Systematic review finds capsaicin data for CHS is promising but low quality
Capsaicin was beneficial in all CHS case reports and series (18 patients total), but two retrospective cohort studies found no significant benefit on ER length of stay.
Quick Facts
What This Study Found
Five full-text articles and 6 conference abstracts were included. Case reports and series (n=18 patients) found capsaicin effective for CHS. However, both retrospective cohort studies failed to find significant benefits for capsaicin on ER length of stay as primary outcome.
Key Numbers
241 articles screened; 11 included; 18 patients in case reports/series all showed benefit; 2 retrospective cohort studies found no significant improvement in ER length of stay.
How They Did This
Systematic review searching MEDLINE, CINAHL, and EMBASE through March 2019. Included 5 full-text articles (3 case reports, 2 case series) and 6 conference abstracts (1 case report, 3 case series, 2 retrospective cohorts).
Why This Research Matters
Capsaicin is recommended as first-line CHS treatment in some guidelines, but this review reveals the evidence behind that recommendation is essentially case reports. The two studies with better designs found no benefit.
The Bigger Picture
The disconnect between positive case reports and negative cohort studies is a cautionary tale for evidence-based medicine. Capsaicin may still help individual patients, but the evidence does not support routine first-line use.
What This Study Doesn't Tell Us
All evidence is low methodological quality. Publication bias likely (positive case reports more likely published). No randomized trials exist. Capsaicin dosing and application varied across studies.
Questions This Raises
- ?Would a randomized trial of capsaicin for CHS settle the question?
- ?How does capsaicin compare to droperidol or benzodiazepines for CHS?
Trust & Context
- Key Stat:
- Cohort studies showed no benefit
- Evidence Grade:
- Preliminary: systematic review constrained by uniformly low-quality included studies.
- Study Age:
- Published in 2019.
- Original Title:
- Efficacy of Capsaicin for the Treatment of Cannabinoid Hyperemesis Syndrome: A Systematic Review.
- Published In:
- The Annals of pharmacotherapy, 53(11), 1145-1152 (2019)
- Database ID:
- RTHC-02168
Evidence Hierarchy
Analyzes all available research on a topic using a structured method.
What do these levels mean? →Frequently Asked Questions
Does capsaicin cream work for CHS?
Case reports say yes (18/18 patients improved), but two retrospective studies with more patients found no significant benefit on ER stay duration. The evidence quality is low overall.
Why is capsaicin used for CHS?
Capsaicin activates TRPV1 receptors, which overlap with cannabinoid receptor pathways in the gut. It mimics the relief patients get from hot showers, which also activate TRPV1 receptors.
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Cite This Study
https://rethinkthc.com/research/RTHC-02168APA
McConachie, Sean M; Caputo, Ryan A; Wilhelm, Sheila M; Kale-Pradhan, Pramodini B. (2019). Efficacy of Capsaicin for the Treatment of Cannabinoid Hyperemesis Syndrome: A Systematic Review.. The Annals of pharmacotherapy, 53(11), 1145-1152. https://doi.org/10.1177/1060028019852601
MLA
McConachie, Sean M, et al. "Efficacy of Capsaicin for the Treatment of Cannabinoid Hyperemesis Syndrome: A Systematic Review.." The Annals of pharmacotherapy, 2019. https://doi.org/10.1177/1060028019852601
RethinkTHC
RethinkTHC Research Database. "Efficacy of Capsaicin for the Treatment of Cannabinoid Hyper..." RTHC-02168. Retrieved from https://rethinkthc.com/research/mcconachie-2019-efficacy-of-capsaicin-for
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.