Management of Cannabinoid Hyperemesis Syndrome: Focus on Capsaicin

2020 ◽  
pp. 089719002093428
Author(s):  
Janice L. Stumpf ◽  
Lauren D. Williams
Keyword(s):  
Abdominal Pain ◽  
Clinical Presentation ◽  
Marijuana Use ◽  
Hot Water ◽  
Severe Nausea ◽  
Trpv1 Receptors ◽  
Cannabinoid Hyperemesis Syndrome ◽  
Topical Capsaicin

Cannabinoid hyperemesis syndrome is a condition characterized by cyclic severe nausea, vomiting, and abdominal pain associated with frequent, long-term marijuana use. The condition resolves with cessation of cannabis but may be temporarily relieved by bathing in hot water. Topical capsaicin cream may also alleviate symptoms, perhaps through antiemetic effects produced by activation of TRPV1 receptors, similar to that of hot water bathing. This review summarizes the epidemiology, clinical presentation, diagnosis, pathophysiology, and management of cannabinoid hyperemesis syndrome, focusing on treatment with topical capsaicin.

scholarly journals Cannabinoid Hyperemesis Syndrome: A Case Report of Cyclic Severe Hyperemesis and Abdominal Pain with Long-Term Cannabis Use

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Julia Hermes-Laufer ◽  
Lola Del Puppo ◽  
Ihsan Inan ◽  
François-Xavier Troillet ◽  
Omar Kherad
Keyword(s):  
Abdominal Pain ◽  
Case Report ◽  
D2 Receptor ◽  
Rare Condition ◽  
Final Diagnosis ◽  
Cannabis Use ◽  
Severe Nausea ◽  
Cannabis Consumption ◽  
Cannabinoid Hyperemesis Syndrome

Introduction.Cannabinoid Hyperemesis Syndrome (CHS) is a rare condition that includes cyclic severe vomiting in subjects who have been consuming large doses of cannabis for several years. One of the major diagnostic criteria is the alleviation of symptoms by hot showers. The syndrome was first described in 2004 and is so far neither completely understood nor well known. The latter leads to continued morbidity in concerned subjects and unnecessary expenses for futile investigations. Standard treatments of vomiting as 5-HT3 or D2-receptor antagonists have been shown to be ineffective in alleviating the symptoms. The only long-term satisfying treatment option is the complete abstinence from cannabis consumption.Case Summary.In this case report we describe a 26-year-old male Caucasian long-term cannabis consumer who repeatedly presented in our emergency room with cyclic severe nausea and vomiting ceased by hot showers and resistant to all other treatments. The final diagnosis was not established until his third visit to the ER.Conclusion.CHS is an important differential diagnosis in patients who present with cyclic vomiting and abdominal pain with a history of long-term cannabis use. Recognition of this syndrome is important in order to avoid unnecessary clinical testing and to help the patients break the cycle of drug use.

scholarly journals Cannabinoid Hyperemesis Syndrome: Case Report of a Paradoxical Reaction with Heavy Marijuana Use

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Benjamin Cox ◽  
Akansha Chhabra ◽  
Michael Adler ◽  
Justin Simmons ◽  
Diana Randlett
Keyword(s):  
Abdominal Pain ◽  
Marijuana Use ◽  
Symptomatic Treatment ◽  
Clinical Findings ◽  
Term Treatment ◽  
Paradoxical Reaction ◽  
Long Term Treatment ◽  
Cannabinoid Hyperemesis Syndrome ◽  
History Of

Cannabinoid hyperemesis syndrome (CHS) is a rare constellation of clinical findings that includes a history of chronic heavy marijuana use, severe abdominal pain, unrelenting nausea, and intractable vomiting. A striking component of this history includes the use of hot showers or long baths that help to alleviate these symptoms. This is an underrecognized syndrome that can lead to expensive and unrevealing workups and can leave patients self-medicating their nausea and vomiting with the very substance that is causing their symptoms. Long-term treatment of CHS is abstinence from marijuana use—but the acute symptomatic treatment of CHS has been a struggle for many clinicians. Many standard medications used for the symptomatic treatment of CHS (including ondansetron, promethazine, and morphine) have repeatedly been shown to be ineffective. Here we present the use of lorazepam as an agent that successfully and safely treats the tenacious symptoms of CHS. Additionally, we build upon existing hypotheses for the pathogenesis of CHS to try to explain why a substance that has been used for thousands of years is only now beginning to cause this paradoxical hyperemesis syndrome.

