Topical capsaicin cream showed promising nausea relief for cannabinoid hyperemesis syndrome in a pilot RCT | Research

The takeaway

In a pilot randomized trial of 30 patients, topical capsaicin cream applied to the abdomen significantly reduced nausea at 60 minutes compared to placebo in suspected cannabinoid hyperemesis syndrome, with 29% achieving complete resolution.

Emergency physicians, chronic cannabis users experiencing cyclical vomiting

Complete nausea resolution: 29% capsaicin vs. 0% placebo; significant at 60 minutes

What the researchers found

At 60 minutes, mean nausea severity was 3.2 cm (capsaicin) vs. 6.4 cm (placebo) on a 0-10 scale (difference = -3.2 cm, 95% CI: -0.9 to -5.4). Nausea reduction: 46% (capsaicin) vs. 25% (placebo). Complete nausea resolution: 29.4% (capsaicin) vs. 0% (placebo, RR = 3.4). At 30 minutes, the difference was not yet statistically significant.

Why it matters

CHS has no established treatment. Topical capsaicin is inexpensive, readily available, and this is the first RCT testing it for CHS, moving beyond case reports to controlled evidence.

The numbers in context

30 patients (17 capsaicin, 13 placebo). At 60 min: 3.2 vs. 6.4 cm nausea (difference -3.2). 46% vs. 25% nausea reduction. Complete resolution: 29.4% vs. 0%. 1 patient discontinued for skin irritation.

How the study worked

Double-blind, randomized, placebo-controlled pilot trial of 30 adults presenting with suspected CHS exacerbation. 0.1% capsaicin or placebo cream applied to anterior abdomen. Nausea assessed by visual analog scale at 30 and 60 minutes.

What this study cannot tell us

Small pilot trial; not powered for definitive conclusions; suspected CHS diagnosis (no gold standard exists); 30-minute endpoint was not significant; one patient could not tolerate the cream.

How to read the evidence

Small pilot RCT providing initial controlled evidence; not powered for definitive conclusions.

When this study was published

Published in 2020.

The bigger picture

CHS is an increasingly common ED presentation with limited treatment options. Topical capsaicin activates TRPV1 receptors, the same pathway involved in the hot shower relief that CHS patients characteristically seek.

Questions still open

Would a larger trial confirm these findings? Is higher-concentration capsaicin more effective? What is the optimal application timing and duration?

Common questions

How does capsaicin cream help with CHS?

Capsaicin activates TRPV1 receptors, the same receptor pathway that responds to heat. This may explain why CHS patients characteristically find relief from hot showers. Applying capsaicin cream to the abdomen may provide similar relief without needing a shower.

Is this now a standard treatment for CHS?

Not yet. This pilot trial is promising, but with only 30 patients, a larger confirmatory trial is needed. However, given the safety profile of topical capsaicin and the lack of other CHS treatments, some emergency departments have already adopted it.

Read the original research

A Pilot Trial of Topical Capsaicin Cream for Treatment of Cannabinoid Hyperemesis Syndrome.

Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 27(11), 1166-1172

View on PubMed ↗Publisher’s paper ↗

Citation

Dean, Diana J; Sabagha, Noor; Rose, Kaitlin; Weiss, Alexander; France, John; Asmar, Timothy; Rammal, Jo-Ann; Beyer, Margaret; Bussa, Rebecca; Ross, Jacob; Chaudhry, Kaleem; Smoot, Thomas; Wilson, Kathleen; Miller, Joseph. (2020). A Pilot Trial of Topical Capsaicin Cream for Treatment of Cannabinoid Hyperemesis Syndrome.. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 27(11), 1166-1172. https://doi.org/10.1111/acem.14062