Cayenne, the dried powder of red chile peppers, has for centuries been a folk treatment for arthritis and rheumatism. Just another unproven remedy?

To the contrary. Over the past five years, more than 1,300 scientific studies on cayenne’s most active ingredient, capsaicin, have been published in medical journals. Many of these studies have confirmed that cayenne and capsaicin do relieve arthritic symptoms and improve joint flexibility.

But that’s not all. Some of the “hottest research” shows that capsaicin also helps chronic neck pain, peptic ulcers, headaches, and even some heart problems.

Capsaicin Cream Helps in Arthritis

For years, herbalists assumed that cayenne and capsaicin worked by simply dilating blood vessels and increasing the supply of nutrients to injured joints. That may be an influence, but capsaicin actually works for a completely different reason.

Doctors know that people suffering from osteoarthritis typically have elevated levels of decapeptide substance P (DSP) in their blood and in the synovial fluid that bathes their joints. DSP has two undesirable functions. First, it breaks down the cartilage cushions in joints, contributing to osteoarthritis. Second, it serves as a pain neurotransmitter in both osteoarthritis and rheumatoid arthritis. In other words, if you have a lot of DSP, you feel a lot pain.

However, researchers have discovered that capsaicin – known to chemists as trans-8-methyl-N-vanillyl-6-nonenamide – inhibits the activity of DSP. A cream containing capsaicin, rubbed on the skin, penetrates to arthritic joints, where it stops the destruction of cartilage, relieves pain, and increases flexibility.

To assess the value of capsaicin cream, Roy Altman, M.D., of the University of Miami School of Medicine, conducted a double-blind study on 96 arthritic patients. The patients applied either a 0.025-percent capsaicin cream or a plain cream to their arthritic joints-most often the knees-four times daily.

Altman tracked the patients’ responses through precise measurements of physical movement and pain, as well as by the patients’ subjective feelings about whether they felt better or worse. Those who used the capsaicin cream had a clear reduction in pain after eight weeks. By the end of the study, four weeks later, 81 percent of the patients applying the capsaicin cream had significantly fewer arthritic symptoms, including less morning stiffness. In contrast, only 54 percent of those using the plain cream felt better – suggesting that simple massage might also be helpful.

As for side effects, about half of the patients complained about a localized burning sensation during the first few weeks of the study. After 12 weeks, only three patients said burning was still a problem.2

Thomas Schnitzer, M.D., Ph.D., of Chicago’s Rush-Presbyterian-St. Luke’s Medical Center, was concerned about “patient compliance”-whether people suffering with arthritis would consistently take the time to apply capsaicin cream four times daily. He wondered whether patients applying capsaicin cream twice daily would have as much pain relief as those using it four times daily.

So Schnitzer asked 48 patients with osteoarthritis of the hands to apply capsaicin cream four times daily for several weeks, then only twice daily for several more weeks. In general, he found that four applications daily brought fast pain relief, but over the long term, two applications daily were almost as good.

Twenty-six percent of the patients using capsaicin cream improved while applying the cream four times daily. When the patients dropped to only two applications daily, half initially experienced an increase in joint pain. But after several weeks of twice daily applications, almost all of these patients were as pain free as they were when they had applied capsaicin cream more often.

“Topical capsaicin relieves the pain associated with neuralgias, rheumatoid arthritis, and osteoarthritis, and is usually administered on a QID [4x/day] basis,” observed Schnitzer. “However, from the perspective of patient compliance, a QID regimen may not be optimal for long-term therapy.”3
Practical Tips for Arthritics

In Seminars in Arthritis and Rheumatism, Chad Deal, M.D., of the Case Western Reserve University School of Medicine, Cleveland, offered some practical tips for the use of capsaicin cream. He pointed out that two strengths of capsaicin cream are commonly sold, 0.025 percent and 0.075 percent. He suggested that patients use the higher strength cream only if they don’t benefit from the lower strength one.

“Patients should be instructed to apply a small amount of capsaicin cream to the skin covering the affected joint; for a knee joint, a pea-sized dab should be sufficient,” Deal wrote. “The cream should be dotted around the joint and gently massaged into the skin until no residue remains. The cream should be applied three to four times every day to obtain maximal benefit.”

“Relief occasionally occurs within a few days,” he added, “but it may take a week or two to achieve full effect….I am convinced that topical capsaicin has a significant role in the treatment of arthritis pain, and I encourage physicians to consider it an early therapeutic option for localized arthritis pain.”4

Capsaicin cream also relieves chronic neck pain. Physicians at the Walter Reed Army Medical Center, Washington, D.C., used a 0.025-percent capsaicin cream to treat 23 patients with chronic neck pain. The patients were instructed to apply the cream four times daily, and only one person dropped out of the study because of “intolerable” burning.

