Chili pepper: benefits, dosage, contraindications
Other name(s)
capsaicin
Scientific name(s)
Capsicum annuum
Family or group:
Plants
Active ingredients:
Capsaicin
Indications
Scoring methodology
EFSA approval.
Diabetic neuropathy ✪✪✪✪✪
Clinical studies have validated the efficacy of capsaicin, the main active component of chili peppers, in the treatment of diabetic neuropathy and other forms of neuropathy. A notable approach is the use of a specific patch containing 8% capsaicin (Qutenza, NeurogesX Inc.). nnThe European Medicines Agency (EMA) has approved the 8% capsaicin patch (trade name Qutenza) for the treatment of peripheral neuropathic pain in non-diabetic adults, either as monotherapy or in combination with other analgesic medications. A single application of this patch to the painful areas of the feet for 30 to 90 minutes, after pretreatment with topical anesthetics, reduces pain for up to 12 weeks compared with placebo, significantly improving sleep quality and reducing pain by 28% versus 21% with placebo.nnCapsaicin, used as a 0.075% cream four times a day, has been studied in several clinical trials for its effectiveness in treating neuropathies, notably diabetic neuropathy. In a significant study, 277 patients with diabetic neuropathy applied this cream or a placebo for 8 weeks. The results showed greater improvement with capsaicin: 69% of treated patients reported pain improvement compared with 53% in the placebo group. nnA meta-analysis indicates that this formulation is as effective as the medicated 5% lidocaine patch for reducing pain. Another study compared capsaicin cream to amitriptyline in 235 patients, revealing a similar reduction in pain intensity in both groups. nnHowever, less frequent use (fewer than four times per day) or lower concentrations of capsaicin appear to be less beneficial. nn
Posologie
Topical
0.3 - 8%
8 - weeks
patch, cream
Qutenza capsaicin
Capsaicin 8% Patch Versus Oral Neuropathic Pain Medications for the Treatment of Painful Diabetic Peripheral Neuropathy: A Systematic Literature Review and Network Meta-analysis
0.075% capsaicin lotion for the treatment of painful diabetic neuropathy: A randomized, double-blind, crossover, placebo-controlled trial
5% lidocaine medicated plaster in painful diabetic peripheral neuropathy (DPN): a systematic review
0.025% capsaicin gel for the treatment of painful diabetic neuropathy: a randomized, double-blind, crossover, placebo-controlled trial
Capsaicin 8% Patch for Spinal Cord Injury Focal Neuropathic Pain, a Randomized Controlled Trial
Topical capsaicin (high concentration) for chronic neuropathic pain in adults
E/S/C/O/P: 2nd Edition of the ESCOP Monographs
Treatment of painful diabetic neuropathy with capsaicin 0.075%
Joint pain ✪✪✪✪✪
Capsaicin, applied as a cream or patch, is widely recognized for its effectiveness in treating joint pain, including osteoarthritis and rheumatoid arthritis. Several clinical studies have demonstrated its significant analgesic potential. A randomized double-blind study involved 70 patients with osteoarthritis and 31 with rheumatoid arthritis, treated with a 0.025% capsaicin cream for four weeks. Results showed significant reductions in pain, superior to placebo, with improvement observed as early as the second week of treatment. In particular, for osteoarthritis the pain reduction was 33%, and for rheumatoid arthritis it was 57%. Meta-analyses have consolidated these findings, highlighting a favorable response in the treatment of osteoarthritis with a 0.025% capsaicin cream. In a study involving 113 patients with osteoarthritis of the knees, ankles, elbows, wrists, or shoulders, 81% of treated patients showed notable improvement versus 54% on placebo after twelve weeks of treatment. The effectiveness of capsaicin has also been demonstrated in studies on musculoskeletal pain, where a 0.025% cream showed significant advantages over placebo. For example, a clinical study of patients with acute pain related to trauma shows that topical application of a gel containing 0.05% capsaicin three times a day for three days reduces pain by at least 50% in 87% of patients, compared with 63% of those using a 0.5% piroxicam gel. The number of patients whose final pain score was less than or equal to 4 was also significantly higher. In the capsaicin group, only 12% of patients met none of these criteria, compared with 31% in the piroxicam group. In summary, capsaicin, well tolerated and effective, could be a promising therapeutic option for a variety of joint and musculoskeletal pain conditions.
