A popular ointment used to relieve muscle pain could also provide relief for cannabinoid hyperemesis syndrome, according to a recent review of the available research. While there is not yet enough evidence to indicate the efficacy of topical capsaicin for relief of this mysterious, rare cannabis-induced syndrome, it is still safe and cheap enough to be recommended for outpatient use.
Found in chili peppers, capsaicin is sold over the counter for treating muscle and joint pain, as well other conditions including postherpetic neuralgia, a complication from shingles.
Cannabinoid hyperemesis syndrome is a rare and serious side effect of chronic cannabis use characterized by repeated, severe instances of vomiting, nausea, and abdominal pain that can last for days.
Patients suffering from the condition often seek relief from their symptoms by taking a hot shower. The only fully effective treatment is prolonged cessation of cannabis use.
The article, which appeared in the Journal of Pharmacy Practice, looked at a total of nine case reports/case series and two retrospective cohort analyses dealing with a total of 94 patients. Of the 94 patients, 72 reported that the treatment was effective, and of these, clinical improvement was documented in 58 patients. Of the 55 patients who reported their level of cannabis use, 50 were daily users.
The treatment given to those users was a 0.075% capsaicin cream applied directly to the patient’s abdomen.
The researchers described a case series of 13 patients that found qualitative improvements, including the ability to ingest food or liquid as well as a reduction in the time it took them to discharge from the emergency room. All of the patients reported that their symptoms improved.
In another study, 10 patients with cannabinoid hyperemesis syndrome who checked into an emergency room were given capsaicin. Of these, the time it took until they were discharged was on average 51 minutes shorter than that of the control group.
Yet another study looked at by the researchers evaluated emergency room discharge time in 43 patients given capsaicin cream and found that it was on average 22 minutes shorter (201 minutes to 179 minutes). They did note, however, that the finding was not statistically significant and may have been influenced by other non treatment-specific factors.
The most common adverse side effect of capsaicin treatment was burning or skin irritation at the site of application. The low cost of capsaicin treatment (about $3 per visit) and the relative dearth of side effects “support the safety of capsaicin within a multi-modal treatment approach for CHS, despite the lack of significant decrease in [emergency department] length of stay,” the researchers wrote.
In their conclusion, they state that despite limited evidence of its efficacy, “[g]iven the risk versus benefit profile, until the results of prospective controlled studies suggest otherwise, topical capsaicin should be incorporated into a multi-modal approach to CHS management.”
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