Capsaicin cream for neuropathy? My friend rubbed it on her feet, then touched her eye. Her brother-in-law keeps his in the cabinet.

My friend Elaine is sixty-six and did hair in Rockford for thirty-eight years. She has spent more of her life standing on a salon floor than sitting in a chair, and for the last two years her feet have been sending her the bill: a burning in both soles that starts around supper, pins and needles in her toes, and a numb strip along the outside of her left foot that she says "feels like I'm wearing a sock I'm not wearing."

Last week she bought a tube of capsaicin cream for neuropathy, the hot-pepper cream the pharmacist keeps next to the arthritis rubs. Day one, she rubbed it into her feet before bed. Day two, she touched her eye. "Denise," she said on the phone, "I have cried less at funerals." Then the real question: "It burns worse before it burns better. Is it supposed to, or am I wasting my time?"

Capsaicin cream for neuropathy: what it can and can't do

Capsaicin is the compound that makes chili peppers hot. On the skin it first fires up the small pain nerves, then, with regular use, it seems to wear down their ability to keep sending that pain signal. It has real research behind it, and a recent review found it held up well against placebo for nerve pain. Here's the honest picture:

• It works slowly, if it works. The over-the-counter creams usually take two to four weeks of use, three or four times a day, before people judge them. One night tells you nothing.
• The first week stings. Burning, warmth and redness at the start are expected, and they usually fade. If the skin blisters or the burning gets worse instead of better, stop.
• It works on pain, not on numbness. It can quiet the burning. It isn't shown to bring feeling back to numb toes, and on skin you can't feel well, you won't notice if you've used too much.
• Wash your hands, or wear gloves. Elaine learned it the hard way. Keep it away from eyes, cuts, and the heating pad. Heat on top of capsaicin can burn.
• The patch is a different thing. There's a high-strength prescription patch that's put on in a doctor's office. That's not the tube on the drugstore shelf.

See a doctor quickly if the numbness is spreading fast, is only on one side, or comes with weakness, a sore you didn't feel, or trouble with balance.

Elaine had already tried the obvious things. Each one helped, but…

Before the cream there was the menthol foot gel her daughter brought from the drugstore, the B-complex her sister swears by, and the Epsom salt soaks Elaine did every Sunday night in the dishpan she used to mix color in. The gel cooled her feet for an evening. The soaks felt wonderful for exactly as long as her feet were in the water.

"So the cream is another evening," she said. "A hotter one." She's right, and she's sharper about it than most of the people who write to me. Every one of those things works on the signal at the very end of the nerve, in the skin of the foot. None of them touches why the nerve started sending the wrong signal in the first place.

What's really going on along the nerve

The nerves that reach your toes are the longest in your body. Each one is wrapped in a thin protective coating, like the insulation on the cord of a blow dryer. Elaine knows exactly what happens when that insulation cracks: the dryer sparks, runs hot in one spot, and then one day it doesn't run at all. Feet do the same thing. Some of the current leaks out as burning and buzzing. Some of it never arrives, and that's the numb strip.

A pepper cream turns the volume down on the spark for a while. But the cracking runs all the way up the cord, and it's usually driven by two slow things working together: a low-grade inflammation around nerves that are already stressed, and poor blood flow to the far end of the line, where the feet get served last. In November, when the mornings go cold and the furnace kicks on, those tiny vessels in the feet tighten up even more.

And here's the part Elaine's pharmacist never brought up. Another spice from the same kitchen shelf as the chili pepper keeps turning up in the research on that inflammation around the nerve. Not the jar in your cabinet, though. The body barely absorbs it on its own, it needs a partner to get in, and when you take it seems to matter. Which one, with what, and at what hour, none of that comes printed on a tube of hot cream.

The brother-in-law working the polls today

Elaine's brother-in-law Ray is seventy-two and fixed transmissions for forty years. Two years ago he quit volunteering at the polling place because he couldn't stand at the sign-in table past lunch. Today, Election Day, he's back at the church fellowship hall, working the whole fourteen hours.

