An ED nurse applied the study medication cream to the abdomen in a uniform manner.Both creams were de-identified, had no scent and were packaged similarly.Treatment Group: 5 g of topical 0.1% capsaicin cream.Eligible patients were randomized to one of the following two groups.Enrollment occurred between December 2017 and July 2019 by research team members present in the ED 7 days a week from 8am to midnight (and not during holidays).Randomized double-blind placebo-controlled pilot trial performed at a single urban academic trauma center with approximately 100,000 annual ED visits.What is the safety and efficacy of topical capsaicin cream for vomiting from suspected cannabinoid hyperemesis syndrome in the emergency department?.A Pilot Trial of Topical Capsaicin Cream for Treatment of Cannabinoid Hyperemesis Syndrome. Treatment typically involves cessation of cannabis use however the authors of this randomized controlled pilot study wished to investigate the use of topical capsaicin cream when compared to placebo. 2 In addition to the history of frequent cannabis use, patients’ self-reported relief of symptoms following hot showers or baths helps distinguish CHS from other cyclic vomiting syndromes. 2 The duration of cannabis use in CHS also widely varies with the majority of patients reporting daily use and beginning use early in life. 1 The pathophysiology of CHS remains unclear and large systematic reviews of the literature have recommended up to 9 differing mechanisms as to why it occurs. doi: 10.1007/s1318-z.Background Information: Cannabinoid Hyperemesis Syndrome (CHS) is characterized by the chronic use of cannabis paired with nausea, recurrent vomiting episodes and diffuse abdominal pain. Cannabinoid hyperemesis syndrome: diagnosis, pathophysiology, and treatment-a systematic review. Resolution of cannabis hyperemesis syndrome with topical capsaicin in the emergency department: a case series. Cyclic vomiting presentations following marijuana liberalization in Colorado. Marijuana legalization: impact on physicians and public health. T., Yarnell S., Radhakrishnan R., Ball S. National estimates of marijuana use and related indicators-national survey on drug use and health, United States, 2002–2014. E, Schauer G., McAfee T., Grant A., Lyerla R. She was discharged on topical capsaicin and counselled on marijuana abstinence, with no return of symptoms.īased on the dramatic resolution of symptoms with topical capsaicin, our case supports this promising intervention and provides an alternate approach to antiemetics and narcotics routinely used in patients with cannabis hyperemesis syndrome.Īzofeifa A., Mattson M. Repeat endoscopic evaluation had no evidence of ulcers, celiac disease, or esophagitis. A trial of topical capsaicin, over the epigastric region, was tried that provided dramatic relief within 24 hours. A diagnosis of cannabis hyperemesis syndrome was made based on history of chronic marijuana use and otherwise negative workup. Intravenous fluids, antiemetics, and morphine were started for pain control with no symptomatic improvement. The patient returned the next day with extreme retching, nausea, and vomiting and was admitted for further evaluation. She was instructed to continue pantoprazole and pain medication and outpatient repeat esophagogastroduodenoscopy. A detailed abdominal exam was only positive for mild epigastric tenderness. On this presentation, basic laboratory workup, EKG, and CT scan of abdomen and pelvis were unremarkable. She had similar, milder symptoms a year ago and underwent endoscopic evaluation which was negative except for mild reflux esophagitis for which she was started on a proton pump inhibitor. A 41-year-old female with a recent excess use of cannabis presented to the emergency department for evaluation of recurrent excruciating epigastric pain accompanied by severe nausea and vomiting. We, therefore, present a case of CHS successfully treated with topical capsaicin application. Most patients with CHS make frequent visits to the emergency room and are usually refractory to conventional treatment. With increasing use of marijuana, the incidence of CHS is expected to increase. Cannabinoid hyperemesis syndrome (CHS), associated with chronic cannabis use, presents with cyclic abdominal pain, nausea, and vomiting.
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