CAPSAICIN
Alternative Treatments for Facial Neuralgias

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TRADE NAME:   Zostrix

Facial Neuralgia Conditions Treated: 
Atypical Facial Pain, Anesthesia Dolorosa, Trigeminal Neuralgia, Atypical Trigeminal Neuralgia

What is Capsaicin
Capsaicin, the substance that makes chile peppers so hot, has been found to reduce pain in arthritis patients when topically applied as a cream repeatedly over several weeks.  Capsaicin is available as a cream, a lotion and as a solid "stick" much like deodorant sticks.  Capsaicin which comes in two strengths, .025 % and .075%, is also used to treat the neuropathic pain of postherpetic neuralgia.  It has been used to treat nerve pain inside the mouth, for patients with painful sores from cancer therapy.   A commercial preparation of capsaicin is called "Zostrix".

How Does it Work?
Researchers have found that capsaicin appears to work by "reducing substance P which is found at nerve endings and is involved in transmitting the pain signal to the brain." Clinical studies are emerging which indicate capsaicin cream is more effective than placebos in treating post-surgical neuropathic pain.  However, for TN, ATN, and ATFP, this treatment should presently be considered "under investigation" or "experimental."

For a more in-depth medical description of the uses of capsaicin in treating oral pain, please select: Capsaicin Use for Oral Pain  which has references to several medical journals. One important observation from the article concludes that:

If capsaicin is reapplied after the burning sensation from a previous application has stopped, desensitization  (less sensitivity to pain) occurs.  However, if capsaicin is reapplied before the burning sensation is gone,  sensitization (more sensitivity to pain) might occur.

 It appears that capsaicin works by elevating the threshold for pain (the level when pain is first felt) in the area where it's applied.  The pain threshold can be further elevated by gradually increasing the capsaicin concentration in a series of repeated applications.

Capsaicin and Atypical Facial Pain
Recently Capsaicin has been used to treat atypical facial pain, especially when a specific pain "trigger point" (a place, if touched, causes or exacerbates facial pain) is involved. Capsaicin is applied directly to this "trigger point" several times a day. If the trigger point is inside the mouth, a plastic dental splint is used to apply the capsaicin cream.  If the trigger point is on the face, it is topically applied. In some cases, pain reduction only occurs after several weeks of application. There is anecdotal evidence that a course of capsaicin treatment can result in long-term pain remission for some patients with atypical facial pain.

Capsaicin and Trigeminal Neuralgia
Capsaicin is not considered a standard treatment for Trigeminal Neuralgia although at least one article in the literature indicates that it may be useful in treating trigeminal neuralgia.  See Science/Health Abstracts Vol. 11, No. 5.  Another article published in the Journal of Orofacial Pain shows that using capsaicin to treat traumatic injury to the trigeminal nerve can result in significant long term pain reduction  (You might have to join Medscape.com in order to access this article in the Journal of Orofacial Pain. There is no fee for joining).

Latest   Research
The March 1, 1998 issue of "Anesthesia and Analgesia" includes a study at the University of California San Francisco that found that capsaicin can significantly reduce chronic, debilitating nerve pain when used in very high doses.  Seven out of ten patients with debilitating foot or chest wall pain from HIV, diabetes or shingles improved at least 50% when treated with 5% - 10% capsaicin cream.  All ten patients reported some pain relief.  Patients reported that capsaicin alleviated their pain for up to 6-8 months.

This is the first time capsaicin has been used in such high concentrations, up to 400 times the concentration of over-the-counter capsaicin at .025% and .075%.  High concentrations of capsaicin (greater than 1%) have not been used in the past because of the intense burning caused by capsaicin   application.  In this study, patients were given regional anesthesia before the capsaicin was applied.  In addition, morphine was given to patients to help stop the burning which could last up to five days after application.  Interestingly, the morphine did not help the initial neuropathic pain but did treat the burning pain caused by the capsaicin.
 
Tips on Using Capsaicin
"Capsaicin usually burns when first applied. It sometimes takes more than a day or two for the effect to kick in, which is when the burning sensation stops. So spending a little more time building up a tolerance to the burning sensation might be one way to make the discomfort a bit more bearable.... It takes something with true detergent action to get this stuff off your skin -- a mild baby shampoo or dish liquid is your best bet -- and a wipe-down with rubbing alcohol won't hurt either. But if you can tolerate it on your skin for at least 15 minutes (so say the package inserts) you will get the benefit even if you have to wash it off later." Source: Anonymous.

Capsaicin is available as a cream or a gel. Researchers at Yale University School of Medicine have devised a candy (butterscotch taffy) with  capsaicin to ease mouth sores caused by chemotherapy  in cancer patients.  The sugar in the candy inhibits the burn of capsaicin in the mouth.  Theoretically, capsaicin candy could be useful in treating oral neuralgias but there is no supporting medical literature at this time.

For more information see:  Informal Guidelines on using Capsaicin Cream to Treat Facial Pain.

A Note of Caution
At least one article in the scientific literature indicates that there have been no large scale studies of long term effects of capsaicin in the digestive tract of patients whose health has been compromised by surgery or long term neuropathy.  An article summarized in Science/Health Abstracts Vol. 5, No. 3,  indicates that capsaicin can have significant toxic effects within the body.

More information on Capsaicin:

  Capsaicin Cream for Surgical Neuropathic Pain

  Hot Pepper Candy Found to Help Chemotherapy Effects.

