Pain Modulation after Oromucosal Cannabinoid Spray (SATIVEX®) in Patients with Multiple Sclerosis: A Study with Quantitative Sensory Testing and Laser-Evoked Potentials

Abstract

Background. Delta-9-tetrahydrocannabinol (THC)/cannabidiol (CBD) (nabiximols or Sativex®) is an oromucosal spray formulation containing THC and CBD at an approximately 1:1 fixed ratio. Its administration for the treatment of pain in patients with multiple sclerosis (MS) has been established. MS patients generally complain of different kinds of pain, including spasticity-related and neuropathic pain. In this study, we compared and evaluated pain modulation and thermal/pain threshold of MS patients before and after THC/CBD administration. Methods. 19 MS patients underwent clinical examination, numerical rating scale (NRS), quantitative sensory testing (QST), and laser-evoked potentials (LEPs) before and after 1 month of therapy. Psychophysiological and neurophysiological data were compared to sex- and age-matched controls. Results. Patients reported a significant reduction in pain. We found statistically significant differences in LEP parameters between patients and controls but no significant change in LEP measures after THC/CBD therapy. Cold and heat detection thresholds were altered in patients but did not change after THC/CBD therapy. There was a significant increase in cold pain threshold by hand stimulation and a significant reduction in abnormal cold perception thresholds. Conclusions. Our results indicate that Sativex® therapy provides pain relief in MS patients and suggest that it might modulate peripheral cold-sensitive TRP channels.

Cannabinoid use among Americans with MS: Current trends and gaps in knowledge

“…Indeed, the utility of various THC:CBD ratios for MS-related pain and other symptoms are not well understood. Both THC and CBD may have different potential benefits for pain and sleep in other populations, or differential effects based on dose, 27 yet the majority of research to date for these symptoms in MS has focused on a 1:1 or 2:1 combination of THC/CBD (Nabiximol/Sativa, Cannador), 13,[28][29][30] with fewer studies dedicated to THC or CBD monotherapy. Interestingly, in a prior study of persons without MS who had insomnia, administration of a conventionally high dose of CBD (160 mg/day) was shown to increase total sleep time and decrease arousals during the night.…”

Combination of Cannabinoids, Δ9- Tetrahydrocannabinol and Cannabidiol, Ameliorates Experimental Multiple Sclerosis by Suppressing Neuroinflammation Through Regulation of miRNA-Mediated Signaling Pathways

“…Cannabinoids have also been shown to ameliorate spasticity and neuropathic pain in MS patients (9, 10). It is for this reason, a combination of Δ9—tetrahydrocannabinol (THC) and Cannabidiol (CBD) has been approved as a drug (Sativex) in several countries including Europe, Australia and Canada (11). THC and CBD combination was tested recently in animal models of MS and was found to suppress neuroinflammation (12, 13).…”

Cannabinoids in multiple sclerosis: A neurophysiological analysis

“…At the same time, several authors stressed the need for neurophysiogical markers of this effect. Laser‐evoked potentials proved abnormal prior to medication but did not change while on cannabinoid therapy 32 . Conversely, THC‐CBD increased the threshold and decreased the area of the RIII, a component of the lower limb flexion reflex, which is mediated by Aδ fibres 24 .…”