Osteoarthritis, one type of arthritis is a painful condition as it is caused by gradual loss of cartilage from the joints and in some condition leads to intense inflammation of joints.
Osteoarthritis can affect almost all types of joints in the body but mostly occurs in the hands, knees, hips, and spine. Other common symptoms associated with this kind of arthritis is stiffness, pain, and difficulty in movement of joints.
Osteoarthritis is a chronic disease which gradually becomes worst with time if kept untreated. Hence treatment of this disease is very important to prevent further complications and pain in patients.
There are number of treatments for osteoarthritis other than medications such as adequate rest, proper physical exercises, weight management and proper intake of diet.
Most of the fruits and vegetables which are known as superfoods such as avocados, pineapple, pomegranate, carrots, red grapes, blueberries, spinach, etc. can be incorporated in the diet of an arthritic patient which help to combat pain and swelling caused by this disease
Along with this fruits and vegetables, there are a number of spices such as turmeric, ginger, dried chili powder and cinnamon which possess anti-inflammatory properties and also play a significant role in reducing the inflammation and pain associated with osteoarthritis.
What is Capsaicin?
Chilli peppers, belongs to the family of food that derives its name from Latin word Capsicum, are part of the staple cuisine worldwide especially in Central America, Asia, and India.
There are different types of chilli peppers which vary in their size, shapes and flavour. Some of the varieties of chilli peppers are habanero, jalapeno,
Anaheim, ancho and cayenne. Cayenne is the most common variety among chilli peppers and is also known as cayenne pepper.
Chilli peppers are usually in green or red color and are mainly used to make chilli powder.
This powdered, fresh or dried chilli peppers are used as a seasoning in a variety of dishes but they also contain good amount of nutritional content.
It also possesses minerals like copper, iron, manganese, and potassium.
Along with its use in food, it is also being used sometimes for medicinal purpose.
Chilli peppers are cultivated now in all continents where China, Turkey, Spain, Mexico, and Nigeria are famous for their largest production.
Chilli peppers are known for their hot and spicy flavour and are mainly used as a seasoning to add spice to all colorful dishes.
This spiciness and heat which chilli peppers contain come from the compound known as Capsaicin.
Capsaicin is the compound that offers hot and spicy flavour to chillies.
Capsaicin and related compounds are called capsaicinoids and these are present in all the plants of genus Capsicum except for bell pepper which does not contain any capsaicin.
Capsaicin and dihydrocapsaicin are the major capsaicinoids. The naturally occurring content of capsaicinoids in spices ranges typically from 0.1 mg/g in chilli pepper to 2.5 mg/g in red pepper and 60 mg/g in oleoresin red pepper.
The Scoville Heat Unit Scale is used to classify the strength of chilli peppers.
The average intake of capsicum spices is 2.5g/person in India and upto 20g/person in Mexico.
Capsaicin improves digestion and hence is used to fight diarrhea and stomach infection.
It is also identified as a fat burner and can control appetite. Research suggests that it may have implications on cancer, cardiovascular health, and respiratory system.
However, its prime use is for pain relief. Topical capsaicin is used for the treatment of diabetic neuropathy, post-surgical pain, cluster headaches, arthritis, and psoriasis.
Capsaicin and several related compounds are called capsaicinoids are produced as secondary metabolites by chilli peppers and related plants to fight against fungal and herbivores attack. Capsaicin is a flavourless, odourless, colorless compound found in different amounts in chilli peppers.
Capsaicin was used as a part of folk medicine for centuries by people for stimulating blood circulation, for promoting proper digestion and relieving pain (when used topically).
It was also found to have potential in treating neuropathic pain (nerve pain), uremic pruritus (chronic kidney disease), and bladder overactivity (urinary inconsistency).
Several studies were carried out to explain the mechanism of action of capsaicin in reducing inflammation and pain associated with inflammatory related diseases such as in arthritis.
How does capsaicin relieve pain in osteoarthritis?
Transient Receptor Potential Channels are an important family of ion channels. Ion channels are a type of protein that serves as a gate and control the ions entering the cells.
There are six subfamilies under TRP and they are activated in response to hot or cold stimulus.
The Transient Receptor Potential Vanillod 1 receptor (TRPV1) belongs to this family and is activated in response to capsaicin, heat, inflammatory mediators, etc. TRPV1 has different functions based on its location.
It is located at the end of nerve fibres and is responsible for the detection of pain, heat, and chemicals.
Earlier it was thought that capsaicin brings about the depletion of substance P, a brain-related chemical involved in pain sensation, from the affected nerve fibres and this leads to pain relief.
However, this no longer considered to be the case now.