After five weeks, doctors asked the remaining 22 patients a number of questions, including: “If your pain returns and you were given a choice, would you choose to use the cream again in the future?” Seventy percent of the patients answered yes – they **would** {ITALICS} continue using the cream.5

Capsaicin for Treating Ulcers

People suffering from ulcers are usually warned to avoid spicy foods. But new research suggests that capsaicin the opposite – that capsaicin might actually protect against peptic ulcers.

A number of experiments over the years have found that capsaicin protects the gastric mucosal membrane against damage from alcohol and aspirin. Jin Y. Kang, M.D., of the National University of Singapore, recently speculated that capsaicin might work by stimulating a hormone that increases blood flow and nourishes the gastric mucosal membrane. He also suggested that capsaicin rather than spicy foods in general might be helpful.6

In an intriguing study, Kang noted that peptic ulcers were more common among Chinese than among Malay and Indian residents of Singapore. After ruling out race as an influence, Kang had a hunch that the high rate of ulcers among the Chinese was the result of their relatively low chile consumption.

So he carefully compared the chile-eating habits of 103 Chinese patients with peptic ulcers and 87 Chinese patients without ulcers. Kang discovered that ulcer-free patients ate 2.6 times more chile than those with ulcers. The ulcer-free patients also ate chile more often-24 times per month, compared with 8 times per month for those with ulcers.7

Several other capsaicin and cayenne studies are noteworthy.

Researchers from the Bristol-Myers Squibb Pharmaceutical Research Institute, Princeton, N.J., reported animal studies in which capsaicin reduced ventricular tachycardias and ventricular fibrillations, types of serious arrhythmias. Furthermore, capsaicin improved blood flow to the heart. Capsaicin seems to function in these roles as a natural calcium blocker, analogous to some prescription heart drugs.8

A nasal application of capsaicin greatly ameliorated symptoms among 52 patients suffering from cluster headaches. Seventy percent of the patients benefitted when the capsaicin was applied to the nostril on the same side as the headache. When capsaicin was applied to the opposite nostril, patients did not improve.9

In a study of 200 patients with psoriasis, application of a 0.025-percent capsaicin cream significantly reduced itching, scaling, thickness, and redness compared with patients who used a plain cream.10

Capsorbin, a carotenoid associated with capsaicin in cayenne, functions as an antioxidant that quenches singlet oxygen free radicals.11

Although there is some evidence that capsaicin is mutagenic, recent studies have found that capsaicin protects against some chemicals that cause cancer and mutations.12 In one study, researchers found that chlorophyll suppressed the mutagenic properties of capsaicin.13

Capsaicin is a remarkable health-promoting substance. But since burning and irritation are common side effects, it may be wise to start using it slowly and building up a tolerance for larger quantities.


  1. Challem JJ and Challem RL, What Herbs Are All About, Keats Publishing, New Canaan, CT, 1980.
  2. Altman RD, et al., “Capsaicin cream 0.025% as monotherapy for osteoarthritis: a double-blind study,” Seminars in Arthritis and Rheumatism, June 1994;23:Suppl 3:25-33.
  3. Schnitzer T, et al., “Topical capsaicin therapy for osteoarthritis pain: achieving a maintenance program,” Seminars in Arthritis and Rheumatism, June 1994;23:Supple 3:34-40.
  4. Deal CL, “The use of topical capsaicin in managing arthritis pain: a clinician’s perspective,” Seminars in Arthritis and Rheumatism, June 1994;23:Suppl 3:48-52.
  5. Mathias BJ, et al., “Topical Capsaicin for chronic neck pain,” American Journal of Physical Medicine & Rehabilitation, Jan./Feb. 1995;74:39-44.
  6. Kang JY, et al., “Effect of capsaicin and chilli on ethanol induced gastric mucosal injury in the rat,” Gut, May 1995;36:664-9.
  7. Kang JY, et al., “Chili-protective factor against peptic ulcer?” Digestive Diseases and Sciences,” March 1995;40:576-9.
  8. D’Alonzo AJ, et al., “In vitro effects of capsaicin: antiarrhythmic and antiischemic activity,” European Journal of Pharmacology, January 16, 1995;272:269-78.
  9. Fusco BM, et al., “Preventive effect of repeated nasal applications of capsaicin in cluster headache,” Pain, December 1994;59:321-5.
  10. Ellis CN, et al., “A double-blind evaluation of topical capsaicin in pruritic psoriasis,” Journal of the American Academy of Dermatology, Sept. 1993;29:438-42.
  11. Hirayama O, et al., “Singlet oxygen quenching ability of naturally occurring carotenoids,” Lipids, Feb. 1994;29:149-50.
  12. Surh YJ, et al., “Capsaicin, a double-edged sword: toxicity, metabolism, and chemopreventive potential,” Life Sciences, April 21, 1995;56:1845-55.
  13. Azizan A and Blevins RD, “Mutagenicity and antimutagenicity testing of six chemicals associated with the pungent properties of specific spices as revealed by the Ames Salmonella/microsomal assay,” Archives of Environmental Contamination & Toxicology,” Feb. 1995;28:248:58.