Cannabinoid Hyperemesis Syndrome (CHS) is a condition that develops in long-term cannabis users, marked by cycles of severe nausea, vomiting, and abdominal pain. This debilitating illness often resists standard anti-nausea medications, leading many sufferers to seek alternative remedies for relief. Capsaicin cream, the compound responsible for the heat in chili peppers, has emerged as a commonly sought palliative treatment for the intense discomfort associated with the hyperemetic phase of the syndrome.
Understanding Cannabinoid Hyperemesis Syndrome
CHS is characterized by repeated, severe bouts of vomiting and abdominal pain in individuals who use cannabis frequently and for extended periods. The condition progresses through three distinct phases, beginning with the prodromal phase. This initial stage involves subtle symptoms like early morning nausea, abdominal discomfort, and a fear of vomiting, which can last for months or even years.
The hyperemetic phase is the most severe, involving overwhelming and recurrent vomiting that may occur up to five times an hour, alongside intense abdominal pain. Patients often find temporary relief from these symptoms by compulsively taking hot showers or baths, a behavior that is a recognized indicator of the syndrome. This phase is when individuals typically seek medical care due to the severity of the symptoms.
The recovery phase begins when cannabis use is completely stopped. Symptoms gradually subside over several days to months, and normal eating patterns return. If cannabis use is resumed, the cycle of the syndrome will restart, leading back to the prodromal or hyperemetic phase.
Mechanism of Action: Why Capsaicin Provides Relief
The scientific rationale for using capsaicin relates to its effect on the transient receptor potential vanilloid 1 (TRPV1) receptor. Capsaicin acts as an agonist, strongly activating this receptor, which is found in sensory nerve fibers in the skin and throughout the body. The TRPV1 receptor is also naturally activated by noxious heat, explaining why many CHS sufferers find temporary relief in hot showers.
Activating the TRPV1 receptors on the skin with capsaicin cream creates a sensation of heat and a mild burning, mimicking the effect of a hot shower. The leading theory suggests this intense peripheral stimulation distracts the nervous system from severe nausea signals originating in the gut. By over-stimulating these receptors, capsaicin may impair the signaling of Substance P, a neurotransmitter involved in transmitting pain and nausea, thereby providing an antiemetic effect.
Capsaicin’s action on the TRPV1 receptors may also help regulate the body’s internal temperature, which is connected to the hypothalamus, the part of the brain that controls both temperature and vomiting. This action may help correct a suspected dysregulation in the endocannabinoid system, believed to be a factor in CHS. Topical capsaicin offers a non-invasive, cost-effective method to achieve a similar effect to hot water hydrotherapy without constant bathing.
Precise Application Guidelines
The most effective application site for capsaicin cream is the abdomen, where a thin, uniform layer should be applied directly to the skin. The abdomen is the primary target because of its proximity to the affected gastrointestinal system. Applying the cream to this area provides rapid symptomatic relief, sometimes within 30 minutes.
For patients experiencing intense, widespread pain or nausea, secondary application sites may include the lower back, forearms, or thighs. The concentration of the cream typically used ranges from 0.025% to 0.1%, though higher concentrations may be more effective. Application frequency is commonly every four to six hours, or as needed for symptom recurrence.
The amount applied should be a thin coating spread lightly over the affected area, not rubbed in like a typical lotion. A temporary burning sensation should be expected immediately after application, confirming the activation of the TRPV1 receptors. Hands must be washed thoroughly with soap and water immediately after application to prevent the transfer of capsaicin to sensitive areas.
Strict safety precautions must be followed to avoid contact with the eyes, nose, mouth, and any mucous membranes, as this causes intense pain and irritation. If irritation occurs outside the application area, rinse the area with milk, as the casein protein helps break down the capsaicin. The skin in the application area should be intact and free from cuts or abrasions.
When Topical Treatment is Insufficient
Capsaicin cream provides palliative care, offering temporary relief from symptoms, but it is not a cure for Cannabinoid Hyperemesis Syndrome. If symptoms persist or worsen despite proper application, the topical treatment is insufficient, and more aggressive medical intervention is required. Patients unable to keep down fluids for an extended period should seek immediate medical attention.
Seeking Medical Intervention
Severe dehydration is a serious complication of prolonged vomiting. Signs include dizziness, fainting, reduced urination, and rapid heartbeat. Persistent vomiting can also lead to an electrolyte imbalance, requiring intravenous fluid and electrolyte replacement in a hospital setting.
If capsaicin cream fails to provide relief, the medical team may administer other medications like haloperidol, which has shown success in treating CHS symptoms. The only definitive treatment that stops the recurring cycles of CHS is the sustained cessation of all cannabis use, including products containing THC and CBD. While capsaicin provides comfort during an acute episode, it does not address the underlying cause of the syndrome.