Topical capsaicin cream relieved cannabinoid hyperemesis symptoms in all 13 patients treated in the ER
All 13 patients with suspected cannabinoid hyperemesis syndrome experienced symptom relief after applying capsaicin cream in the emergency department, even after other treatments had failed.
Quick Facts
What This Study Found
Thirteen patients with daily cannabis use and symptoms consistent with cannabinoid hyperemesis syndrome (CHS) were treated with topical capsaicin cream at two academic medical center emergency departments. All 13 experienced symptom relief after capsaicin application.
The treatment was used after other approaches had failed. The proposed mechanism involves capsaicin binding to TRPV1 receptors with high specificity, overstimulating them to impair substance P signaling in the area postrema and nucleus tractus solitarius (brain regions that control vomiting). This may explain the antiemetic effect.
Key Numbers
13 patients treated. All 13 experienced symptom relief. Treatment: topical capsaicin cream. Used at 2 academic medical centers. Mechanism: TRPV1 receptor overstimulation impairing substance P signaling.
How They Did This
Retrospective case series. Electronic health records at two academic medical centers were queried to identify patients with documented daily cannabis use, CHS-consistent symptoms, and topical capsaicin treatment. Thirteen cases were identified.
Why This Research Matters
CHS is notoriously difficult to treat in the ER. Standard antiemetics often fail, and patients may receive unnecessary testing and prolonged stays. Topical capsaicin cream is inexpensive, widely available, and easy to apply. If these findings are confirmed in controlled trials, it could become a first-line ER treatment for CHS.
The Bigger Picture
The capsaicin-CHS connection reveals an intriguing pharmacological interaction. CHS patients often compulsively take hot showers for relief, and capsaicin activates the same heat-sensing TRPV1 receptor. Topical capsaicin essentially provides a concentrated, targeted version of the hot shower effect, offering a more practical treatment in the clinical setting.
What This Study Doesn't Tell Us
Retrospective, uncontrolled case series. No placebo comparison. 13 patients is a small number. Symptoms may have resolved spontaneously. The strength and application site of capsaicin cream varied. No standardized outcome measures.
Questions This Raises
- ?Would a randomized controlled trial confirm capsaicin's effectiveness for CHS?
- ?What is the optimal concentration and application site?
- ?How long does the relief last?
- ?Could capsaicin be used for outpatient CHS management?
Trust & Context
- Key Stat:
- 13/13 CHS patients improved with topical capsaicin after other treatments failed
- Evidence Grade:
- Small retrospective case series. Promising results but no control group or standardized protocol.
- Study Age:
- Published in 2017. Topical capsaicin for CHS has since been studied in additional case series and is increasingly used in emergency departments.
- Original Title:
- Resolution of cannabis hyperemesis syndrome with topical capsaicin in the emergency department: a case series.
- Published In:
- Clinical toxicology (Philadelphia, Pa.), 55(8), 908-913 (2017)
- Authors:
- Dezieck, Laurel, Hafez, Zachary, Conicella, Albert, Blohm, Eike, O'Connor, Mark J, Schwarz, Evan S, Mullins, Michael E
- Database ID:
- RTHC-01369
Evidence Hierarchy
Describes what happened to one person or a small group.
What do these levels mean? →Frequently Asked Questions
How does capsaicin cream help with vomiting?
Capsaicin binds to TRPV1 receptors, the same receptors activated by heat. Overstimulating these receptors is thought to impair substance P signaling in the brain regions that control vomiting (area postrema and nucleus tractus solitarius). This is similar to why CHS patients find relief from hot showers.
Where do you apply the capsaicin cream?
The case series did not specify a standardized application site. In practice, capsaicin cream for CHS is typically applied to the abdomen, but protocols vary. The active ingredient in the cream is the same compound that makes hot peppers hot.
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Cite This Study
https://rethinkthc.com/research/RTHC-01369APA
Dezieck, Laurel; Hafez, Zachary; Conicella, Albert; Blohm, Eike; O'Connor, Mark J; Schwarz, Evan S; Mullins, Michael E. (2017). Resolution of cannabis hyperemesis syndrome with topical capsaicin in the emergency department: a case series.. Clinical toxicology (Philadelphia, Pa.), 55(8), 908-913. https://doi.org/10.1080/15563650.2017.1324166
MLA
Dezieck, Laurel, et al. "Resolution of cannabis hyperemesis syndrome with topical capsaicin in the emergency department: a case series.." Clinical toxicology (Philadelphia, 2017. https://doi.org/10.1080/15563650.2017.1324166
RethinkTHC
RethinkTHC Research Database. "Resolution of cannabis hyperemesis syndrome with topical cap..." RTHC-01369. Retrieved from https://rethinkthc.com/research/dezieck-2017-resolution-of-cannabis-hyperemesis
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.