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.
Read this if you experience cannabinoid hyperemesis or are an ER provider looking for CHS treatment options.
13/13 CHS patients improved with topical capsaicin after other treatments failed
What the researchers 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.
Why it 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 numbers in context
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 the study worked
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.
What this study cannot 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.
How to read the evidence
Small retrospective case series. Promising results but no control group or standardized protocol.
When this study was published
Published in 2017. Topical capsaicin for CHS has since been studied in additional case series and is increasingly used in emergency departments.
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.
Questions still open
- 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?
Common questions
How does capsaicin cream help with vomiting?
Where do you apply the capsaicin cream?
Read the original research
Resolution of cannabis hyperemesis syndrome with topical capsaicin in the emergency department: a case series.
Clinical toxicology (Philadelphia, Pa.), 55(8), 908-913
Citation
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
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