Posologie
Topical (cutaneous)
0.025 - 0.05 %
4 weeks
patch, cream
Effectiveness and safety of topical capsaicin cream in the treatment of chronic soft tissue pain
Neuromodulators for pain management in rheumatoid arthritis
Comparison of topical capsaicin and topical piroxicam in the treatment of acute trauma-induced pain: A randomized double-blind trial
E/S/C/O/P: 2nd Edition of the ESCOP Monographs
Dietary Ingredients as an Alternative Approach for Mitigating Chronic Musculoskeletal Pain: Evidence-Based Recommendations for Practice and Research in the Military
Low back pain ✪✪✪✪✪
In the treatment of low back pain, topical use of capsaicin, extracted from capsicum, shows positive results. Patches containing 11 mg of capsaicin significantly reduce pain when applied each morning for 4 to 8 hours. In addition, a 0.05% capsaicin cream applied three times a day for 21 days reduces low back pain by 58% compared with placebo. A study also found that capsaicin combined with diclofenac modestly reduces back pain, with comparable effects when used alone. These results support the use of capsaicin as a therapeutic option for back pain.
Posologie
Topical (cutaneous)
0.05 %
patch, cream
Herbal medicine for low back pain: a Cochrane review
Efficacy and Safety of Diclofenac + Capsaicin Gel in Patients with Acute Back/Neck Pain: A Multicenter Randomized Controlled Study
Topical treatment of chronic low back pain with a capsicum plaster
Itching, Psoriasis ✪✪✪✪✪
Clinical studies have shown that capsaicin-containing creams are effective in treating various skin conditions, including psoriasis accompanied by itching. The application of a cream containing 0.025% capsaicin four times a day for six weeks resulted in a significant improvement in psoriasis severity scores and a notable reduction in itching compared with placebo. The itch-reducing effects of capsaicin are also observed in the treatment of aquagenic pruritus and anal pruritus. Patients treated with capsaicin creams reported substantial itch relief, often with an initial burning sensation that diminishes over time. Studies suggest that capsaicin reduces itching by depleting neuropeptides from cutaneous nerve fibers, disrupting the transmission of itch signals. Capsaicin has also shown beneficial effects against severe prurigo nodularis and other inflammatory skin diseases, providing itch relief during continuous treatment. However, symptoms may recur after treatment cessation, suggesting a potential need for ongoing application to maintain benefits.
Posologie
Topical
0.025%
patch, cream
Arthritis, Osteoarthritis ✪✪✪✪✪
The effectiveness of capsaicin in the treatment of joint pain, particularly osteoarthritis, is well documented by several clinical studies. The use of creams containing 0.025% to 0.075% capsaicin has been shown to be temporarily effective in relieving chronic pain related to conditions such as osteoarthritis and rheumatoid arthritis. Randomized controlled trials demonstrate that topical application of capsaicin can significantly reduce pain in patients with knee or hand osteoarthritis. For example, one study involved 70 patients with osteoarthritis who received a 0.025% capsaicin cream for four weeks. The results showed a significant reduction in pain measured by visual analog scales (VAS) and an improvement according to physicians' global assessment, with effectiveness superior to placebo for osteoarthritis (p = 0.033) and rheumatoid arthritis (p = 0.003). In addition, a meta-analysis of the studies showed that 0.075% capsaicin is beneficial for treating musculoskeletal pain, with a notable relative benefit compared with placebo. Furthermore, another study of 113 patients with osteoarthritis observed that application of 0.025% capsaicin to the affected areas for 12 weeks resulted in a greater reduction in pain severity compared with placebo, with significant effects from the fourth week that were maintained through the twelfth week. These results suggest that capsaicin, when used topically, offers an effective and well-tolerated treatment option for osteoarthritis-related pain, supporting its inclusion among treatments recommended by bodies such as the American College of Rheumatology, while noting certain limitations regarding its use for hip osteoarthritis because of the depth of the joint beneath the skin surface.
