Abstract

Background: Marijuana- both medical and recreational- is often used to manage pain and nausea. However, there is emerging evidence that marijuana may have adverse effects on pain and nausea. It appears cannabis can not only suppress nausea in certain situations, but also cause it in vulnerable patients. Cannabinoid hyperemesis syndrome (CHS) can cause chronic pain.

Objective: This case report assesses the potential link between myofascial pain affecting the abdominal musculature and marijuana use. It also raises awareness about cannabinoid hyperemesis syndrome in patients with chronic pain who are not requesting opioid therapy.

Result: We present the case of a 22-year-old male with acute on chronic abdominal pain and recurrent vomiting for over two years. He had multiple evaluations by various gastroenterologists and psychiatrists with no specific cause found for his symptoms. The patient had previously tried zofran, hydroxyzine, and sertraline without benefit. He reported smoking marijuana on a daily basis to address the pain and nausea. The patient experienced > 50% relief of his chronic abdominal pain with a combination of trigger point injections and abstinence from marijuana.

Conclusion: To our knowledge, this is the first case in the literature of marijuana discontinuation leading to a greater than 50% improvement in myofascial pain symptoms in the abdomen and pelvis. Cannabinoid hyperemesis syndrome is a potential cause of chronic pain in a minority of patients.

Key words: CannabinoidS, Marijuana, Myofascial Pain, Trigger Points, Hyperemesis, Vomiting