Capsaicin Cream For Pain Relief?

'Another Independent Investigation To Help You Get Better Pain Relief'

Capsaicin – a compound found in chilli peppers has been linked with delivering pain relief. As a result, as well as purchasing capsaicin cream for pain relief, you can now find it in a wide range of gels and patches. But does capsaicin really work? Is capsaicin a pain relief fact or a pain relief myth?

We try to pull the pepper from the seed and work out the true benefit of our spicy little friend…

Capsaicin is a chemical compound found in a range of spicy peppers including jalapeño peppers, cayenne peppers, and other chili peppers. 

It is actually the spicy substance that gives such peppers their ‘kick’.

It was traditionally used in pain relief because the compound that creates the spicy ‘kick’ was also thought to provide something of a numbing effect.

More modern thinking suggests it ight work through what is known as ‘gate theory’– in other words it affects the communication of pain signals direct to the brain. By sending unusual signals to the brain, it blocks some of the pain signals, not allowing them to be read and transmitted.

And as we discussed in a different section on how a TENS machine works, if you can block the pain signals to the brain, then less signals equals less pain.

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Where Is The Evidence Behind Using Capsaicin Cream For Pain Relief?

Perhaps one of the most conclusive reviews into the benefits of capsaicin cream for pain relief was published in 2011 by The British Society For Rheumatology (De Silva et al).

This review noted that across five separate trials on patients with hand and knee osteoarthritis, that capsaicin, administered on those occasions as a gel, was significantly more effective for pain relief than the placebo (an identical gel with nothing in it).

Indeed, it was further measured that there was over a 50% drop in pain reported with capsaicin usage.

How it works however is somewhat less clear. Without going into technical detail, capsaicin has it’s own receptor, the affectionately named ‘transient receptor potential vanilloid subfamily member 1’ (TRPV1).

It is when capsaicin enters your bloodstream that it activates it’s TRPV1 receptors (O’Neill et al), which is thought to stimulate ‘substance P’. Substance P (and other pain messengers) help to transmit pain signals to the brain.

By stimulating it’s production, your body ends up depleting local stores of Substance P, meaning the local nerve fibres transmit less pain signals.

Fewer pain transmissions ends up with less reaching the brain and ultimately less pain being felt (Harvard Health Publishing). 

There is still some dispute over this though – as other studies note the depletion of Substance P as being purely circumstantial. Instead Anand et al, put the reason for capsaicins pain relieving properties down to a process of ‘defunctionalization’ of nociceptor fibres.

“Defunctionalization is due to a number of effects that include temporary loss of membrane potential, inability to transport neurotrophic factors leading to altered phenotype, and reversible retraction of epidermal and dermal nerve fibre terminals”.

Ok, great – but all you really need to know (unless you are an academic reading this), is that it works and there is evidence to support it.

However, not all the results are entirely positive. Another study in 2014 (often cited for showing capsaicin works) actually also reported 43% of people taking capsaicin as suffering some form of side effect.

This not only showed that for a cream or gel that should have relatively few systemic side effects, it still has a high potential for burns/ skin reactions, but also that it was only as effective as topical clonidine with more side effects (Kiani et al).

In summary of the evidence, there is a definitive link between capsaicin use and pain relief. Whether a cream or gel is used, there is significant evidence to suggest it works.

However, capsaicin only works for pain relief in the short term. It does not directly treat the source of our pain, so is likely to return. As a result, the regular regime is to apply it approx. 4 times a day (please read the manufacturers label for the exact amount) to maintain some form of relief.

Capsaicin can be used in conjunction with other pain relief treatments (including various drugs), so it is worth considering trying this alongside others.

Side Effects

We touched on the potential of capsaicin to cause side effects, even though it is thought not to be systemically harmful.
These side effects will occur very shortly after application and include –

  • Itching
  • Redness
  • Pain
  • Dry Skin
  • Inflammation
  • A Burning Sensation
  • Hypersensitivity

In most cases, any reaction is relatively minor and likely to clear up following a number of uses.

As with all side effects, if they do not do away of if they actually get worse, then you should stop using the product and get to a doctor as soon as possible.

Similarly we need to note that due to capsaicin’s use on the skin, using warm/ hot water or exposing a reaction to hot weather may also make it worse.

Sunscreen should be used every time you go outside in the warmth with capsaicin on.

Heart Warnings – If you suffer with cardiovascular issues or high blood pressure, then you should consult your doctor as using capsaicin patches have been known on rare occasions to cause changes in blood pressure or heart rates.

And finally under side effects, we should point out that improper use, either via inhaling or applying internally (or in your eyes) is very likely to have serious consequences.

You should get to a hospital immediately if this happens.

Typical Reasons To Use Capsaicin Cream For Pain Relief

Arthritis.

Arthritis is probably the number one reason you might us capsaicin cream for pain relief.

This includes all of the very common versions – osteoarthritis and rheumatoid arthritis, as well as the less common fibromyalgia.

It is unclear as to whether it might work in Gout patients, although theoretically it is possible, albeit without treating the gout itself.

Back/ Shoulder Pain.

There is limited research directly into back pain and capsaicin, although it is thought that is would be effective. There has been some research published in the International Journal of Pain Management that showed some improvement, but that was with a patch and showed improvement in 40% of cases. 

Other Muscle Pain.

