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Background and Purpose: This study combined Transient Receptor Potential Vanilloid channel 1 (TRPV1) receptor agonist, dihydrocapsaicin (DHC), with physical hypothermia (PH) (ice pad) to achieve faster cooling to enhance its neuroprotective effects, thus potentially avoiding side effects brought on by monotherapies of high dose DHC and physical hypothermia.Methods: Middle cerebral artery (MCA) occlusion (2 h) was achieved using an intraluminal filament. Rats (n=8) were randomized to 7 groups: sham surgery, stroke only, PH, low DHC (0.5 mg/kg), low DHC/active rewarming (AR), high DHC (1.5 mg/kg) or combination (low DHC plus PH). The treatments were maintained for 3 h at the onset of reperfusion, which was 24 h. Rate to target hypothermia (31 °C) onset was measured. Extent of brain injury was determined by infarct volume, neurological deficit, and apoptotic cell death. Expressions of pro- and anti-apoptotic proteins were evaluated through Western blotting. Metabolic changes and oxidative injury were determined by ATP and ROS productions.Results: Combination had 28.6% faster cooling than PH, 350% faster than low DHC group and 200% faster than high DHC group. Combination had 63.2% reduction in infarct volume and low DHC had 25.9% reduction in infarct volume compared to stroke only. High DHC, DHC (AR) and PH and did not induce significant neuroprotection. Combination therapy significantly decreased apoptotic cell death by 48.5%, as compared to 24.9% with low DHC, in association with significantly increased anti-apoptotic and reduced pro-apoptotic protein expression. Combination therapy largely increased ATP levels by 42.9%, as compared to 25% increase with low DHC. Only combination therapy and PH had significant reductions in ROS at 6 and 24 h post-reperfusion. Neurological testing showed that combination therapy had the best outcomes at 24 h of reperfusion.Discussion: Combination of DHC and PH enhanced the neuroprotective effect produced by each alone. This synergistic protection is associated with faster cooling and more dramatic reduction in apoptotic cell death and more favorable cellular metabolism. The combination therapy is promising in clinical settings for its non-invasive, quick and effective outcomes.