Capsaicin is an extract of cayenne pepper that may ease many types of chronic pain when applied regularly to the skin. In animal studies, capsaicin was consistently effective at reducing pain when given by mouth, by injection, or when applied topically.^19,20 A controlled trial in humans found that application of a solution of capsaicin (0.075%) decreased sensitivity of skin to all noxious stimuli.²¹ One review article deemed the research on capsaicin’s pain-relieving properties “inconclusive.”²² However, in several uncontrolled and at least five controlled clinical trials, capsaicin has been consistently shown to decrease the pain of many disorders, including trigeminal neuralgia, shingles, diabetic neuropathy, osteoarthritis, and cluster headaches.^{23,24,25,26,27} For treatment of chronic pain, capsaicin ointment or cream (standardized to 0.025 to 0.075% capsaicin) is typically applied to the painful area four times per day.²⁸ It is common to experience stinging and burning at the site of application, especially for the first week of treatment; avoid getting it in the eyes, mouth, or open sores.

Substance P is a nerve chemical involved in pain transmission that may cause some of the symptoms of cluster headache.^29,30 Capsaicin, a constituent of cayenne pepper, can reduce the levels of substance P in nerves.³¹ Preliminary clinical trials investigating the use of intranasal capsaicin for the prevention and treatment of cluster headaches report significant decreases in the number of cluster episodes in some of the participants.³² The decreases usually lasted no more than 40 days after the end of treatment,³³ although a few patients have experienced relief for up to two years.³⁴ In a double-blind study, patients who received capsaicin intranasally twice daily for seven days during a cluster episode had a significant reduction in pain for the following 15 days.³⁵ As capsaicin can cause burning and irritation, this treatment should be utilized only under the supervision of a qualified doctor.

Topical cayenne pepper has been used for centuries to reduce pain, and more recently, to diminish localized pain for a number of conditions,³⁶ including chronic pain,³⁷ although low back pain has not been specifically investigated. Cayenne creams typically contain 0.025–0.075% capsaicin.³⁸ While cayenne cream causes a burning sensation the first few times used, this decreases with each application. Pain relief is also enhanced with use as substance P, the compound that induces pain, is depleted.³⁹ To avoid contamination of the mouth, nose, or eyes, hands should be thoroughly washed after use or gloves should be worn. Do not apply cayenne cream to broken skin.

There is preliminary evidence that capsaicin, the active constituent of cayenne, can be applied inside the nose as a treatment for acute migraine.⁴⁰ However, as intranasal application of capsaicin produces a burning sensation, it should be used only under the supervision of a doctor familiar with its use.

A cream containing small amounts of capsaicin, a substance found in cayenne pepper, can help relieve pain when rubbed onto arthritic joints, according to the results of a double-blind trial.⁴⁶ Capsaicin achieves this effect by depleting nerves of a pain-mediating neurotransmitter called substance P. Although application of capsaicin cream initially causes a burning feeling, the burning lessens with each application and disappears for most people in a few days. Creams containing 0.025–0.075% of capsaicin are available and may be applied to the affected joints three to five times a day. A doctor should supervise this treatment.

Topical cayenne pepper has been used for centuries to reduce pain, and more recently, to diminish localized pain for a number of conditions,⁴⁷ including chronic pain,⁴⁸ although low back pain has not been specifically investigated. Cayenne creams typically contain 0.025–0.075% capsaicin.⁴⁹ While cayenne cream causes a burning sensation the first few times used, this decreases with each application. Pain relief is also enhanced with use as substance P, the compound that induces pain, is depleted.⁵⁰ To avoid contamination of the mouth, nose, or eyes, hands should be thoroughly washed after use or gloves should be worn. Do not apply cayenne cream to broken skin.

While there have been few studies on herbal therapy for bursitis, most practitioners would consider using anti-inflammatory herbs that have proven useful in conditions such as rheumatoid arthritis. These would include boswellia, turmeric, willow, and topical cayenne ointment.

Cayenne contains a resinous and pungent substance known as capsaicin. This chemical relieves pain and itching by depleting certain neurotransmitters from sensory nerves. In a double-blind trial, application of a capsaicin cream to the skin relieved both the itching and the skin lesions in people with psoriasis.⁵¹ Creams containing 0.025 to 0.075% capsaicin are generally used. There may be a burning sensation the first several times the cream is applied, but this usually become less pronounced with each use. The hands must be carefully and thoroughly washed after use, or gloves should be worn, to prevent the cream from accidentally reaching the eyes, nose, or mouth and causing a burning sensation. The cream should not be applied to areas of broken skin.