Comparison of the Analgesic Effects of Dronabinol and Smoked Marijuana in Daily Marijuana Smokers

Abstract

Recent studies have demonstrated the therapeutic potential of cannabinoids to treat pain, yet none have compared the analgesic effectiveness of smoked marijuana to orally administered D 9 -tetrahydrocannabinol (THC; dronabinol). This randomized, placebocontrolled, double-dummy, double-blind study compared the magnitude and duration of analgesic effects of smoked marijuana and dronabinol under well-controlled conditions using a validated experimental model of pain. Healthy male (N ¼ 15) and female (N ¼ 15) daily marijuana smokers participated in this outpatient study comparing the analgesic, subjective, and physiological effects of marijuana (0.00, 1.98, or 3.56% THC) to dronabinol (0, 10, or 20 mg). Pain response was assessed using the cold-pressor test (CPT): participants immersed their left hand in cold water (4 1C), and the time to report pain (pain sensitivity) and withdraw the hand from the water (pain tolerance) were recorded. Subjective pain and drug effect ratings were also measured as well as cardiovascular effects. Compared with placebo, marijuana and dronabinol decreased pain sensitivity (3.56%; 20 mg), increased pain tolerance (1.98%; 20 mg), and decreased subjective ratings of pain intensity (1.98, 3.56%; 20 mg). The magnitude of peak change in pain sensitivity and tolerance did not differ between marijuana and dronabinol, although dronabinol produced analgesia that was of a longer duration. Marijuana (1.98, 3.56%) and dronabinol (20 mg) also increased abuse-related subjective ratings relative to placebo; these ratings were greater with marijuana. These data indicate that under controlled conditions, marijuana and dronabinol decreased pain, with dronabinol producing longer-lasting decreases in pain sensitivity and lower ratings of abuse-related subjective effects than marijuana.

Brain Mapping-Based Model of Δ9-Tetrahydrocannabinol Effects on Connectivity in the Pain Matrix

“…Local injections of cannabinoid receptor agonists reduce pain in various rodent models (Agarwal et al, 2007;Kehl et al, 2003;Lozano-Ondoua et al, 2010). A few human studies also demonstrated a decreased sensitivity and increased tolerance to pain in a THC dose-dependent manner (Cooper et al, 2013;Greenwald and Stitzer, 2000), which is in line with the observation of reduced coupling between thalamus and S2 as the lateral spinothalamic tract is critical for the sensorydiscriminative processing of pain (Maihofner et al, 2006;Price, 2002). The fact that subjects tended to perceive CO 2 stimuli as less intense during THC administration would support this effect.…”

Medical cannabis in the treatment of cancer pain and spastic conditions and options of drug delivery in clinical practice

“…It is generally accepted that smoking cannabis ameliorates the perception of pain in healthy volunteers [39][40][41] . However, it is questionable, whether the effect is of antinociceptive or rather psychotropic nature and possibly both components may play a role 42 .…”

Phytotherapeutical implications in pain perception - focusing on schizophrenia

“…In detail Cesamet® (Nabilone, Meda Pharmaceuticals, Somerset, New Jersey, USA) and Marinol® (Dronabinol, Abbvie Inc., North Chicago, ILN, USA) incorporate synthetic derivative of the plant cannabinoid tetrahydrocannabinol (THC), both of them holding pain relief capacities, one of them showing efficiency in chronic neuropathic pain [79], the other demonstrating analgesic competency [80]. At the same time, a tolerance/dependence statistic has not been assessed for Cesamet® (Nabilone, Meda Pharmaceuticals, Somerset, New Jersey, USA) and regarding Marinol® (Dronabinol, Abbvie Inc., North Chicago, ILN, USA), new evidence suggests the presence of a psychoactive effect resembling the one met in cannabis use if utilized in the treatment of chronic non-cancer pain patients [81].…”