Meta-analysis of cannabis based treatments for neuropathic and multiple sclerosis-related pain
Abstract
OBJECTIVE: Debilitating pain, occurring in 50-70% of multiple sclerosis (MS) patients, is poorly understood and infrequently studied. We summarized efficacy and safety data of cannabinoid-based drugs for neuropathic pain. DATA SOURCES: Studies were identified from Medline, Embase, and Cochrane databases; Bayer Healthcare provided additional trials. STUDY SELECTION: Accepted were randomized, double-blinded placebo-controlled trials of cannabinoid-based treatments for MS-related/neuropathic pain in adults > or = 18 years of age. DATA EXTRACTION: Two reviewers identified studies and extracted data; a third adjudicated disagreements. Data included baseline and endpoint pain scores on visual analog or 11-point ordinal scales. DATA SYNTHESIS: Of 18 articles and three randomized controlled trial (RCT) reports identified, 12 articles and two reports were rejected (9 = inappropriate disease or outcome, 1 = duplicate, 1 = review, and 1 = abstract); six accepted articles and one RCT-report involved 298 patients (222 treated, 76 placebo); four examined Sativex (a cannabidiol/delta-9-tetrahydrocannabinol (THC) buccal spray) (observations = 196), five cannabidiol (n = 41), and three dronabinol (n = 91). Homogeneity chi(2) values were non-significant, allowing data combination. Analyses focused on baseline-endpoint score differences. The cannabidiol/THC buccal spray decreased pain 1.7 +/- 0.7 points (p = 0.018), cannabidiol 1.5 +/- 0.7 (p = 0.044), dronabinol 1.5 +/- 0.6 (p = 0.013), and all cannabinoids pooled together 1.6 +/- 0.4 (p < 0.001). Placebo baseline-endpoint scores did not differ (0.8 +/- 0.4 points, p = 0.023). At endpoint, cannabinoids were superior to placebo by 0.8 +/- 0.3 points (p = 0.029). Dizziness was the most commonly observed adverse event in the cannabidiol/THC buccal spray arms (39 +/- 16%), across all cannabinoid treatments (32.5 +/- 16%) as well as in the placebo arms (10 +/- 4%). CONCLUSION: Cannabinoids including the cannabidiol/THC buccal spray are effective in treating neuropathic pain in MS. LIMITATIONS: This review was based on a small number of trials and patients. Pain related to MS was assumed to be similar to neuropathic pain.
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RCTs of cannabinoid use or interventions to reduce cannabis use tend to have follow-up periods too short to yield useful information about psychosis risk arising from long term use.
“RCTs of cannabinoid use or interventions to reduce cannabis use tend to have follow-up periods too short to yield useful information about psychosis risk arising from long term use (2) and are not discussed further here.”
From Association Between Cannabis and Psychosis: Epidemiologic Evidence (2016) · cites this paper as [2]
A recent meta-analysis examining six studies of cannabinoid-based medications used for the treatment of multiple sclerosis-related neuropathic pain revealed that cannabis preparations were superior to placebo.
“A recent meta-analysis examining six studies of cannabinoid-based medications used for the treatment of MS-related neuropathic pain revealed that cannabis preparations were superior to placebo.148”
From Cannabinoids as Pharmacotherapies for Neuropathic Pain: From the Bench to the Bedside (2009) · cites this paper as [148]
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- Authors
- Iskedjian, M., Bereza, B., Gordon, A., Piwko, C., & Einarson, T. R.
- Affiliations
- PharmIdeas (Canada) (CA)
- Mount Sinai Hospital (CA)
- University of Toronto (CA)
- Corresponding author
- Einarson, Thomas R.
- Venue
- Current Medical Research and Opinion
- Publisher
- Informa Healthcare
- Published
- 2006-11-27
- Volume
- 23
- Issue
- 1
- Pages
- 17-24
- ISSN
- 0300-7995 (ISSN-L)
- 1473-4877
- OpenAlex
- W2146626244
- Cited by
- 216
- References
- 38
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 5 · 2023: 20 · 2022: 13 · 2021: 15 · 2020: 16 · 2019: 8 · 2018: 16 · 2017: 11 · 2016: 9 · 2015: 13 · 2014: 9 · 2013: 7 · 2012: 11
- FWCI
- 1.52
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Current Medical Research and Opinion (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Bayer HealthCare
- Bayer Canada
- Topics
- Health Sciences › Medicine › Pharmacology › Cannabis and Cannabinoid Research
- Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Keywords
- neuropathic pain, multiple sclerosis, Sativex, cannabidiol, dronabinol, THC, analgesia, adverse events, dizziness, drug safety, VAS pain score, quality of life
- MeSH terms
- Cannabinoids, Humans, Multiple Sclerosis, Neuralgia, Pain, Pain Measurement, Chi-Square Distribution, Randomized Controlled Trials as Topic
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