of cayenne or capsaicin can actually protect the stomach against ulcers caused by anti-inflammatory drugs. However, contrary to some reports, cayenne does not appear to be able to kill Helicobacter pylori, the stomach bacterium implicated as a major cause of ulcers. Additionally, it appears that, contrary to long-standing belief, hot peppers do not cause increased pain in people with hemorrhoids. Oral use of cayenne has also been studied for its efficacy in reducing the symptoms of inflammatory diseases, such as inflammatory bowel disease. Studies have shown cayenne may promote weight loss by contributing to feelings of satiety and boosting metabolism. Preliminary research suggests cayenne may benefit cardiovascular health by lowering blood pressure and cholesterol. Very early research suggests cayenne may also have anti-cancer properties. Further research and scientific study is needed to support these preliminary findings.

Scientific Evidence

Oral uses of cayenne. In a double-blind, placebo-controlled study, thirty individuals with dyspepsia were given either 2.5 g daily of red pepper powder (divided up and taken prior to meals) or a placebo for five weeks. By the third week of treatment, individuals taking red pepper were experiencing significant improvements in pain, bloating, and nausea compared with a placebo, and these relative improvements lasted through the end of the study. A placebo-controlled crossover study failed to find benefits, but it only enrolled eleven participants, which is far too few to have much chance of identifying a treatment effect. Studies on the oral uses of cayenne for weight management, cardiovascular health, and anti-cancer properties have also been undertaken and show promising results. However, additional scientific study is needed.

Topical uses of cayenne. Nearly all double-blind studies of topical capsaicin (or cayenne) suffer from one drawback—it is impossible to hide the burning sensation that occurs during the initial use of the treatment. For this reason, such studies probably are not truly double-blind. It has been suggested that researchers should use some other substance (such as camphor) that causes at least mild burning instead of an inactive placebo. 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 here is less meaningful than it might initially 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), peripheral neuropathy (nerve pain that occurs most commonly as a complication of diabetes but may occur with human immunodeficiency virus infection and other conditions), pain after surgery for cancer or hernia repair, and osteoarthritis. Weaker evidence supports the use of topical capsaicin for fibromyalgia. Capsaicin instilled into the nose may be helpful for cluster headaches.

Actual cayenne, rather than capsaicin, has been tested for pain as well. A three-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 a placebo.

A double-blind, placebo-controlled trial of nearly two hundred individuals found that topical capsaicin can improve itching and the overall severity of psoriasis. Benefits were also seen in a smaller double-blind study of topical capsaicin for psoriasis. Topical capsaicin is thought to be helpful for various itchy skin conditions, such as prurigo nodularis, but double-blind studies are lacking.

Intranasal uses of cayenne. One study of 208 patients with idiopathic rhinitis found that using a capsicum nasal spray three times daily for three days (4 micrograms per puff) may reduce symptom frequency.

Safety Issues

Capsaicin creams commonly cause an unpleasant burning sensation when first applied; this sensation disappears over subsequent days as treatment continues. Cayenne is generally recognized as a safe, commonly used food. Contrary to some reports, it does not appear to aggravate stomach ulcers.

Important Interactions

Cayenne might increase the amount of the asthma drug theophylline's absorption, possibly leading to toxic levels. However, it might also protect the stomach from damage caused by nonsteroidal anti-inflammatory drugs.

Bibliography

"Cayenne." Icahn School of Medicine at Mount Sinai, www.mountsinai.org/health-library/herb/cayenne. Accessed 16 Oct. 2024.

Bortolotti, M., et al. "The Treatment of Functional Dyspepsia with Red Pepper." Alimentary Pharmacology and Therapeutics, vol. 16, 2002, pp. 1075-1082.

Eduardo, J. "Capsaicinoids and Their Effects on Cancer: The 'Double-Edged Sword' Postulate from the Molecular Scale." Cells, vol. 12, no. 21, 2023, p. 2573, doi.org/10.3390/cells12212573. Accessed 16 Oct. 2024.

"Health Benefits of Cayenne Pepper." Cleveland Clinic, 30 Nov. 2021, health.clevelandclinic.org/cayenne-pepper-benefits. Accessed 20 Aug. 2023.

Janssens, Pilou L. H. R., et al. "Capsaicin Increases Sensation of Fullness in Energy Balance, and Decreases Desire to Eat after Dinner in Negative Energy Balance." Appetite, vol. 77, 2014, pp. 44-49, doi:10.1016/j.appet.2014.02.018. Accessed 16 Oct. 2024.

Kumar, Karthik. "What Cayenne Pepper Does to Your Body." MedicineNet, 2 May 2024, www.medicinenet.com/what‗cayenne‗pepper‗does‗to‗your‗body/article.htm. Accessed 16 Oct. 2024.

Ludy, Mary, et al. "The Effects of Capsaicin and Capsiate on Energy Balance: Critical Review and Meta-analyses of Studies in Humans." Chemical Senses, vol. 37, no. 2, 2012, pp. 103-121, doi.org/10.1093/chemse/bjr100. Accessed 16 Oct. 2024.

McCleane, G. "Topical Application of Doxepin Hydrochloride, Capsaicin, and a Combination of Both Produces Analgesia in Chronic Human Neuropathic Pain." British Journal of Clinical Pharmacology, vol. 49, 2000, pp. 574-579.

Petran, Elena Mihaela, et al. "Capsaicin: Emerging Pharmacological and Therapeutic Insights." Current Issues in Molecular Biology, vol. 46, no. 8, 2024, pp. 7895-7943, doi.org/10.3390/cimb46080468.

Rodriguez-Stanley, S., et al. "The Effects of Capsaicin on Reflux, Gastric Emptying, and Dyspepsia." Alimentary Pharmacology and Therapeutics, vol. 14, 2000, pp. 129-134.

Stander, S., T. Luger, and D. Metze. "Treatment of Prurigo Nodularis with Topical Capsaicin." Journal of the American Academy of Dermatology, vol. 44, 2001, pp. 471-478.

Todd, C. "Meeting the Therapeutic Challenge of the Patient with Osteoarthritis." Journal of the American Pharmaceutical Association, vol. 42, 2002, pp. 74-82.