Elaine noticed at Sunday dinner. Ray used to spend the whole meal with his boots off under the table. This time he kept them on and went out to rake leaves afterward. So she asked him, the way a hairdresser asks things, which is directly: "What are you rubbing on your feet?"

"Nothing," Ray said. "I've got two tubes of that pepper stuff in the medicine cabinet. They're fine for a bad night." What changed things, he said, was working on the cord, every morning, from the inside, instead of putting out the sparks at the end of it every night. He went out to the truck and came back with the bottle.

It was NervoLyn. Elaine read the label at the kitchen table with her reading glasses on top of her head, the way she used to read the back of a color tube before she mixed it:

• Turmeric extract, standardized to 95% curcuminoids. For the body's normal inflammation response around stressed nerves. "Not the kind in the spice rack," Ray said, and wouldn't say more.
• Butcher's broom. A traditional herb for circulation, to help blood make the long trip down to the toes on cold mornings.
• Alpha lipoic acid. An antioxidant the company describes as one of the most studied for the nerves of the hands and feet.
• Magnesium glycinate. The gentle form, which the company connects with calmer nerve signals and better sleep.
• L-carnitine and Coenzyme Q10. Fuel for the cells, so a worn nerve has the energy for its own slow repair.

"So the cream is for the sparks," Elaine said, "and this is for the wire." She did it the careful way. She took a photo of the label to her doctor, who checked it against her blood pressure pill and her thyroid pill, told her to take it with breakfast, and said she could keep the cream for the bad nights as long as she wore gloves and kept it away from the heating pad.

What Elaine is watching for, and when

• Week 1. Nothing. Ray told her not to expect anything yet, and she says she's "being patient the way you're patient with a perm. You don't touch it."
• Weeks 2 and 3. Ray warned her it might feel like more pins and needles before it got better. Some people notice a nerve wake up before it settles down, though nobody can promise how it goes for anyone else.
• Month 1. That's when Ray says the suppertime burning stopped arriving on schedule, and the pepper tubes started living in the cabinet.
• Months 2 and 3. Where Ray is now: fourteen hours on his feet at the polling place, boots on, feeling the floor of the fellowship hall.

Why so slow? Because nothing in that bottle heats, cools or numbs anything. A coating that wore thin over years gets rebuilt on the body's schedule, and the longest nerves get their turn last. The company says many people notice early changes in three to four weeks and fuller results over eight to twelve. Elaine ordered the three-month supply. "The cream says give it four weeks," she said. "I'm giving the wire a whole winter."

Who it's for, and who it isn't

It may be worth a look if you're over 50, the tingling, burning or numbness is in both feet, your doctor has checked the basics (blood sugar, B12, thyroid), and the creams, gels and soaks you've tried quiet the burning for an evening without ever reaching the numbness underneath.

It is not for you if the symptoms came on suddenly or only on one side, if a foot or leg feels weak, or if you have a sore that isn't healing. Those need a doctor first. If you take medicine for blood sugar, blood pressure, blood thinning, thyroid or nerve pain, have kidney problems, or are pregnant or nursing, show your doctor the label before you start, and never stop a prescription on your own.

The company gives you 60 days, with your money back if your feet don't notice. It's a one-time order, nothing that renews behind your back, made in the United States in a GMP-certified facility. "Sixty days," Elaine said. "The cream was eleven dollars and I'll never get my eye back."

So, does capsaicin cream help neuropathy?

It can ease burning nerve pain for some people with regular use over a few weeks, and the research on it is better than on most drugstore creams. Expect a sting at the start, wash your hands or wear gloves, keep it away from eyes and heat, and stop if the skin blisters. It works on the pain signal in the skin, not on numbness, and it doesn't reach the two things that keep feet numb: the worn coating and the poor blood flow at the end of the line. Results with any supplement vary from person to person, and Ray's and Elaine's are their own.

P.S. Elaine is driving Ray his supper at the polling place tonight, around six. She says if he's still got his boots on at eight, she's buying the second bottle for her sister. If you're the one with the hot cream in the drawer and the numb strip still there every morning, here's what Ray brought in from the truck. And if you've got one of those buzzing boxes in your Black Friday cart too, read what my cousin Linda's podiatrist asked her first.

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