Capsaicin is a member of vanilloid family of compounds such as vanillin from vanilla, eugenol from cloves, etc.
Capsaicin binds to TRPV1 and brings about a similar reaction in the brain as that caused by heat.
Therefore initially when you apply capsaicin based cream you experience warmth, itching and burning sensation.
On long term or on repeated application capsaicin leads to loss of function of the nerve receptors and leads to an impaired sensation of pain.
Higher concentrations of topical capsaicin bring about neurolysis or temporary damage of nerve fibre which reduces pain sensation and nerve function is restored on cessation of capsaicin used.
3 Benefits Of Capsaicin In Osteoarthritis
Quite a bit of research has been directed on the utility of topical capsaicin on osteoarthritis and the conclusion is affirmative.
1. It relieves osteoarthritis symptoms
A study dated back to 1991 demonstrated that 0.025% topical capsaicin reduced pain by 33% in osteoarthritis patients within 4 weeks of treatment.
In fact, 80% of the patients reported a reduction in pain within 2 weeks of treatment.
The transient burning sensation was felt in 23 out of 52 individuals and 2 individuals withdrew from the study due to this effect.
Researchers concluded that capsaicin is a safe and effective treatment for arthritis.
Topical capsaicin 0.075% applied 4 times a day is found to relieve pain and tenderness in painful osteoarthritis of the hand.
Even low dose capsaicin gel treatment for four weeks results in significant reduction in stiffness and pain score in osteoarthritis. However burning sensation was reported but no participant withdrew from the study.
Topical herbal cream containing capsaicin and menthol is reported to reduce pain and stiffness in osteoarthritis.
Another study showed that capsaicin present in ointment and creams are safe and well tolerated when used for osteoarthritis patients. It was indicated, topical capsaicin is moderately effective in reducing pain when applied four times daily regardless of the site of application and its dose.
What does this mean? Topical capsaicin reduces joint pain, stiffness and swelling involved in osteoarthritis.
2. It reduces inflammation
Capsaicin receptors are proteins to which capsaicin binds in the body. These are present at the end of nerve fibres.
Capsaicin finds to these receptors and leads to reduced sensitization of pain.
This effect is held responsible for the reduction in inflammation and pain by capsaicin in arthritis.
Additionally capsaicin demonstrates anti-inflammatory effect by inhibiting the action of inflammatory enzymes such as prostaglandins, COX-2, and nitric oxide synthase.
Animal study shows that curcumin’s anti-inflammatory effect is comparable to that of conventional painkiller diclofenac.
A study was carried out to prove the anti-inflammatory property of capsaicin by finding its effect on the production of inflammatory molecules in lipopolysaccharide (LPS) – stimulated murine peritoneal macrophages (a type of white blood cell).
In this study, the effect of capsaicin on the expression levels of COX-2 (cyclooxygenase enzyme-2), NOS (Nitric oxide synthase), and vanilloid receptor -1 (VR-1) were determined.
It was observed clearly that capsaicin inhibit the enzyme activity of COX-2 and the expression of the iNOS protein and was also found to inactivate NK-kB.
Cyclooxygenase enzymes-2(COX-2) and nitric oxide synthase play a key role in prostaglandins biosynthesis pathways.
And prostaglandins play an important role in causing inflammation in osteoarthritis patients and hence inhibiting its biosynthesis helps in reducing the inflammation and pain associated with these diseases.
The full study, hence proved that the capsaicin, a major ingredient present in hot chilli pepper possess anti-inflammatory properties and can be considered as promising drug candidates for ameliorating inflammatory diseases and cancer.
What does this mean? Capsaicin exerts an anti-inflammatory effect by counteracting the action of inflammatory enzymes and its anti-inflammatory activity is comparable to that of painkiller, diclofenac.
3. It acts as a painkiller
A review of studies evaluating the effect of capsaicin on pain, revealed that application of capsaicin 4 times a day for 20 weeks reduce pain intensity in those suffering from osteoarthritis irrespective of dose and site of application.
Another review study examining the effect of capsaicin in pain reports that capsaicin alone does not relieve pain but can be used as an adjunct for patients who do not respond to or can’t tolerate regular treatments.
Glyceryl trinitrate is a medicine used to relieve pain due to heart failure but also used for pain management and soft tissue repair.
A study demonstrated that the combination of capsaicin and glyceryl trinitrate relieves pain better than individual formulations in painful osteoarthritis.
Also, this combination was more tolerable than capsaicin alone.
The higher strength of capsaicin cream works better in relieving pain in osteoarthritis. Schnitzer et.al compared the effect of 0.25% capsaicin cream and 0.025% capsaicin cream on osteoarthritis pain.