scholarly journals Cannabinoid Hyperemesis Syndrome: A Case Report of an Underdiagnosed Condition

2020 ◽  
pp. 1-5
Author(s):  
João Machado Nogueira ◽  
Inês Fonseca ◽  
Marco Duarte
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Diagnostic Tests ◽  
Clinical Symptoms ◽  
Definitive Diagnosis ◽  
Hot Water ◽  
Illustrative Case ◽  
Raising Awareness ◽  
Detailed Medical History ◽  
Cannabinoid Hyperemesis Syndrome

Cannabinoid hyperemesis syndrome (CHS) is characterized by episodic bursts of nausea, vomiting and abdominal pain, affecting chronic cannabis users. The clinical picture mimics an acute abdomen, usually leading to multiple assessments in the emergency department. Several complementary diagnostic examinations are performed with non-specific results, making differential diagnosis puzzling. We present a case of a 42-year-old man, who has been admitted multiple times to the emergency department in the last 3 months for abdominal pain, nausea and vomiting, without triggering factors and improving only with hot water baths. He was evaluated by different specialties, the various complementary diagnostic tests performed showed no significant results, and no definitive diagnosis was obtained. Treatment resulted only in a partial and transient resolution of symptoms. A more detailed medical history revealed cannabis use for more than 5 years, with a recent increase in the amount consumed. After psychoeducation, explaining the risks associated with consumption and its relationship with the clinical symptoms, which resulted in complete suspension of cannabis, there have been no new symptomatic episodes since then. We present an illustrative case of a poorly reported clinical entity despite having a probable significant prevalence, raising awareness in order that clinicians identify and properly manage these cases.

scholarly journals Topical Capsaicin for Treating Cannabinoid Hyperemesis Syndrome

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Ansar Aziz ◽  
Tayyab Waheed ◽  
Olubunmi Oladunjoye ◽  
Adeolu Oladunjoye ◽  
Midhat Hanif ◽  
...  
Keyword(s):  
Epigastric Pain ◽  
Symptomatic Improvement ◽  
Nausea And Vomiting ◽  
Endoscopic Evaluation ◽  
Severe Nausea ◽  
Capsaicin Application ◽  
Cannabinoid Hyperemesis Syndrome ◽  
History Of ◽  
Topical Capsaicin ◽  
Cannabis Hyperemesis Syndrome

Introduction. Cannabinoid hyperemesis syndrome (CHS), associated with chronic cannabis use, presents with cyclic abdominal pain, nausea, and vomiting. With increasing use of marijuana, the incidence of CHS is expected to increase. Most patients with CHS make frequent visits to the emergency room and are usually refractory to conventional treatment. We, therefore, present a case of CHS successfully treated with topical capsaicin application. Case Presentation. 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. 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. On this presentation, basic laboratory workup, EKG, and CT scan of abdomen and pelvis were unremarkable. A detailed abdominal exam was only positive for mild epigastric tenderness. She was instructed to continue pantoprazole and pain medication and outpatient repeat esophagogastroduodenoscopy. The patient returned the next day with extreme retching, nausea, and vomiting and was admitted for further evaluation. Intravenous fluids, antiemetics, and morphine were started for pain control with no symptomatic improvement. A diagnosis of cannabis hyperemesis syndrome was made based on history of chronic marijuana use and otherwise negative workup. A trial of topical capsaicin, over the epigastric region, was tried that provided dramatic relief within 24 hours. Repeat endoscopic evaluation had no evidence of ulcers, celiac disease, or esophagitis. She was discharged on topical capsaicin and counselled on marijuana abstinence, with no return of symptoms. Conclusion. Based 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.

Cannabinoid hyperemesis syndrome

2016 ◽  
Vol 33 (S1) ◽  
pp. S306-S307 ◽  
Author(s):  
S. López-Romeo ◽  
G. Ledesma-Iparraguirre
Keyword(s):  
Abdominal Pain ◽  
Outpatient Service ◽  
Somatoform Disorder ◽  
Cannabis Use ◽  
Abdominal Ultrasonography ◽  
Cannabinoid Hyperemesis Syndrome ◽  
History Of ◽  
Disorder Treatment ◽  
Competing Interest

