Native Americans have used cayenne (Capsicum annuum or frutescens, or red pepper) as both food and medicine for at least 9,000 years. The hot and spicy taste of cayenne pepper is primarily due to a substance known as capsaicin, which has pain-relieving qualities. Cayenne has been used orally and topically for medicinal purposes.

Cayenne pepper is an important spice, particularly in Cajun and Creole cooking, and in the cuisines of Southeast Asia, China, Southern Italy, and Mexico. Cayenne has also been used in traditional Indian Ayurvedic, Chinese, Japanese, and Korean medicines as an oral remedy for digestive problems, poor appetite, and circulatory problems. It has also been used as a topical remedy for arthritis and muscle pain. Today, topical preparations of capsaicin are used in the United States and Europe primarily to relieve pain associated with conditions such as arthritis and shingles (Herpes zoster). Capsaicin is also a key ingredient in many personal defense sprays.

Pain control

Capsaicin has very powerful pain-relieving properties when applied to the surface of the skin. It is a counterirritant that temporarily reduces substance P, a chemical that carries pain messages to the brain. When substance P is depleted, the pain messages no longer reach the brain, and the person feels relief. Capsaicin is often recommended for topical application for the following conditions:

Pain

• Osteoarthritis and rheumatoid arthritis, as well as joint or muscle pain from fibromyalgia or other causes
• Nerve pain from shingles and other painful skin conditions (postherpetic neuralgia) that recurs even after the skin blisters have disappeared. Not all studies agree, and the research is limited. Results may depend on the individual. Check with your doctor to see if trying this topical treatment is right for you.
• Postsurgical pain, following, for example, a mastectomy (breast removal for breast cancer) or pain after an amputation
• Pain from peripheral neuropathy (nerve damage experienced in the feet or legs) due to diabetes. However, capsaicin appears ineffective for peripheral neuropathy pain from HIV.
• Low back pain: Homeopathic gels of capsaicin are available for low back pain, but they are not generally considered a first-line remedy because other homeopathic remedies have fewer side effects.

Psoriasis

Capsaicin cream can reduce itching and inflammation associated with psoriasis (a chronic skin disease that generally appears as patches of raised red skin covered by a flaky white buildup).

Weight loss

Some animal and human studies show that taking capsaicin orally may increase the body's production of heat for a short time. It may also help to regulate blood sugar levels by affecting the breakdown of carbohydrates after a meal. Based on these studies, capsaicin is being investigated to see if it would be useful in treating obesity. These studies, however, are still ongoing.

Cluster headaches

Administering capsaicin via the nose seems to help relieve cluster headaches (a severe one-sided headache that tends to occur in clusters, happening repeatedly every day at the same time for possibly several weeks). Such treatment should only be done by a health care professional.

Other uses

• As a homeopathic remedy, capsaicin may help treat ear infections (otitis media).
• Some evidence suggests capsaicin may help treat heartburn, but several people in the study stopped taking capsaicin because of abdominal discomfort.
• Capsaicin is being investigated for treating circulatory problems (for example, heart disease from atherosclerosis or plaque blocking the arteries to the heart) and reducing risk of an irregular heart rhythm.

Cayenne is a shrub that originated in Central and South America and now grows in subtropical and tropical climates. Its hollow fruit grows into long pods that turn red, orange, or yellow when they ripen. The fruit is eaten raw or cooked, or is dried and powdered into the spice that has been used for centuries in meals and medicines.

Capsaicin is the most active ingredient in cayenne, but other important ingredients include vitamins A and C, and flavonoids and carotenoids (plant pigments with antioxidant properties).

As a spice, cayenne may be eaten raw or cooked. Dried cayenne pepper is available in powdered form, and may be added to food, stirred into juice, tea, or milk. It is also available in capsule form or in creams for external use (should contain at least 0.075% capsaicin).

Topical capsaicin should not be applied to cracked skin or open wounds.

Pediatric

Cayenne should not be given to children under 2 years of age. However, cayenne may be used topically with caution in older children as an ointment. Topical cayenne ointments should not be used for more than 2 consecutive days in children.

Adult

For shingles, psoriasis, arthritis, or muscle pain: Capsaicin cream (0.025 - 0.075% capsaicin) may be applied directly to the affected area up to four times a day. Because cayenne works by first stimulating and then decreasing the intensity of pain in the body, the pain may increase slightly at first, but then should diminish greatly over the next few days. Capsaicin should be applied regularly several times a day. It usually takes 3 - 7 days before noticeable pain relief begins.

For digestive problems: Capsaicin may be taken in capsules (30 - 120 mg, three times daily).

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, herbs should be taken with care, under the supervision of a health care provider.

Cayenne does not dissolve easily in water, so use vinegar to remove this substance from the skin. Capsaicin cream may cause an itching, burning sensation on the skin, but these symptoms tend to go away quickly. Test capsaicin cream on a small area of the skin before extended use. If it causes irritation, or if symptoms do not improve after 2 - 4 weeks, discontinue use. Do not use capsaicin with a heating pad, and do not apply capsaicin cream immediately before or after hot showers. Wash hands well after use, and avoid touching your eyes.

Capsaicin capsules may cause stomach irritation. People with ulcers or heartburn should talk to their health care provider before using capsaicin.

People who are allergic to latex, bananas, kiwi, chestnuts, and avocado may also have an allergy to cayenne.

Eating cayenne as a spice is considered safe during pregnancy, but pregnant women should avoid taking cayenne as a supplement. Cayenne does pass into breast milk, so nursing mothers should avoid cayenne both as a spice and a supplement.

If you are currently being treated with any of the following medications, you should not use cayenne preparations without first talking to your health care provider.

ACE inhibitors -- Using capsaicin cream on the skin may increase the risk of cough associated with ACE inhibitors. These are medications used to regulate blood pressure, including captopril, enalapril, and lisinopril. People who take ACE inhibitors should talk to their doctor before taking cayenne.

Stomach acid reducers -- Capsaicin can cause an increase in stomach acid, lessening the effect of drugs such as cimetidine (Tagamet), famotidine (Pepcid), ranitidine (Zantac), omeprazole (Prilosec), and esomeprazole (Nexium). The same is true of over-the-counter drugs such as Maalox, Rolaids, Tums, and nonprescription versions of Tagamet, Pepcid, Zantac, and Prilosec.

Aspirin -- Capsaicin may decrease the effectiveness of aspirin to relieve pain, and may increase the risk of bleeding associated with aspirin.

Blood-thinning medications and herbs -- Capsaicin may increase the risk of bleeding associated with certain blood-thinning medications (such as warfarin and heparin) and herbs (such as ginkgo, ginger, ginseng, and garlic).

Theophylline -- Regular use of cayenne may increase the absorption of theophylline, a medication used to treat asthma, to toxic levels.

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