Posologie
Topical (cutaneous)
0.025 - 0.075 %
patch, cream
Obesity ✪✪✪✪✪
Capsicum, commonly used in the form of chili pepper, is being studied for its potential effects on weight management.nnRecent research, including a comprehensive meta-analysis, highlights the potential role of capsaicinoids, extracts from chili peppers, in reducing energy intake. The systematic analysis of various studies suggests that prior ingestion of capsaicinoids may decrease caloric intake by 74 kcal per meal. This finding underscores their potential in weight management strategies, particularly for those seeking to reduce their caloric intake naturally. It is important to note that to obtain these beneficial effects, a minimum of 2 mg of capsaicinoids is required. nnIn a clinical trial, daily intake of capsinoids at 3 mg twice a day, 30 minutes before meals for 12 weeks, reduced abdominal fat by about 1%, without a significant reduction in total body weight. Additionally, another study in overweight individuals showed that a specific 200 mg chili extract, combined with fenugreek dietary fibers for sustained release, administered to provide 4 mg of capsaicinoids per day for 28 days, reduced body weight and BMI by about 2%, with no impact on blood pressure.nn
Posologie
Oral route
2 - 6 mg
standardized extract
Could capsaicinoids help to support weight management? A systematic review and meta-analysis of energy intake data
Influence of a Novel Food-Grade Formulation of Red Chili Extract (Capsicum annum) on Overweight Subjects: Randomized, Double-Blinded, Placebo-Controlled Study
Sports performance, Muscle pain ✪✪✪✪✪
The use of capsaicin by athletes to improve athletic performance shows mixed results across clinical studies. Capsaicin activates TRPV1 receptors in skeletal muscle, thereby promoting calcium release and increasing muscle contraction force. It may also reduce the oxidative costs of muscle contraction and increase epinephrine-induced plasma free fatty acid levels. A meta-analysis of several small clinical trials indicates that consuming capsaicin before exercise may improve muscular endurance, but not aerobic endurance, compared with a placebo. Doses generally range around 12 mg. However, these studies have methodological limitations, such as small sample sizes and short study durations, which affect the reliability of the results.
Posologie
Oral, topical
12 - 26 mg
cream, standardized extract
Acute Capsaicin Analog Supplementation Improves 400 M and 3000 M Running Time-Trial Performance
Effects of paprika carotenoid supplementation on bone turnover in postmenopausal women: a randomized, double-blind, placebo-controlled, parallel-group comparison study
Capsaicin Supplementation during High-intensity Continuous Exercise: A Double-blind Study
Capsaicin supplementation increases time to exhaustion in high-intensity intermittent exercise without modifying metabolic responses in physically active men
Effects of Capsaicin and Capsiate on Endurance Performance: A Meta-Analysis
Chronic capsiate supplementation increases fat-free mass and upper body strength but not the inflammatory response to resistance exercise in young untrained men: a randomized, placebo-controlled and double-blind study
Fibromyalgia ✪✪✪✪✪
Preliminary clinical research indicates that applying a cream containing 0.025% capsaicin, the active component of capsicum, four times a day to tender areas for 4 weeks reduces localized tenderness in patients with fibromyalgia. Another study showed that applying a 0.075% capsaicin cream three times a day for 6 weeks, in addition to standard treatment, increased the pain threshold compared with standard treatment alone. However, capsaicin does not appear to reduce overall pain or improve physical function in these patients. The long-term effects of capsaicin on fibromyalgia-related pain remain uncertain.
Posologie
Topical
patch, cream
Properties
Analgesic
The chili pepper, or capsicum, is known for its analgesic effects and is used in the management of chronic pain such as arthritis or diabetic neuropathy. Capsaicin, its main active component, binds to TRPV1 receptors on sensory neurons, initially causing a burning sensation, followed by the release of substance P, a neuropeptide involved in pain transmission. Repeated application of capsaicin leads to desensitization and a decreased sensitivity to painful stimuli. This process results from the depletion of substance P stores, leading to a reduction in pain perception. Studies have shown that capsaicin also causes desensitization to other stimuli such as heat, through a reduction of the erythematous area and an elevation of the pain perception threshold, observed up to 10 hours after application and returning to normal within three weeks. Moreover, prolonged topical application significantly reduces neurogenic vasodilation induced by histamine and attenuates the skin inflammatory reaction. This analgesic and anti-inflammatory action makes capsicum an effective component for the topical treatment of various painful conditions.
Usages associés
Anti-inflammatory
Capsicum, thanks to its active capsaicin, provides significant anti-inflammatory effects after prolonged use. Initially, capsaicin may cause inflammation, but in the long term it helps suppress inflammation by depleting neuropeptides such as substance P, which are responsible for inflammatory and allergic skin reactions. This mechanism is particularly useful in the treatment of chronic inflammatory conditions such as diabetic neuropathy and fibromyalgia. It also helps reduce itching induced by histamine and bradykinin, thereby helping to prevent allergic skin reactions.