Case reportA 25-year-old man was attended in multiple times at Emergency Department by referring abdominal pain and vomiting. No organic disease was found and he was referred to Psychiatric Emergency to assess him. He had history of cannabis use (4–5 times/day) during last 5 years. He referred recurrent episodes of abdominal pain and vomiting since 4 years ago, he had found that having hot showers alleviate his symptoms. Urine screening was positive for THC and negative for other drugs. In results of blood tests, abdominal X-ray, abdominal ultrasonography, abdominal tomography and fibrogastroscopy didn’t find any abnormality. He was diagnosed from suffering a somatoform disorder. Treatment with Setraline 50 mg/day was prescribed and cannabis abstinence was recommended. He was referred to Mental Health outpatient service. He maintained cannabis abstinence for 1 month and some symptoms disappeared. However, 2 months later, he relapsed in cannabis use and all symptoms reappeared. Later he achieved cannabis abstinence again and he got full recovery, then he was diagnosed from cannabinoid hyperemesis syndrome.ConclusionCannabinoid hyperemesis syndrome is characterized by recurrent nausea, vomiting and colicky abdominal pain in patients with long-term cannabis use. These symptoms have been reported to be alleviated temporarily by taking a hot shower or more permanently by abstaining from the use of cannabis. The phenomenon of cannabinoid hyperemesis and clinical diagnosis remained obscure until recently. For this reason, it is necessary to take it into account in order to recognize it and help provide these patients early and better approach.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Cannabinoid hyperemesis syndrome, a treatment discussion

2017 ◽  
Vol 41 (S1) ◽  
pp. S318-S318 ◽  
Author(s):  
S. Ramos-perdigues ◽  
M.J. Gordillo ◽  
C. Caballero ◽  
S. Latorre ◽  
S.V. Boned ◽  
...  
Keyword(s):  
Emergency Department ◽  
Case Series ◽  
Hot Water ◽  
Potential Treatment ◽  
Severe Nausea ◽  
Adequate Treatment ◽  
Routes Of Administration ◽  
Cannabinoid Hyperemesis Syndrome ◽  
Competing Interest ◽  
Chronic Use

IntroductionCannabinoid hyperemesis syndrome (CHS), is characterized by recurrent episodes of severe nausea and intractable vomiting, preceded by chronic use of cannabis. A pathognomonic characteristic is compulsive bathing in hot water. The resolution of the problem occurs when cannabis use is stopped. However, patients are often reluctant to discontinue cannabis. Treatment with anti-emetic medication is ineffective. Case series suggested haloperidol as a potential treatment. Other antipsychotics as olanzapine has been used as anti-emetic treatment in chemotherapy.ObjectivesTo describe three cases of patients with CHS whom showed a successful response to olanzapine, even when, haloperidol had failed.AimsTo present an alternative treatment for CHS which can offer benefits over haloperidol.MethodsWe present three cases of patients who suffered from CHS and were admitted to emergency department. All patients were treated with olanzapine after conventional anti-hemetic treatment failure. One patient was also unsuccessfully treated with haloperidol.ResultsAll three patients showed a good response to olanzapine treatment. Different presentations were effective: velotab and intramuscular. Their nausea, vomits and agitation were ameliorated. They could be discharge after maintained remission of symptoms.ConclusionsOlanzapine should be considered as an adequate treatment for CHS. Its suitable receptorial profile, its availability in different routes of administration and its side effects profile could offer some benefits over haloperidol.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Use of Capsaicin Cream in Cannabinoid Hyperemesis Syndrome in Patients Presenting to the Emergency Department

2021 ◽  
pp. 106002802110185
Author(s):  
Allison Lee ◽  
Zlatan Coralic
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Pain Score ◽  
Adverse Drug Events ◽  
Symptomatic Relief ◽  
Symptomatic Therapy ◽  
Cannabis Consumption ◽  
Cannabinoid Hyperemesis Syndrome ◽  
Report Data ◽  
Topical Capsaicin

Background Cannabinoid hyperemesis syndrome (CHS) is characterized by cyclical nausea, vomiting, and abdominal pain often relieved with hot showers. Patients with CHS are usually long-term cannabis smokers whose symptoms are not relieved by antiemetics. The use of topical capsaicin has been recently reported as an adjunctive therapy in the emergency department (ED). Objective To describe the use of capsaicin cream in patients presenting to the ED with suspected CHS. Methods We performed a retrospective review of patients with suspected CHS receiving capsaicin in an ED from July 2014 to October 2018. We report data on demographics, cannabis consumption, hot showers use, length of stay, concurrent treatments, pain scores, and adverse events. Results There were 57 patients who received capsaicin cream for suspected CHS. Nearly all patients received antiemetics (98%), whereas 47% of patients received an opioid. Antiemetics were typically administered first (median, 1.6 hours; interquartile range [IQR], 0.9-2.4]), followed by an opioid (median, 1.8 hours [IQR, 1-3.75]), followed by capsaicin cream (median 4 hours [IQR, 2.7-5.2]). The overall precapsaicin pain score was 8 (IQR, 2-9), decreasing to 5.5 (IQR, 0-8). Around 42% of patients received no further symptomatic therapy after capsaicin. No adverse drug events to capsaicin were reported. Conclusion and Relevance This is the largest retrospective study describing capsaicin cream use in suspected CHS patients with a focus on abdominal pain relief. Capsaicin treatment was associated with a modest pain score reduction. Application of these findings may help providers in identifying more effective therapies to provide symptomatic relief for CHS patients.

