title: Randomized placebo-controlled double-blind clinical trial of cannabis-based medicinal product (Sativex) in painful diabetic neuropathy: depression is a major confounding factor.
abstract: OBJECTIVE
  To assess the efficacy of Sativex, a cannabis-based medicinal extract, as adjuvant treatment in painful diabetic peripheral neuropathy (DPN).
  
  
  METHODS
  In this randomized controlled trial, 30 subjects with painful DPN received daily Sativex or placebo. The primary outcome measure was change in mean daily pain scores, and secondary outcome measures included quality-of-life assessments.
  
  
  RESULTS
  There was significant improvement in pain scores in both groups, but mean change between groups was not significant. There were no significant differences in secondary outcome measures. Patients with depression had significantly greater baseline pain scores that improved regardless of intervention.
  
  
  CONCLUSIONS
  This first-ever trial assessing the efficacy of cannabis has shown it to be no more efficacious than placebo in painful DPN. Depression was a major confounder and may have important implications for future trials on painful DPN.
authors.affiliation: Diabetes Research Department, Royal Hallamshire Hospital, Sheffield, UK. dinesh.selvarajah@gmail.com
authors.forename: Dinesh
authors.initials: D
authors.lastname: Selvarajah
authors.forename: Rajiv
authors.initials: R
authors.lastname: Gandhi
authors.forename: Celia J
authors.initials: CJ
authors.lastname: Emery
authors.forename: Solomon
authors.initials: S
authors.lastname: Tesfaye
mesh_terms: D000328:Adult; D000368:Aged; D002185:Cannabidiol; D003863:Depression / Q000139:chemically induced*; D003929:Diabetic Neuropathies / Q000188:drug therapy* / Q000523:psychology; D004311:Double-Blind Method; D013759:Dronabinol; D004338:Drug Combinations; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy; D010147:Pain Measurement; D010919:Placebos; D010936:Plant Extracts / Q000009:adverse effects* / Q000627:therapeutic use*; D011788:Quality of Life; D016896:Treatment Outcome
chemical_list: D004338:Drug Combinations; D010919:Placebos; D010936:Plant Extracts; D002185:Cannabidiol; D013759:Dronabinol; C587251:nabiximols