Hot water and topical capsaicin likely relieve CHS symptoms by activating TRPV1 receptors, which interact extensively with the endocannabinoid system and trigger downstream anti-nausea effects through multiple pathways.
CHS patients, emergency physicians, pharmacologists studying endocannabinoid-TRPV1 interactions.
About 20 published cases have documented capsaicin successfully treating CHS symptoms, with effects potentially lasting longer than hot showers due to topical capsaicin's longer half-life.
What the researchers found
Capsaicin and hot water both activate TRPV1 receptors, which share extensive cross-talk with the endocannabinoid system. TRPV1 activation triggers modulation of tachykinins, somatostatin, PACAP, CGRP, and histaminergic/cholinergic/serotonergic transmission - all of which have anti-emetic potential. The review identified 137 relevant articles detailing these mechanisms.
Why it matters
CHS patients often instinctively seek hot showers for relief, and capsaicin cream has emerged as a treatment option. Understanding why these work reveals fundamental connections between the endocannabinoid system and temperature-sensing pathways that could lead to better treatments.
The numbers in context
2,417 articles screened, 137 included. About 20 published cases of capsaicin successfully treating CHS. TRPV1 responds to temperatures above 43 degrees C and pH below 6.
How the study worked
Systematic literature search of PubMed, OpenGrey, and Google Scholar through April 2017, screening 2,417 articles for relevant thermoregulatory and anti-emetic mechanisms. 137 articles were included.
What this study cannot tell us
Largely theoretical, connecting mechanisms from separate research areas. Most CHS treatment evidence is from case reports. The exact contribution of each proposed pathway remains unknown.
How to read the evidence
Preliminary - theoretical framework connecting diverse mechanisms, supported by case reports rather than controlled trials.
When this study was published
Published in 2018. Capsaicin for CHS has gained wider acceptance since.
The bigger picture
The connection between the endocannabinoid system and TRPV1 receptors may explain not just CHS symptoms but also broader phenomena around how cannabinoids interact with pain, temperature regulation, and nausea throughout the body.
Questions still open
- Could synthetic TRPV1 agonists be more effective than capsaicin? Is there an optimal temperature for hot water therapy? Could combining capsaicin with other TRPV1 activators enhance relief?
Common questions
Why do hot showers help with cannabinoid hyperemesis syndrome?
Does capsaicin cream work for CHS?
Read the original research
Cannabinoid hyperemesis syndrome: potential mechanisms for the benefit of capsaicin and hot water hydrotherapy in treatment.
Clinical toxicology (Philadelphia, Pa.), 56(1), 15-24
Citation
Richards, John R; Lapoint, Jeff M; Burillo-Putze, Guillermo. (2018). Cannabinoid hyperemesis syndrome: potential mechanisms for the benefit of capsaicin and hot water hydrotherapy in treatment.. Clinical toxicology (Philadelphia, Pa.), 56(1), 15-24. https://doi.org/10.1080/15563650.2017.1349910
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