scholarly journals Cannabinoid Hyperemesis

2018 ◽  
Vol 1 (2) ◽  
pp. 73-95 ◽  
Author(s):  
Joseph V. Pergolizzi Jr. ◽  
Jo Ann LeQuang ◽  
John F. Bisney
Keyword(s):  
Public Opinion ◽  
Clinical Practice ◽  
Accurate Diagnosis ◽  
Cannabis User ◽  
Cannabinoid Hyperemesis Syndrome ◽  
Topical Capsaicin ◽  
Cyclic Vomiting

Cannabinoid hyperemesis syndrome (CHS) is a paradoxical condition in which a long-term cannabis user suffers an episode of intractable vomiting that may last days separated by longer asymptomatic periods of weeks or months. Cannabinoids are often utilized for their antiemetic properties, so CHS can be a puzzling condition, and the diagnosis of CHS may be disputed by patients. Unlike other cyclic vomiting syndromes, CHS can be relieved by hot showers or topical capsaicin. Abstinence from cannabinoids causes CHS to resolve, sometimes in a matter of days or hours. Marijuana users as well as many clinicians are not aware of CHS, and patients may undergo unnecessary tests, scans, and other procedures to get an accurate diagnosis. Symptoms may be severe enough to require hospitalization. With liberalization of marijuana laws and favorable public opinion about the healing properties of cannabis, CHS may be more frequently observed in clinical practice.

scholarly journals Cannabinoid Hyperemesis

2010 ◽  
Vol 24 (5) ◽  
pp. 284-285 ◽  
Author(s):  
Stephen Sullivan
Keyword(s):  
Abdominal Pain ◽  
Eating Disorder ◽  
Cannabis Use ◽  
Cyclic Vomiting Syndrome ◽  
Severe Nausea ◽  
Drug Seeking ◽  
Temporary Relief ◽  
Cannabinoid Hyperemesis Syndrome ◽  
Hot Bath ◽  
Cyclic Vomiting

Cannabinoid hyperemesis syndrome is characterized by chronic, heavy use of cannabis, recurrent episodes of severe nausea and intractable vomiting, and abdominal pain. Temporary relief of symptoms is achieved by taking a hot bath or shower, and resolution of the problem when cannabis use is stopped. Failure to recognize the syndrome leads to misdiagnoses such as psychogenic vomiting, the cyclic vomiting syndrome, an eating disorder or ‘drug-seeking behaviour’, and may lead to extensive, expensive and unproductive investigations, psychiatric referrals and ineffective treatments. Other than stopping cannabis use, there is no proven treatment. Why a substance known for its antiemetic properties should cause such a syndrome is unknown.

Cannabinoid hyperemesis syndrome: a specific cause of cyclical vomiting

2014 ◽  
Vol 26 (1) ◽  
pp. 153-156 ◽  
Author(s):  
Reshmi Morris ◽  
Martin Fisher
Keyword(s):  
Young Adults ◽  
Marijuana Use ◽  
Hot Water ◽  
Nausea And Vomiting ◽  
Adolescents And Young Adults ◽  
The Past ◽  
Cannabinoid Hyperemesis Syndrome ◽  
Almost All

Abstract Cyclical vomiting syndrome (CVS) is a disorder that occurs mostly in children, adolescents and young adults in which episodes of nausea and vomiting occur up to six to 12 times per year. In the past decade, one specific cause of cyclical vomiting syndrome, referred to as cannabinoid hyperemesis syndrome (CHS), has been described in a subset of patients who report chronic marijuana use. Of interest, almost all of these patients report compulsive bathing in hot water as part of the syndrome. In this report, we present the case of a 20-year-old female with CHS, review the issues generally encountered in CVS and discuss the known details of CHS. This is an important syndrome that needs to be considered as a potential diagnosis when patients present with cyclical vomiting.

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