OBJECTIVE: Debilitating pain, occurring in 50-70% of multiple sclerosis (MS) patients, is poorly understood and infrequently studied. We summarized efficacy and safety data of cannabinoid-based drugs for neuropathic pain. DATA SOURCES: Studies were identified from Medline, Embase, and Cochrane databases; Bayer Healthcare provided additional trials. STUDY SELECTION: Accepted were randomized, double-blinded placebo-controlled trials of cannabinoid-based treatments for MS-related/neuropathic pain in adults > or = 18 years of age. DATA EXTRACTION: Two reviewers identified studies and extracted data; a third adjudicated disagreements. Data included baseline and endpoint pain scores on visual analog or 11-point ordinal scales. DATA SYNTHESIS: Of 18 articles and three randomized controlled trial (RCT) reports identified, 12 articles and two reports were rejected (9 = inappropriate disease or outcome, 1 = duplicate, 1 = review, and 1 = abstract); six accepted articles and one RCT-report involved 298 patients (222 treated, 76 placebo); four examined Sativex (a cannabidiol/delta-9-tetrahydrocannabinol (THC) buccal spray) (observations = 196), five cannabidiol (n = 41), and three dronabinol (n = 91). Homogeneity chi(2) values were non-significant, allowing data combination. Analyses focused on baseline-endpoint score differences. The cannabidiol/THC buccal spray decreased pain 1.7 +/- 0.7 points (p = 0.018), cannabidiol 1.5 +/- 0.7 (p = 0.044), dronabinol 1.5 +/- 0.6 (p = 0.013), and all cannabinoids pooled together 1.6 +/- 0.4 (p < 0.001). Placebo baseline-endpoint scores did not differ (0.8 +/- 0.4 points, p = 0.023). At endpoint, cannabinoids were superior to placebo by 0.8 +/- 0.3 points (p = 0.029). Dizziness was the most commonly observed adverse event in the cannabidiol/THC buccal spray arms (39 +/- 16%), across all cannabinoid treatments (32.5 +/- 16%) as well as in the placebo arms (10 +/- 4%). CONCLUSION: Cannabinoids including the cannabidiol/THC buccal spray are effective in treating neuropathic pain in MS. LIMITATIONS: This review was based on a small number of trials and patients. Pain related to MS was assumed to be similar to neuropathic pain.
OBJECTIVE: Debilitating pain, occurring in 50-70% of multiple sclerosis (MS) patients, is poorly understood and infrequently studied. We summarized efficacy and safety data of cannabinoid-based drugs for neuropathic pain. DATA SOURCES: Studies were identified from Medline, Embase, and Cochrane databases; Bayer Healthcare provided additional trials. STUDY SELECTION: Accepted were randomized, double-blinded placebo-controlled trials of cannabinoid-based treatments for MS-related/neuropathic pain in adults > or = 18 years of age. DATA EXTRACTION: Two reviewers identified studies and extracted data; a third adjudicated disagreements. Data included baseline and endpoint pain scores on visual analog or 11-point ordinal scales. DATA SYNTHESIS: Of 18 articles and three randomized controlled trial (RCT) reports identified, 12 articles and two reports were rejected (9 = inappropriate disease or outcome, 1 = duplicate, 1 = review, and 1 = abstract); six accepted articles and one RCT-report involved 298 patients (222 treated, 76 placebo); four examined Sativex (a cannabidiol/delta-9-tetrahydrocannabinol (THC) buccal spray) (observations = 196), five cannabidiol (n = 41), and three dronabinol (n = 91). Homogeneity chi(2) values were non-significant, allowing data combination. Analyses focused on baseline-endpoint score differences. The cannabidiol/THC buccal spray decreased pain 1.7 +/- 0.7 points (p = 0.018), cannabidiol 1.5 +/- 0.7 (p = 0.044), dronabinol 1.5 +/- 0.6 (p = 0.013), and all cannabinoids pooled together 1.6 +/- 0.4 (p < 0.001). Placebo baseline-endpoint scores did not differ (0.8 +/- 0.4 points, p = 0.023). At endpoint, cannabinoids were superior to placebo by 0.8 +/- 0.3 points (p = 0.029). Dizziness was the most commonly observed adverse event in the cannabidiol/THC buccal spray arms (39 +/- 16%), across all cannabinoid treatments (32.5 +/- 16%) as well as in the placebo arms (10 +/- 4%). CONCLUSION:Cannabinoids including the cannabidiol/THC buccal spray are effective in treating neuropathic pain in MS. LIMITATIONS: This review was based on a small number of trials and patients. Pain related to MS was assumed to be similar to neuropathic pain.
Authors: Matthew W Elmes; Martin Kaczocha; William T Berger; KwanNok Leung; Brian P Ralph; Liqun Wang; Joseph M Sweeney; Jeremy T Miyauchi; Stella E Tsirka; Iwao Ojima; Dale G Deutsch Journal: J Biol Chem Date: 2015-02-09 Impact factor: 5.157
Authors: Zuzana Justinova; Regina A Mangieri; Marco Bortolato; Svetlana I Chefer; Alexey G Mukhin; Jason R Clapper; Alvin R King; Godfrey H Redhi; Sevil Yasar; Daniele Piomelli; Steven R Goldberg Journal: Biol Psychiatry Date: 2008-09-23 Impact factor: 13.382
Authors: Janet Weber; Marcus Schley; Matthias Casutt; Helmut Gerber; Guido Schuepfer; Roman Rukwied; Wolfgang Schleinzer; Michael Ueberall; Christoph Konrad Journal: Anesthesiol Res Pract Date: 2009-10-25