Topical capsaicin helped more CHS patients in the emergency department than standard treatment alone

A significantly greater proportion of patients receiving capsaicin achieved efficacy (55% vs. 21%, p<0.001). Time to discharge after treatment was shorter in the capsaicin group (3.72 vs. 6.11 hours, p=0.001). However, capsaicin did not reduce total medications received or total ED length of stay, suggesting it may work best as a first-line treatment rather than a rescue add-on.

Single-center retrospective cohort study of 201 patients (25 pediatric) with suspected or confirmed CHS presenting to the ED. Compared outcomes between patients who received topical capsaicin and those who did not. Primary outcome: requiring one or fewer rescue medications after treatment.

CHS is increasingly common and notoriously difficult to treat in the ED. Capsaicin cream applied to the abdomen is cheap, low-risk, and appears to provide meaningful symptom relief, potentially reducing ED stays and the need for multiple antiemetics.

The biological rationale involves TRPV1 receptors, which capsaicin activates and which are also involved in cannabinoid signaling. The finding that capsaicin works better early in the ED course (before multiple medications) supports using it as a first-line approach.

Retrospective design. Non-randomized treatment assignment. Single center. CHS diagnosis was clinical (no biomarker). Cannot control for which patients received capsaicin vs. not.