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DrG's Medisense Feature Article

19061-Capsaicin Capsaicin, the Un-American, Natural, Pain-Relief Cream
by Ann Gerhardt, MD
June 2019
Print Version

Bottom line at the top:  Use capsaicin cream CORRECTLY to alleviate muscle, joint and mild neuropathic pain, while avoiding the side effects of oral medication.

Here’s how humans generally approach medication – Take it only as long as a discomfort requires it and expect it to cure almost immediately.  That especially applies to pain relievers, since happiness and productivity suffer along with you until the pain is gone.  Many people also believe that ‘natural’ remedies are better than prescription medications. 

Capsaicin (the ‘hot’ in chili peppers), salicylic acid (aspirin) and opium are ‘natural’ pain relievers.  Only opiates satisfy the ‘immediate’ criterion, but incur potential addictive, social and legal side effects.  Aspirin, viewed by many as too blasé for their pain, has less potency, slightly slower onset and the not-so-painless risk of kidney failure and bleeding ulcer.

The tongue and any human tissues that capsaicin touches feel burned, making it a great bear-repellant and self-defense pepper-spray.  As such, it’s counter-intuitive that capsaicin cream could be a good pain remedy.  But it is... if used correctly.

At extremely low concentrations, a 0.025% or 0.1% capsaicin cream relieves minor musculoskeletal pain from arthritis, muscle injury and sprains.  Higher doses may help various neuropathies. 

It works by first stimulating, then inactivating sensory pain nerves’ ability to perceive pain.  An internet search tells us that it depletes pain-inducing Substance P, but that is not the primary mechanism by which capsaicin works.

Here’s where capsaicin defies the human requirement for immediate benefit and the all-American maxim of ‘more is better.’  It requires repeated, low doses over a relatively long time to alleviate pain. 

This just makes sense, when we consider people who love and don’t even register the burn of the hottest Carolina Reaper or ghost peppers.  Their lifetime of eating hot chili peppers shuts down oral pain nerves.  On the other hand, my uninitiated grandson will scream and swear he’s dying from three bites of his first moderately spicy pizza. 

Even at low concentration, too much capsaicin cream reddens and blisters skin.  This is not due to direct toxic injury, but rather the body’s inflammatory response to an injury the brain assumes we have because nerves tell it they feel pain. Once we blame the cream for painful blisters, only masochists would continue to use it.  A medication not taken doesn’t have a chance of working.

With a little patience it’s possible to achieve sustained pain relief.  Used three times daily for about two weeks should work.  After that once or twice daily application will sustain the effect. 

Be careful, though:  Use gloves so your eyes don’t burn later when you touch them.  Apply an almost invisibly thin smear over the painful area daily.  Apply only to unbroken skin. 

The cream might also help the pain of diabetic or HIV neuropathy and post-herpetic (shingles) neuralgia.  If not, relieving those pains might take a prescription patch with a specialized delivery system, which must be applied by a healthcare professional.