Low dose treatment with the synthetic cannabinoid Nabilone significantly reduces spasticity-related pain

Abstract

About 30% of patients with chronic upper motor neuron syndrome (UMNS) suffer from disabling spasticity-related pain not sufficiently correctable by conventional treatment. Delta9-tetrahydrocannabinol (Delta(9)-THC) was reported to add benefit in the treatment of pain in patients with multiple sclerosis (MS). The question arose whether synthetic cannabinoids with lower potential for psychotropic side effects could be effective as well. To evaluate the safety and efficacy of low dose treatment with the synthetic cannabinoid Nabilone (1 mg per day) on spasticity-related pain a placebo-controlled double-blind crossover trial was performed.11 out of 13 included patients completed the study. The 11-Point-Box-Test showed a significant decrease of pain under Nabilone (p < 0.05), while spasticity, motor function and activities of daily living did not change. 5 patients reported side effects: one moderate transient weakness of the lower limbs (Nabilone phase, drop out), three mild drowsiness (two Nabilone, one placebo) and one mild dysphagia (placebo). One patient was excluded from the study due to an acute relapse of multiple sclerosis (Nabilone phase, drop out). Nabilone 1 mg per day proved to be a safe and easily applicable option in the care of patients with chronic UMNS and spasticity-related pain otherwise not controllable.

Oxidation of the Endogenous Cannabinoid Arachidonoyl Ethanolamide by the Cytochrome P450 Monooxygenases: Physiological and Pharmacological Implications

“…Such pharmaceuticals include dronabinol and nabilone, which are prescribed as antiemetics and appetite stimulants to patients afflicted with the AIDS wasting syndrome or receiving cancer chemotherapy (Mechoulam and Hanus, 2000). Nabilone is also used as an adjunct therapy for the management of chronic pain associated with fibromyalgia and multiple sclerosis (Wissel et al, 2006;Skrabek et al, 2008). The true potential of the cannabinoid-based agents as potential therapeutics became more apparent after the cloning of the receptors for ⌬ 9 -THC (Matsuda et al, 1990;Munro et al, 1993).…”

Pharmacological Management of Neuropathic Pain: Current Trends and Possible Approaches

“…Recently, preliminary guidelines also give knowledge about the use of smoked cannabis (84). Synthetic cannabinoid such as nabilone (1 mg/day) decreased spasticity related pain without much of these adverse effects (85). Further, adjuvant effects of 10 and 20 mg doses of dronabinol were also observed in patients with chronic pain who are under opioid therapy (86).…”

The Pharmacological Basis of Cannabis Therapy for Epilepsy

“…Cannabinoids are used to treat a variety of nervous system conditions (Wissel et al, 2006;Notcutt, 2015). Many ongoing trials on a diverse range of cannabinoids have shown them to be beneficial for epilepsy (Cunha et al, 1980;Wallace et al, 2001); however, other studies have shown that cannabis can have variable effects on seizures in different species (Meldrum et al, 1974;Martin and Consroe, 1976;Chiu et al, 1979).…”