Experience with the synthetic cannabinoid nabilone in chronic noncancer pain.
Chronic noncancer pain includes a heterogeneous group of disorders and is often refractory to treatment. Cannabis products have historically been used for chronic pain and are attracting renewed pharmaceutical interest. Nabilone is a synthetic cannabinoid licensed in Canada for the treatment of severe nausea and vomiting associated with cancer chemotherapy. We have used nabilone off-label for the treatment of chronic noncancer pain since 1999. In this article, we review our clinical experience of 20 adult patients with chronic noncancer pain who had been treated with nabilone and followed up for an average of 1.5 years. Prior to nabilone therapy, patients had used a wide range of therapies, including 11 who had used cannabis. Fifteen patients reported subjective overall improvement with nabilone, and nine reported reduced pain intensity. Beneficial effects on sleep and nausea were the main reasons for continuing use. Intolerable side effects were experienced in three patients (palpitations, urinary retention, dry mouth). Nabilone may be a useful addition to pain management and should be further evaluated in randomized controlled trials.
McGill University Medical School, McGill University Health Center, Montreal, Quebec, Canada.
David M
DM
Berlach
Yoram
Y
Shir
Mark A
MA
Ware
D000328:Adult; D000700:Analgesics / Q000008:administration & dosage / Q000009:adverse effects; D014151:Anti-Anxiety Agents / Q000008:administration & dosage / Q000009:adverse effects; D001145:Arrhythmias, Cardiac / Q000139:chemically induced; D002908:Chronic Disease / Q000523:psychology / Q000628:therapy; D004305:Dose-Response Relationship, Drug; D013759:Dronabinol / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D017288:Pain Threshold / Q000187:drug effects; D010148:Intractable Pain / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology; D012189:Retrospective Studies; D012890:Sleep / Q000187:drug effects; D012894:Sleep Stages; D012893:Sleep Wake Disorders / Q000188:drug therapy / Q000209:etiology; D016896:Treatment Outcome; D014555:Urination Disorders / Q000139:chemically induced; D014987:Xerostomia / Q000139:chemically induced
D000700:Analgesics; D014151:Anti-Anxiety Agents; C011941:nabilone; D013759:Dronabinol