Usages associés
Digestive effect
Capsaicin, an active compound of chili pepper, is recognized for its gastroprotective properties. Research suggests that capsicum protects the gastrointestinal mucosa against damage caused by alcohol and nonsteroidal anti-inflammatory drugs. This action could reduce the risk of gastroduodenal ulcer disease. Capsaicin promotes mucus secretion, thereby forming a protective barrier in the stomach, which may explain its protective effect. Moreover, oral administration of capsaicin influences gastrointestinal secretion and motility, and has demonstrated a protective effect against peptic ulcers and mucosal lesions induced by acetylsalicylic acid in humans. However, excessive consumption may be associated with necrosis, ulceration, and carcinogenesis. In individuals with swallowing dysfunction, capsaicin stimulates the swallowing reflex, thereby facilitating ingestion.
Cardiovascular
Capsaicin induces arterial vasodilation that may be beneficial in conditions such as Hortons headache (cluster headache) and coronary artery disease. When applied locally, it promotes the release of nitric oxide, improving the ischemic threshold during exercise tests in patients with stable coronary artery disease. In addition, capsaicin shows antiplatelet effects in vitro and may reduce blood coagulation. However, some clinical research suggests that it does not influence platelet aggregation. nnA meta-analysis of small clinical trials also indicates that consumption of capsicum in various forms does not significantly affect heart rate.nn
Metabolic
Capsicum is being studied for its effects on weight loss. Capsaicin and other constituents of capsicum appear to increase metabolic rate, energy expenditure, fat oxidation, and body temperature, thereby contributing to weight loss. Further research indicates that adding capsicum to meals can suppress appetite, leading to reduced caloric intake and subsequent weight loss. It is suggested that the increased satiety associated with capsicum ingestion may be due to gastrointestinal stress rather than an increase in satiety hormones. Finally, capsicum appears to reduce postprandial insulin levels, thereby contributing to weight loss.nn
Usages associés
Capsaicin-containing chili improved postprandial hyperglycemia, hyperinsulinemia, and fasting lipid disorders in women with gestational diabetes mellitus and lowered the incidence of large-for-gestational-age newborns
Dermatologic effect
Capsicum, used in clinical research, appears to improve microcirculation and protect tissues against hypoxia and ischemia, particularly in the context of dermatologic surgical interventions. Topical application of a capsaicin-based cream to the upper back in adults increases relative superficial hemoglobin levels, as well as dermal oxygenation and blood flow velocity, both at the surface and at depth. These effects peak 30 minutes after application and persist up to 120 minutes. This property of capsicum offers therapeutic potential to improve skin health and aid tissue recovery after medical or surgical procedures. Capsaicin has also been studied in the treatment of psoriasis. One study describes the use of capsaicin in a murine model of imiquimod-induced psoriasis. It was observed that topical application of capsaicin could significantly attenuate epidermal hyperplasia and cutaneous inflammation. Capsaicin interferes with activation of the IL-23/IL-17 pathways (key inflammatory pathways in psoriasis), reducing the expression of inflammatory cytokines and modulating immune cell infiltration into the skin, which leads to a notable reduction in dermatitis.
Usages associés
Safe dosage
Adults aged 12 years and older: 0.025% - 0.075% (patch, cream)
Topical route: preparations containing extracts equivalent to 0.025% - 0.075% capsaicinoids, 3-4 times per day. For patches: extracts equivalent to 10-40 μg of capsaicinoids per cm².
Interactions
Médicaments
Antiplatelet agents/Anticoagulants: moderate interaction
Research indicates that capsicum may increase the effects of antiplatelet medications and is associated with an increased risk of bleeding in patients on warfarin. However, a single dose of capsaicin with aspirin does not affect platelet aggregation.
Antidiabetic: minor interaction
Capsicum consumption reduces the postprandial glucose peak and increases insulin in healthy individuals as well as in diabetic patients, without affecting fasting levels.
Precautions
Adults aged 12 years and older: use with caution
Oral route: pepper extracts have been used safely at doses up to 200 mg per day for 28 days. The extracts used delivered up to 30 mg/day of capsaicin. Long-term use or use at high doses have been linked to liver or kidney damage, as well as hypertensive crises.
Pregnancy: use with caution
Capsicum 5 mg per day was used for up to 28 days during the second half of the second trimester and the third trimester.
Breastfeeding: use with caution
Topical use of products containing cayenne pepper is generally safe during breastfeeding, but oral intake may be inappropriate. Some spicy foods can cause dermatitis in breastfed infants.
Contraindications
Children: prohibited
There is not enough reliable information on the safety of capsicum when used orally in children.
Wounds: prohibited
Capsicum is contraindicated on damaged skin; do not apply to an open wound.
