Friday, October 26, 2007


There's a great topical drug that helps facilitate back pain control. We used to use it for Shingles (a form of viral herpes skin infections) which is very painful and sometimes leads to morphine sulfate use for control of pain. It's uses have been extended to standard pain issues. Many people will see it in the pharmacy next to the Icy Hot or Tiger Balm. Most folks pass right by it since packaging isn't eye catching. I've seen several great forms of capsaisin in the form of Zostrix cream (my personal favorite in the emergency room for people with back pain or neck pain) and salonpas adhesive patches (my personal favorite -most of my older relatives in the Philippines used to walk around with these pads stuck to them and before medical school I used to think of it a some form of voodoo). Any topical pain reliever is made to cause a sensation to the skin that will overpower normal sensation. Example, when a baby is given a cap/hat for the first time, kid usually pulls it off since it doesn't feel right. Soon after trying over and over again, the baby gets used to it. When applying zostrix to skin, it burns. It's a dull sensation but the feeling is like applying hot pepper to skin. Actually, the active ingredient is from hot peppers. The feeling is distracting to the person in pain and one of the methods of relief is to make them think about something else....well, hot pepper will make you do that!

The other relief in pain is more scientific and separates this component from the Icy Hots and Tiger Balms. RCT (randomized clinical trials) performed with capsicum the active ingredient in capsaisin cream, revealed it reduced the amount of Substance P to the area it's applied to. Substance P is a neurotransmitter found in pain fibers and when depleated, pain fibers don't fire to send messages of pain to the brain. Overall, pain sensation if reduced. Practical problem for the cream has always been accidentally applying too much or getting it in the eyes. One of the reasons I like the patches of Salonpas (walgreens) is you could cut as much of a size as you like and not get the hands greasy. Caution: there are salonpas patches at walgreens that don't have capsicum so read ingredients before you buy.

The place it comes from is the seed and little ribs found in red peppers. Different peppers have different ratings usually measured in Scoville heat units (SHU). This rating is usually talked about during the pepper eating contests of Texas. (some people have too much free time although I find myself attracted to watching this and hotdog eating contests while riding my stationary bike at Planet Fitness)

So far, I have not read any info on chronic use and becoming accomodated to it. There have been no other problems aside from people with allergies to peppers using it without reading ingredients. The Saguil Approach to proper use is to apply it 4 times a day and after achieving pain relief, work to stretch the triggered/spasmed muscle. Usually it will be painful at first like any stretch done properly. If continued on a regular basis, the stretch will lengthen muscle fiber and help overall to reduce pain and inoperability of the muscle causing the pain. More stretching leads to more blood flow to injured muscle and faster healing. Alone it may work for small spasms, for larger and more chronic areas, it would be an excellent adjunct to other therapies. Should always inform the massage therapist or physical therapist of it's use. I remember when doing my sports medicine fellowship, we used to comment on russian coaches spraying every injury they had with topical anesthetic and i would always laugh at the technique. Now that I am wiser-(herbally), they actually had a great technique overall in attempting to distract the athlete while ultimately stretching injured muscle. Now using it for a fracture .....not!

*Capsicum also comes in oral form....obviously since it is derived from pepper. But I think its best application it topically, as you will read from other posts, I prefer the use of turmeric, white willow bark boswelia for inflammation. In the future I will talk about arnica and tea tree oil.

(Altman RD et al, Semin Arthritis Rhean 1994, 23:25-33).

(Watson CPN et al Clin Ther 1993, 15:510-526)

(Diabetes Study Group, Diabetes Care 1992, 15: 159-165).