The high strength cream was applied twice a day while low strength cream was applied 4 times a day. After two days the pain reduced by 48% in high strength group and 17% in low strength group.
55% of the individuals experienced 50% reduction in pain with high strength capsaicin while a similar result was observed within 14 days in low strength group.
The burning sensation was higher in high strength group but this sensation reduced within 2 days of treatment and declined rapidly throughout the study period in both groups.
High concentration capsaicin patches (8%) are efficacious for extreme pain. A single 60-minute application of this patch relieves pain up to 12 weeks.
What does this mean? Topical application of capsaicin relives painful osteoarthritis with 2-4 weeks of treatment. High strength capsaicin creams and capsaicin patches are fast acting in pain relief.
How to include chilli peppers in the diet for osteoarthritis?
First of all try to select vivid, glossy and firm chillies if you using fresh chillies from shops. Avoid those chillies which are wrinkles, soft and showing black spots.
If you are taking dried ones, try to check their color. The one which have lost their color doesn’t have good flavour too.
And if you are choosing powdered chilli powder, it should be dry and free of moisture. Fresh chillies, dry chillies and chilli powder can be used in a number of dishes as a seasoning to add extra spice and flavour to your food.
Hence there is no certain recipe to follow and it completely depends on individual choice how to use and how much to use. Still, I would like to put some tips where they can be used.
- You can use fresh green or red chillies in sauted vegetables and salads to give some extra spice to dish.
- Dried chillies can be used in number of curries and dals for seasoning
- Green chilli peeper chutney can be used as a dip and side dish. You can also use minced chilli pepper to yogurt and raita.
- You can make puree of fresh chilli pepper with olive oil, garlic, coriander, and peppermint. You can use it as a side dish with vegetables, fish or meat products.
- Cayenne pepper and lemon juice mixture make a great compliment dish for bitter greens.
How to use capsaicin for osteoarthritis?
Eating capsaicin present in chilli peppers is generally considered safe, but when used in moderate amount. Large intake of chilli peppers and for longer period of time is usually not recommended as it can lead to side effects such as sweating, flushing, running nose and stomach problems.
Capsaicin is available as capsules and creams for external use. Oral consumption of capsaicin is not found to be beneficial for pain relief.
Capsaicin is commercially available as 0.025%, 0.075%, and 0.1% creams. These can be applied 3-4 times a day.
Most of the creams contain 0.025% to 0.075% capsaicin content and for arthritic patients they are mainly applied 3-4 times daily for around 14 days for complete relief.
A single-application high-dose capsaicin 8% patch is available. This patch is generally applied by a medical practitioner and can be applied as frequently as every 3 months.
Initial burning and stinging sensation are possible that fades away and progressively reduces with repeated applications.
However, if you notice redness or excessive burning sensation, please discontinue the use.
Where chillies can add spice and flavour to your dish, it can also cause burning sensation if your skin comes in contact with it.
And it becomes worst when it touches your lips or eyes and hence you need to be very careful while working or cooking with chillies or chilli powder.
Capsaicin which is responsible for its spiciness, is mainly present in its seeds and fleshy white membrane. Hence the heat can be minimized by removing this parts from chillies. And it is also advisable to use gloves while using chillies for sensitive person.
Allergic reactions are possible with capsaicin. Therefore please do a patch test before using capsaicin topical cream. Do not apply capsaicin to broken skin.
It is advisable not use capsaicin for children. After using capsaicin wash your hands thoroughly and avoid touching eyes. Capsaicin does not wash off with water; you can use vinegar to wash it off.
Inhalation of capsaicin can cause respiratory irritation, sneezing, and tearing.
Capsaicin supplements should be avoided in pregnancy and breastfeeding. Capsaicin capsules can cause stomach irritation and should be avoided if suffering from heartburn or ulcers.
Capsaicin supplements could have drug interactions with blood pressure medications, blood thinning medications, diabetes medications and stomach acid reducing agents.
Also, a burning sensation is observed in the application of capsaicin.
This is not a side effect or adverse event but its manner of action and this sensation fades off in a while and reduces with repeated application.
Consult a doctor about the strength of capsaicin cream and usage of the cream.
Many plants extracts and their components have been used from ancient times as a part of herbal or in Ayurveda remedy in the treatment of arthritis and other joint pains.
And they were always proved to be effective and safe as compared to antibiotics and other chemical drugs which are mostly used in modern medicine.
Therefore herbal remedies are gaining importance in the treatment of various ailments such as arthritis and osteoarthritis.
Capsaicin found in chillies is one of such ingredient which has shown promising role in reducing the pain and inflammation related to joint disorders because of it anti-inflammatory and analgesic properties when taken orally in form of food or when used topically in form of creams and ointments.
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