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22nd Annual Pain Medicine Meeting 2023
November 10 - 11, 2023 | New Orleans Marriott | New Orleans, Louisiana, USA
5033
DEVELOPMENT OF CANNABINOID HYPEREMESIS SYNDROME FOLLOWING USE OF A CANNABINOID VAPE PEN FOR CHRONIC PAIN MANAGEMENT: A CASE REPORT
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Medically Challenging Cases
Development of Cannabinoid Hyperemesis Syndrome Following Use of a Cannabinoid Vape Product for Chronic Pain Management:
A Case Report
INTRODUCTION:
•There has been increased interest in cannabinoid-based supplements containing cannabidiol (CBD) and tetrahydrocannabinol (THC) for chronic pain management.
•Those suffering from unalleviated chronic pain may use CBD as an “add on” therapy to reduce opioid dependency.
•CBD products containing unknown amounts of THC can lead to development of Cannabinoid Hyperemesis Syndrome (CHS), characterized by a triad of chronic cannabis use, cyclic vomiting, and compulsive hot bathing.
CASE PRESENTATION:
•53-year-old female with past medical history of hypertension, and type 2 diabetes mellitus presented with a two-month history of cyclical vomiting and epigastric pain with episodes occurring approximately every two weeks and lasting 24-48 hours.
•She was asymptomatic during the interepisodic period and noted improvement of symptoms with hot showers.
•The patient reported near daily use of a CBD vape pen with an unknown formulation three months prior to symptom onset to help manage her chronic neck pain secondary to a prior motor vehicle accident.
•The diagnostic workup was largely negative for other causes.
•Anti-emetics provided little relief and at discharge, she was advised discontinuation of the CBD vape pen, the likely cause of her cyclical symptoms.
DISCUSSION:
•CHS is a clinical diagnosis. Symptomatic relief with hot baths is considered a pathognomonic feature.
•The most frequent duration of cannabis use among CHS patients is between 2-5 years (36.3.%) followed by 1 year or less (25.1%).1
•To achieve recovery, patients should be counseled regarding cessation of cannabis and its derivatives.
•Work is ongoing to understand the role of cannabinoid-based supplements in the treatment of chronic pain. Small to moderate improvement in pain has been reported with formulations with high and comparable THC:CBD ratio during short term treatment (1-6 months).2