Capsaicin cream has been again proven here to be effective when treating deep muscular pain. Capsaicin can also been given as an injection which can further help when your problem is a hypersensitivity to pain (hyperalgesia).

Migraines.

The reasons why this might work can be somewhat confusing, but it is reported as a possible treatment for migraine pain.

Diabetic Neuropathy.

This is nerve damage that has been caused by the symptoms of diabetes. Capsaicin has been tested with patients suffering from diabetic neuropathy and has been proven to help with pain relief.

Obesity, Cancer A Host Of Other Conditions.

Capsaicin itself has now been linked with actually treating a host of other problems from obesity to some GI disorders through even to cancer.

However, much more research needs to be done before it could be recommended for any of these.

How To Use Capsaicin Cream

Typically, capsaicin cream should be applied 3 to 4 times a day. It is a short term pain reliever and so needs regular topping up to achieve some sort of continuous pain relief.

Always read the label on your cream though, as recommended doses may vary according to concentrations of capsaicin in the cream.

Migraines/ Headaches.

Apply directly to the scalp 3-4 times a day (or label guidance).

Make sure you do not get it in your eyes, ears or nose.

Arthritis Or Painful Joints

Apply directly to the painfully affected joints.

Diabetic Neuropathy

This is the only slightly less than obvious application. Here it really depends on where is affected. Depending on the location, you should apply the cream below your ankles or above your wrists.

General Advice…

Make sure you rub the cream fully into your skin, but never into any open wounds or rashes. Make sure you read the instructions and always consult a doctor if you are on other medications.

Also be very careful to make sure you do not spread the capsaicin cream anywhere else. Many people apply it with tough rubber gloves as contact with children or pets is not advised and maybe transferred through your hands.

Similarly if you are putting this on your feet – make sure you rub it all in and wear socks/ slippers to avoid some getting on the floor and transferring to others that way.

Patches Or Creams?

It is difficult to answer this conclusively. One review in 2017 (in the Cochrane Database Of Systematic Reviews) concluded that an especially concentrated patch (8% capsaicin) saw only a small number of patients with big improvements to pain levels.

This would seem less than a lot of the data behind creams with a much lower concentration of capsaicin (although it is impossible to compare from a clinical standpoint).

Ultimately, it probably comes down to what suits you best. Creams should be more targeted and are likely to get in to the bloodstream faster, but if time/ convenience is a factor, then a patch may be much more appropriate.

Different Versions of Capsaicin

As with most creams/ gels and patches, there are numerous different strengths and potencies available.

In the case of capsaicin, the highest strength you are likely to find without presription is approximately 0.1%. Products with this level are likely to be labelled as ‘high potency’.

There are numerous versions available from local pharmacies and online retailers with varying degrees of strength – Papzasin P is one easy to order cream with 0.1 topical analgesic, available from Amazon.

For a medium strength formulation, ‘Zostrix Maximum Strength’ is one highly established option at 0.075, while it’s compatriot ‘Zostrix’ is a weaker alternative still as 0.033.

Remember – it is always best to use the least amount of pain relief, titrating down to lower doses if you can to slow down any tolerance being built.

The Final Word –

Capsaicin cream for pain relief go hand in hand. Much of the data supports this supposition, but do not get caught in to thinking that just because it comes in creams, gels or patches, it is not potent.

That sort of assumption could not be further from the truth.
However, if you are sensible with it’s use and follow the guidance above, it turns out our spicy little pepper can provide a very useful pain reliever.

I have heard mixed reactions in the past to capsaicin cream – some loving it and others not likely the burning/ tingling sensation that is common when you apply it.

I would have no problem in proposing as one option, capsaicin cream for pain relief, although (as always) this is generic advice and cannot take the place of personalised medical advice from your own doctor (as per our disclaimer).

Capsaicin cream or patches is readily available at numerous stores and is by no means a ‘new’ treatment on the market – but it may well be one worth considering.

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References –

1. Vijitha De Silva, Ashraf El-Metwally, Edzard Ernst, George Lewith, Gary J. Macfarlane. (May 2011). Evidence for the efficacy of complementary and alternative medicines in the management of osteoarthritis: a systematic review. British Society For Rheumatology.

2. Jessica O’Neill, Christina Brock, Anne Estrup Olesen, Trine Andresen, Matias Nilsson, and Anthony H. Dickenson. (Oct 2012) Unravelling the Mystery of Capsaicin: A Tool to Understand and Treat Pain. Pharmacological Reviews.

3. Celeste Robb-Nicholson, M.D. (Oct 2011) Ask the doctor: How does hot pepper cream work to relieve pain? Harvard Health Publishing

4. P. Anand and K. Bley. (Aug 2011). Topical capsaicin for pain management: therapeutic potential and mechanisms of action of the new high-concentration capsaicin 8% patch. British Journal of Anaesthesia.

5. Javad Kiani, Firuzeh Sajedi, Saman Ahmad Nasrollahi, and Farzaneh Esna-Ashari. (April 2015). A randomized clinical trial of efficacy and safety of the topical clonidine and capsaicin in the treatment of painful diabetic neuropathy. Journal Of Research In Medical Sciences.

6. Julian Prosenz, Stefan Neuwersch, Herwig Kloimstein, Rudolf Likar, B. Gustorff. First Lumbar Treatment of Chronic Mixed Low Back Pain with High Dose Capsaicin 8% Patch. International Journal of Pain Management

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