Capsaicin Cream for Cannabinoid Hyperemesis Syndrome in the ER | Research

The takeaway

Topical capsaicin cream provided modest pain relief for emergency department patients with suspected cannabinoid hyperemesis syndrome, with 42% needing no further treatment afterward.

Emergency medicine providers, cannabis users experiencing cyclical vomiting

42% needed no further therapy after capsaicin

What the researchers found

Among 57 patients receiving capsaicin for suspected CHS, pain scores dropped from a median of 8 to 5.5, and nearly half required no additional symptomatic therapy after application.

Why it matters

Cannabinoid hyperemesis syndrome is notoriously difficult to treat. Standard antiemetics often fail, and many patients receive opioids. A simple topical cream that provides relief could reduce reliance on more problematic medications.

The numbers in context

57 patients; pain score median 8 to 5.5; 98% received antiemetics; 47% received an opioid; 42% needed no further therapy after capsaicin; capsaicin applied at median 4 hours into visit

How the study worked

Retrospective chart review of 57 patients with suspected CHS who received capsaicin cream in an emergency department between July 2014 and October 2018.

What this study cannot tell us

Retrospective design without a control group. Capsaicin was typically given after antiemetics and opioids, making it hard to isolate its independent effect.

How to read the evidence

Retrospective chart review without a control group, and capsaicin was given after other treatments in most cases.

When this study was published

Published in 2022

The bigger picture

CHS has become increasingly common as cannabis use has risen. Finding effective non-opioid treatments for the severe abdominal pain it causes remains a clinical priority.

Questions still open

Would earlier capsaicin application produce better results? Could capsaicin reduce the need for opioids if given as a first-line treatment for CHS?

Common questions

What is cannabinoid hyperemesis syndrome?

CHS is a condition in long-term cannabis users characterized by cyclical severe nausea, vomiting, and abdominal pain, often temporarily relieved by hot showers.

How does capsaicin cream help with CHS?

Applied topically to the abdomen, capsaicin cream reduced pain scores from a median of 8 to 5.5 in this study. The exact mechanism is unclear but may involve activating TRPV1 receptors, similar to the relief from hot showers.

Read the original research

Use of Capsaicin Cream in Cannabinoid Hyperemesis Syndrome in Patients Presenting to the Emergency Department.

The Annals of pharmacotherapy, 56(2), 151-154

View on PubMed ↗Publisher’s paper ↗

Citation

Lee, Allison; Coralic, Zlatan. (2022). Use of Capsaicin Cream in Cannabinoid Hyperemesis Syndrome in Patients Presenting to the Emergency Department.. The Annals of pharmacotherapy, 56(2), 151-154. https://doi.org/10.1177/10600280211018516