  Recipe for Hot Pepper Candy

Scientific information on Chile pepper

  Getting at the Molecular Roots of Pain - Interesting discussion in "The Scientist," January, 1999 of capsaicin and its role in pain suppression.

Personal Experiences

Positive Experiences
	Trigeminal Neuralgia "I wish more people would try Capsaicin. I have been pain-free for two months and am taking NO DRUGS. It is like a miracle. The pain lessened with the first application, and was gone after the second application four hours later. I was very reluctant to believe that I had found something that worked--but now I am convinced. The anxiety is gone, I sleep through every night, and I think I have my life back. Some days I don't even think about it! But I never forget to apply the cream. I no longer experience the burning--unless I get it in my eye. That's unpleasant. But this slight discomfort is nothing compared to the pain of TN. I was concerned at first that perhaps I had gone into a temporary remission, and that the cream might not have had anything to do with the abatement of the pain. But now, I am convinced that the cream is working. I occasionally feel and "stiffening" or "tingling" in my face that I believe is the nerve trying to cause the pain! But it doesn't happen. There is NO reason not to try capsaicin. It is cheap, available without a prescription at your local drug store, and there are no bad side effects. It can be used "forever" according to the RN to whom I spoke. In fact, after six weeks of usage, she said the recommended applications of four per day can be reduced to two per day." Source: Barbara Martin email:  thabar@hotmail.com   (Sept, 1998) Update: "I am still pain-free -- it's been eight months now." (April, 1999) Update: (February, 2001) "I am happy to report that I am still pain-free (I think it is nearly three years now!). I seldom even think about my TN--the fear is almost totally gone. In fact, I only apply the cream if I think an attack is coming.  It is a very strange thing...people still write to me about that message I left on the Resources page and when they do, I get twinges. Someone else told me that she also gets "sympathy twinges" when she talks to someone about the pain. Of all the people I have replied to, only a few have written back to say that the capsaicin was effective for them. I do hear from more people who say it was NOT effective. I wish I knew why it works for some and not for others."
	Atypical Facial Pain - "I've been using capsaicin with a dental splint off and on for over a year to treat atypical facial pain. It always relieves the deepest pain after 2-3 applications." Source: Anonymous.
	Trigeminal Neuralgia - "I consider Zostrix to have cured my tic doloroux or whatever name you care to give it. I don't use  the word cure lightly, however, in my case I believe it applies." Source: Anonymous.
	Trigeminal Neuralgia - "I was in the midst of my longest attack ever--five weeks.  I was desperate, grasping at straws.  I bought a tube of Capsaicin cream (in the .05% strength).  The pain lessened with the first application!  Three hours later, after the second application, the pain was GONE.  I have been using it ever since--four applications per day.  I have had NO PAIN.  I can't believe it...but it's true!  I hope everyone will try it--I read a study that said it worked for about half of the TN sufferers who tried it!  Lucky 50%.  I hope you fall into that category!"   Source:  Anonymous
	Glossopharyngeal Neuralgia and Trigeminal Neuralgia - "My experience with cayenne has been somewhat successful. I have been taking cayenne capsules 4 times x 2 daily with food since December and my attacks have been lessened by more than 80%. I can't complain about that. it works for me. "  Source: Anonymous.
	"Capsaicin usually burns when first applied. It sometimes takes more than a day or two for the effect to kick in, which is when the burning sensation stops. So spending a little more time building up a tolerance to the burning sensation might be one way to make the discomfort a bit more bearable.... It takes something with true detergent action to get this stuff off your skin -- a mild baby shampoo or dish liquid is your best bet -- and a wipe-down with rubbing alcohol won't hurt either. But if you can tolerate it on your skin for at least 15 minutes (so say the package inserts) you will get the benefit even if you have to wash it off later." Source: Anonymous.
	[Hot peppers]: "I get some relief for a while if I eat really hot peppers." Source: Anonymous.
Negative Experiences
	Last week at three in the morning...when the excruciating pain had gone on for hours...I found this link on the Internet and read about Capsaicin. I went out the next day and bought a tube. Of course the thought of putting something that was going to hurt on the place (my face, no less) that was already in pain had me pretty scared. My physician suggested I try diluting it with some other facial cream. I finally tried it, combining it with Neutrogena lotion. It certainly burns...I've put it on four times a day for several days now with no reduction in pain. Of course I've been washing it off in between applications. After re-reading the testimonies, while a bit more awake, I've noted that washing it off may not be helping. I'll keep trying, since I'm fairly desperate. I'll let you know what happens after a few weeks. Thanks for this web site. It has helped to know I'm not alone with this. Cat
	[Hot peppers]:"All I get is a burning mouth. Just more pain." Source: Anonymous.
Mixed Experiences
	"It seemed to work during my first attack of this, but now I'm thinking that maybe the sensations just went away on their own, because it doesn't seem to work anymore." Source: "Janine"

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REFERENCES

Epstein JB, et al., Topical application of capsaicin for treatment of oral neuropathic pain and trigeminal neuralgia. Oral Surg Oral Med Oral Pathol. 1994 Feb;77(2):135-40.

W.R. Robbins et al., "Treatment of intractable pain with topical large-dose capsaicin: Preliminary reports," Anesthesia and Analgesia, 86:579­83, March 1998.