Dear Pain Matters blog readers,
Dr Mark Ware, McGill University in Montreal, reported that Nabilone (‘Cesamet’), an oral synthetic cannabinoid, may offer some pain relief in both cancer and non cancer pain.
Specifically, Nabilone may help alleviate painful symptoms in patients with:
– Nerve pain (e.g. complex regional pain syndrome, CRPS);
– Multiple sclerosis;
– Fibromyalgia;
– Other chronic non cancer pain (eg postoperative or traumatic pain, arthritis, Crohn’s disease, interstitial cystitis, HIV-associated myopathy, post-polio syndrome, idiopathic inguinal pain, and chronic headaches); and
– Cancer pain.
Dr May Ong-Lam reported that in 10 patients with refractory CRPS, Nabilone treatment resulted in up to 60% pain reduction. Opioids and other pain medication were no longer required by 7 patients following Nabilone therapy. Improved quality of life and better sleep resulted. Nabilone treatment resulted in improved physical ability including the ability to bear weight, resume work, and perform housework. There were few side effects, and patients did not develop tolerance to Nabilone.
Prior to Nabilone treatment, and despite receiving many different pain medications, these 10 CRPS patients suffered burning pain, allodynia, autonomic nervous system changes, and physical disability. Pre-Nabilone, all 10 CRPS patients ranked CRPS pain as 10 out of 10 (on 10-point visual analog scale; VAS).
Importantly, post-Nabilone therapy, overall pain decreased to 3 – 6 (on VAS) in all 10 CRPS patients.
Fibromyalgia patients reported that Nabilone offered significant benefits in pain relief and functional improvement.
A cancer pain study reported that pain scores in Nabilone-treated cancer patients were significantly reduced, compared to those who were not treated with Nabilone. Other improvements in Nabilone-treated cancer patients included reduced nausea, less anxiety/overall distress, and slight improvement in appetite. Nabilone-treated cancer patients were also able to reduce (or discontinue) dosages of other drugs including nonsteroidal anti-inflammatory agents, tricyclic antidepressants, and gabapentin.
A cannabis extract may be used to treat refractory spasticity in multiple sclerosis.
POSSIBLE MECHANISMS
Cannabinoid agonists (including Nabilone) activate cannabinoid receptor types CB1 and CB2. Activation of CB2 leads to anti-inflammatory effects including reduction of TNF-alpha-induced endothelial cell activation, monocyte migration and adhesion. This may partly explain why cannabis and cannabinoids are able to reduce pain including nerve pain (CRPS, multiple sclerosis).
For more posts on medical cannabis (aka medical marijuana) as well as cannabis-based pain medication (eg Sativex), please see:
https://painmatters.wordpress.com/2016/09/22/medical-cannabis-medical-marijuana-and-nerve-pain/
and
Wishing less pain to all pain patients,
Sabina Walker
References:
(1) Mark A. Ware; Cannabinoids in Pain Management: An Update from the 2009 Canadian Pain Society Meeting, Quebec QC
Click to access Viewpoints_in_Cannabinoids_MASTER.pdf
(2) Berlach, Shir, Ware. Experience with the synthetic cannabinoid nabilone in chronic noncancer pain. Pain Med. 2006 Jan-Feb;7(1):25-9.
Click to access Experience%20with%20the%20synthethic%20cannabinoid%20nabilone.pdf
(3) David Wild; Refractory CRPS Patients Discontinue Opiates With Cannabinoid Treatment (A Study by May Ong-Lam, MD, Clinical Assistant Professor, Dept of Medicine, St Paul’s Hospital, Vancouver); Pharmacy Practice News (8 Feb, 2011).
(4) Skrabek RQ, Galimova L, Ethans K, Perry D; Nabilone for the treatment of pain in fibromyalgia. J Pain 2008;9(2):164-173.
http://www.ncbi.nlm.nih.gov/pubmed/17974490
(5) Maida et al, 2008. Adjunctive nabilone in cancer pain and symptom management: a prospective observational study using propensity scoring. J Support Oncol. 2008 Mar;6(3):119-24.
http://www.ncbi.nlm.nih.gov/pubmed/18402303
(6) Grotenhermen, Müller-Vahl; The therapeutic potential of cannabis and cannabinoids; Dtsch Arztebl Int (2012 July);109(29-30):495-501.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3442177/
(7) Rajesh et al; CB2-receptor stimulation attenuates TNF-alpha-inducedCB2-receptor stimulation attenuates TNF-alpha-induced human endothelial cell activation, transendothelial migration of monocytes, and monocyte-endothelial adhesion; Am J Physiol Heart Circ Physiol (2007 Oct);293(4):H2210-8.
Pain Matters 
Very interesting read as i am about to start therapy with cesamet for my CRPS of over ten years. I remember trying it once but the results i cant seem to recall. I did not use the med very long maybe that was the reason for it being ineffective. I have discussed the medication with my Dr. He encouraged me to try the drug and stick with it for awhile, even if i need to endure some minor side effects. We are also starting with a low dose and slowly increasing to required levels. Slowly. My Dr and I have a great relationship. We have open communication and i respect him and his practice. They all have had great hand in helping me navigate the world of chronic pain and CRPS. I am very fortunate to have the support of a great health network. CMH and their continuous counselling and support have also helped me on my journey. The illness was the result of Carpal Tunnel Surgery and two other wrist procedures. I have been riddled with pain and many other nasty symptoms ever since. I do not place blame with the surgeons who cut me but with a system that failed to diagnose my illness within a reasonable amount of time. It took over three years since my last wrist surgery to get the diagnosis of CRPS/RSD. Because of horrendous wait times within the system for various testing and specialist it took three long years to reach a diagnosis and appropriate treatment. At that point the CRPS was well entrenched and spread through my body from wrist to full right side. With pail in my right eye and ear. I also experienced the craziest pain in my left shin. The disease has changed my life. I have been disabled for a long time now. It is is a full time job trying to keep well. I work hard at it and try many alternative treatments as well as many mainstream or common treatment of pain. I have tried many many meds and am currently trying to reduce the amount of opioid medication i take. My Dr has been very helpful in the process. I also have access to a great pharmacist team. They have been most helpful when it comes to the world of prescription medication. They sometimes know more than the doctor. Anyways i hope this med Cesamet helps me deal with some of my issues without too much side effect. Sorry for running on on but RSD?CRPS is very close to me and affects my everyday…so i go on and on. Thanks for the info.
Sincerely Timothy Scott Boles
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Hello Tim Boles,
I am sorry about your CRPS. Thank you for sharing your challenging life journey with CRPS with us. It is important to get stories like yours out there.
I have added links to 2 other blog posts that I wrote on medical cannabis and Sativex, for your consideration. Nabilone is a synthetic agonist that acts on the same cannabinoid receptors as medical cannabis and Sativex. Here are the 2 links:
and
I hope you find pain relief soon!
Sabina Walker
Pain Matters (in WordPress)
PS Please feel free to share this blog on Facebook, etc.
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Thank you for the reply and kind words.
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No problem, Tim.
Please make sure you read these recent blog posts about Dr Katinka’s amazing approach for treating CRPS (she is based in Arkansas). I will be posting more details about her work on this blog sometime this week or next, so keep posted:
This is Dr Katinka’s Facebook:
https://www.facebook.com/TheNeurologicReliefCenter/?fref=mentions&pnref=stor
Here are some posts on her :
Maybe you could consider seeing her, or someone who uses her approach for CRPS, too?
If you find something that helps significantly, please write to me! I love hearing about patients who find pain relief!!
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