Table 5.

Proposed treatments for CHS

Proposed treatment	Supportive evidence	Author	Study design	GRADE rating
Cessation of cannabis	Cessation of cannabis led to resolution of symptoms in 30 of 31 patients	Wallace [10]	Case series	Very low
	Among 10 CHS patients with follow-up, 30% did not abstain and continued to have symptoms and 60% stopped using and had complete resolution of symptoms. One patient experienced no symptomatic improvement with self-reported abstinence.	Simonetto [16]	Case series	Very low
	Among 10 patients, 7 of 10 abstained and had resolution of symptoms. Three patients did not and illness continued. Three patients rechallenged themselves after a period of abstinence, and all suffered a return to illness	Allen [6]	Case series	Very low
Application of capsaicin cream to the abdomen	Five CHS patients experienced near complete resolution of symptoms after application of topical capsaicin cream to the abdomen	LaPoint [168]	Case series	Very low
	Case report of dramatic relief of symptoms in CHS patient with topical application of capsaicin	Biary [169]	Case report	Very low
Dopamine antagonists	Δ9-THC increases dopamine synthesis, turnover, and efflux and dopamine cell firing. Δ9-THC withdrawal, induced by abrupt discontinuation of chronic Δ9-THC treatment or administration of rimonabant, results in decreased dopamine efflux and neurotransmission	Schulze [103]	Experimental model	Very low
	CHS patient received 5 mg haloperidol and experienced complete resolution of symptoms within 1 h	Hickey [40]	Case report	Very low
Avoidance of opiate-based medications	Opioid analgesic use is associated with bowel dysfunction, and GI side effects have been reported in up to 47% of opioid-treated patients	Argoff [188]	Review	Very low
	Opiates should be used with caution as they have the potential to cause emesis	Galli [170]	Case report	Very low