Does the cannabinoid dronabinol reduce central pain in multiple sclerosis? Randomised double blind placebo controlled crossover trial
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OBJECTIVE: To evaluate the effect of the oral synthetic delta-9-tetrahydrocannabinol dronabinol on central neuropathic pain in patients with multiple sclerosis. DESIGN: Randomised double blind placebo controlled crossover trial. SETTING: Outpatient clinic, University Hospital of Aarhus, Denmark. PARTICIPANTS: 24 patients aged between 23 and 55 years with multiple sclerosis and central pain. INTERVENTION: Orally administered dronabinol at a maximum dose of 10 mg daily or corresponding placebo for three weeks (15-21 days), separated by a three week washout period. MAIN OUTCOME MEASURE: Median spontaneous pain intensity (numerical rating scale) in the last week of treatment. RESULTS: Median spontaneous pain intensity was significantly lower during dronabinol treatment than during placebo treatment (4.0 (25th to 75th centiles 2.3 to 6.0) v 5.0 (4.0 to 6.4), P = 0.02), and median pain relief score (numerical rating scale) was higher (3.0 (0 to 6.7) v> 0 (0 to 2.3), P = 0.035). The number needed to treat for 50% pain relief was 3.5 (95% confidence interval 1.9 to 24.8). On the SF-36 quality of life scale, the two items bodily pain and mental health indicated benefits from active treatment compared with placebo. The number of patients with adverse events was higher during active treatment, especially in the first week of treatment. The functional ability of the multiple sclerosis patients did not change. CONCLUSIONS: Dronabinol has a modest but clinically relevant analgesic effect on central pain in patients with multiple sclerosis. Adverse events, including dizziness, were more frequent with dronabinol than with placebo during the first week of treatment.
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Research into oral cannabinoid use in the management of chronic and neuropathic pain has been encouraging.
“Research into oral cannabinoid use in the management of chronic and neuropathic pain has been encouraging.18,32”
From Nabilone for the treatment of pain in fibromyalgia. (2008) · cites this paper as [32]
Dronabinol improved median radiating pain intensity and pressure threshold, sleep quality, spasms, and spasticity in multiple sclerosis patients.
“Additionally, this drug improved median radiating pain intensity and pressure threshold,134 sleep quality, spasms, and spasticity143 in MS patients.”
From Cannabinoids as Pharmacotherapies for Neuropathic Pain: From the Bench to the Bedside (2009) · cites this paper as [134]
Dronabinol reduced spontaneous pain intensity as measured with a numerical rating scale over a treatment period of 3 weeks and improved overall pain ratings on the category-rating scale over a treatment period of 15 weeks.
“Dronabinol reduced spontaneous pain intensity as measured with a numerical rating scale (NRS) over a treatment period of 3 weeks134 and improved overall pain ratings on the category-rating scale over a treatment period of 15 weeks143.”
From Cannabinoids as Pharmacotherapies for Neuropathic Pain: From the Bench to the Bedside (2009) · cites this paper as [134]
Unwanted side-effects, in contrast to analgesic effects, may undergo tolerance.
“However, unwanted side-effects, in contrast to analgesic effects, may undergo tolerance.134”
From Cannabinoids as Pharmacotherapies for Neuropathic Pain: From the Bench to the Bedside (2009) · cites this paper as [134]
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Mealy, M. A., Kozachik, S. L., & Levy, M. (2019) · Pain Management Nursing · doi:10.1016/j.pmn.2019.03.003 · Cited by 20 · see citing works
- Authors
- Svendsen, K. B., Jensen, T. S., & Bach, F. W.
- Affiliations
- Aarhus University Hospital (DK)
- Corresponding author
- Bach, Flemming W
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2004-07-16
- Volume
- 329
- Issue
- 7460
- Pages
- 253
- ISSN
- 0007-1447 (ISSN-L)
- 0959-8138
- 1468-5833
- PMC
- PMC498019
- OpenAlex
- W2114826780
- Cited by
- 500
- References
- 50
- Citations by year
- 2026: 8 · 2025: 9 · 2024: 13 · 2023: 20 · 2022: 22 · 2021: 19 · 2020: 26 · 2019: 13 · 2018: 25 · 2017: 20 · 2016: 14 · 2015: 20 · 2014: 21 · 2013: 22 · 2012: 29
- FWCI
- 27.00
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- BMJ (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Cannabis and Cannabinoid Research
- Health Sciences › Medicine › Pathology and Forensic Medicine › Multiple Sclerosis Research Studies
- Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
- Keywords
- dronabinol, multiple sclerosis, central pain, delta-9-tetrahydrocannabinol, cannabinoids, analgesia, pain intensity, quality of life, adverse events, dizziness
- MeSH terms
- Administration, Oral, Adult, Cannabinoids, Double-Blind Method, Female, Humans, Male, Middle Aged, Multiple Sclerosis, Pain, Dronabinol, Treatment Outcome, Cross-Over Studies, Analgesics, Non-Narcotic
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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