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 