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Chilli pepper

Capsicum annuum

Also calledCapsici fructus (pharmacy) · Paprika · Ginnie or Indian pepper (Gerard)

Capsaicin, the burning compound of chillies, is a licensed pain medicine: an 8% patch for nerve pain applied in clinics, and lower-strength plasters and creams with an EMA well-established-use monograph for muscle and low back pain. It works by first activating and then exhausting the heat-pain nerve endings in skin. Low-strength creams for nerve pain have not been shown to beat placebo.

Full natural-history sheet →

What it is used for

  • The 8% capsaicin patch (Qutenza) is authorised in the EU for peripheral neuropathic pain and applied by health professionals. In post-herpetic neuralgia about 10% more people were much improved than with a low-dose 'active placebo' (number needed to treat about 9; moderate-quality evidence).3,4

  • Back pain
    Moderate

    EMA well-established use: capsicum plasters and creams for muscle pain such as low back pain, adults only. A Cochrane review found capsicum cream or plaster probably better than placebo for chronic low back pain (3 trials, 755 people, moderate-quality evidence).1,2

  • Part of the same EMA well-established-use indication.1

  • Low-concentration (0.075%) capsaicin cream: a Cochrane review of 6 small studies found too little data and concluded it is unlikely to have meaningful effect beyond placebo cream; skin reactions were common.5

How it is prepared

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Medicated plaster containing capsicum soft extract, applied to the painful area for 4–12 hours; wash hands after handling and avoid extra heat.

EMA monograph: one plaster (4.8 or 11 mg capsaicinoids) a day, at least 12 hours apart at the same site; up to 3 weeks, then a break of at least 2 weeks. Adults only.

Back pain · Muscle pain and cramps

ointment / salve

Cream or ointment applied in a thin layer.

EMA monograph: preparations with 40–53 mg capsaicinoids per 100 g, 2–4 times daily, up to 3 weeks.

Back pain · Muscle pain and cramps

Amounts are as recorded by the named source, not a recommendation.

Safety

Pregnancy
Insufficient data
Breastfeeding
Insufficient data
Children
EMA: not recommended under 18 for medicinal plasters and creams.

Interactions with medicines

  • other topical products on the same skin (rubefacients, pain gels)MinorEMA: not to be applied together; interactions can occur up to 12 hours after the plaster is removed.
Interaction checker →

Do not use if

  • Allergy to capsaicin sources such as chilli or paprika
  • Broken skin, wounds or eczema
  • Near the eyes or on mucous membranes

Side effects

  • Burning, redness and warmth at the application site (expected)
  • Rarely blistering or allergic skin reactions — stop at once
  • Burning of eyes and mucous membranes after handling

In the healing traditions

  • Mesoamerican

    Chīlli

    Domesticated in Mexico about 6,000 years ago; Maya and Aztec peoples used capsicums to treat many illnesses, and decoctions were still drunk in the Caribbean in the 20th century.

  • Western herbalism

    Ginnie or Indian pepper; cayenne

    Gerard (1597) describes Capsicum brought from Guinea, India and those parts into Spain and Italy, and grown in England from seed.

    Gerard, Herball (1597), Book II ch. 66

  • Modern pharmacology

    Capsaicin (TRPV1 agonist)

    8% patch for peripheral neuropathic pain; standardised plasters and creams for muscle pain.

Active compounds

capsaicin and dihydrocapsaicin
capsaicinoids; activate the TRPV1 heat-pain receptor, then desensitise the nerve endings
carotenoids (capsanthin)
red pigments

History

Capsicum annuum was domesticated in Mexico around 6,000 years ago and reached the Old World after Columbus. Gerard grew 'Ginnie or Indian pepper' from imported seed. In 1997 the capsaicin receptor was identified as a heat-activated pain channel, explaining how the same molecule burns and then numbs.

Gerard’s Herball, 1597 →

Sources

  1. 1.EMA/HMPC: European Union herbal monograph on Capsicum annuum L. var. minimum and small-fruited C. frutescens, fructus (2015)
  2. 2.Oltean H et al. Herbal medicine for low-back pain. Cochrane Database Syst Rev 2014
  3. 3.EMA: Qutenza (capsaicin) EPAR
  4. 4.Derry S et al. Topical capsaicin (high concentration) for chronic neuropathic pain in adults. Cochrane Database Syst Rev 2017
  5. 5.Derry S, Moore RA. Topical capsaicin (low concentration) for chronic neuropathic pain in adults. Cochrane Database Syst Rev 2012
  6. 6.Wikipedia: Capsicum annuum (domestication; Maya and Aztec use)
  7. 7.Caterina MJ et al. The capsaicin receptor: a heat-activated ion channel in the pain pathway. Nature 1997

Reference, not prescription. Nothing here is medical advice. Herbs can interact with medicines and be dangerous in pregnancy; tell your doctor or pharmacist about anything you take.