First reported cases of capsaicin cream successfully treating cannabinoid hyperemesis in adolescents
Two adolescent patients with cannabinoid hyperemesis syndrome who did not respond to standard anti-nausea treatments improved with topical capsaicin cream in a pediatric ER, marking the first reported use of this treatment in children.
Quick Facts
What This Study Found
Two adolescent patients presented to a pediatric emergency department with nausea, vomiting, and abdominal pain in the setting of chronic cannabis use. Standard antiemetic therapies failed to relieve their symptoms.
Both patients responded to topical capsaicin cream administration. The mechanism involves capsaicin's high-specificity binding to TRPV1 receptors, which impairs substance P signaling in brain regions that control vomiting (area postrema and nucleus tractus solitarius).
These are the first reported cases of capsaicin being used to treat CHS in pediatric patients. The treatment is cost-effective and has few serious side effects, making it an attractive alternative to haloperidol, which carries risks of dystonia, extrapyramidal reactions, and neuroleptic malignant syndrome.
Key Numbers
2 adolescent patients. Both had chronic cannabis use, nausea/vomiting/abdominal pain. Both failed standard antiemetics. Both responded to topical capsaicin. First pediatric cases reported.
How They Did This
Case series of two adolescent patients with CHS symptoms refractory to standard antiemetic treatment, treated with topical capsaicin cream in a pediatric emergency department.
Why This Research Matters
CHS is increasingly recognized in adolescents but is often misdiagnosed. Standard treatments frequently fail, and alternatives like haloperidol carry significant risks in young patients. Capsaicin cream offers a safe, inexpensive option that the adult literature has shown to be effective, and this case series extends it to the pediatric population.
The Bigger Picture
CHS in adolescents is an under-recognized diagnosis that can lead to repeated ER visits and unnecessary testing. Establishing capsaicin cream as a safe pediatric treatment option could reduce healthcare costs and complications from more aggressive therapies. The publication in Pediatrics brings this treatment option to the attention of pediatric providers specifically.
What This Study Doesn't Tell Us
Only two cases. No control group. Case reports cannot establish efficacy or determine optimal dosing. Self-resolving symptoms cannot be excluded. The long-term effectiveness and need for ongoing cannabis cessation were not assessed.
Questions This Raises
- ?What is the optimal capsaicin concentration for pediatric CHS patients?
- ?How long does symptom relief last?
- ?Would capsaicin be effective for outpatient CHS management in adolescents?
Trust & Context
- Key Stat:
- First pediatric cases: capsaicin cream relieved CHS when standard treatments failed
- Evidence Grade:
- Two-case series. Provides proof of concept for pediatric capsaicin use in CHS but very limited evidence.
- Study Age:
- Published in 2017 in Pediatrics. Capsaicin for CHS has gained wider acceptance in pediatric emergency medicine since.
- Original Title:
- Capsaicin Cream for Treatment of Cannabinoid Hyperemesis Syndrome in Adolescents: A Case Series.
- Published In:
- Pediatrics, 140(6) (2017)
- Authors:
- Graham, Jessica, Barberio, Michael, Wang, George Sam(15)
- Database ID:
- RTHC-01388
Evidence Hierarchy
Describes what happened to one person or a small group.
What do these levels mean? →Frequently Asked Questions
Is capsaicin cream safe for teenagers?
Topical capsaicin cream is generally well tolerated with few serious side effects. The main side effect is local skin irritation or burning sensation. In these two cases, it was used safely in adolescents in a supervised emergency department setting.
Why is capsaicin used instead of regular anti-nausea medications?
CHS is often resistant to standard antiemetics. Capsaicin acts through a different mechanism (TRPV1 receptors) that may specifically address the pathophysiology of CHS. It is also cheaper and safer than alternatives like haloperidol, which can cause serious neurological side effects.
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Cite This Study
https://rethinkthc.com/research/RTHC-01388APA
Graham, Jessica; Barberio, Michael; Wang, George Sam. (2017). Capsaicin Cream for Treatment of Cannabinoid Hyperemesis Syndrome in Adolescents: A Case Series.. Pediatrics, 140(6). https://doi.org/10.1542/peds.2016-3795
MLA
Graham, Jessica, et al. "Capsaicin Cream for Treatment of Cannabinoid Hyperemesis Syndrome in Adolescents: A Case Series.." Pediatrics, 2017. https://doi.org/10.1542/peds.2016-3795
RethinkTHC
RethinkTHC Research Database. "Capsaicin Cream for Treatment of Cannabinoid Hyperemesis Syn..." RTHC-01388. Retrieved from https://rethinkthc.com/research/graham-2017-capsaicin-cream-for-treatment
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.