Highlights
- •All Neuropathic Pain Scale descriptors were improved by vaporized cannabis.
- •There was significantly more pain relief with active cannabis than with placebo.
- •The two active doses did not significantly differ from each other in terms of analgesic potency.
- •Many of the psychoactive side effects were delta 9-THC concentration-dependent.
Abstract
Using 8-hour human laboratory experiments, we evaluated the analgesic efficacy of
vaporized cannabis in patients with neuropathic pain related to injury or disease
of the spinal cord, most of whom were experiencing pain despite traditional treatment.
After obtaining baseline data, 42 participants underwent a standardized procedure
for inhaling 4 puffs of vaporized cannabis containing either placebo, 2.9%, or 6.7%
delta 9-THC on 3 separate occasions. A second dosing occurred 3 hours later; participants
chose to inhale 4 to 8 puffs. This flexible dosing was used to attempt to reduce the
placebo effect. Using an 11-point numerical pain intensity rating scale as the primary
outcome, a mixed effects linear regression model showed a significant analgesic response
for vaporized cannabis. When subjective and psychoactive side effects (eg, good drug
effect, feeling high, etc) were added as covariates to the model, the reduction in
pain intensity remained significant above and beyond any effect of these measures
(all P < .0004). Psychoactive and subjective effects were dose-dependent. Measurement of
neuropsychological performance proved challenging because of various disabilities
in the population studied. Because the 2 active doses did not significantly differ
from each other in terms of analgesic potency, the lower dose appears to offer the
best risk-benefit ratio in patients with neuropathic pain associated with injury or
disease of the spinal cord.
Perspective
A crossover, randomized, placebo-controlled human laboratory experiment involving
administration of vaporized cannabis was performed in patients with neuropathic pain
related to spinal cord injury and disease. This study supports consideration of future
research that would include longer duration studies over weeks to months to evaluate
the efficacy of medicinal cannabis in patients with central neuropathic pain.
Key words
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Article info
Publication history
Published online: June 07, 2016
Accepted:
May 20,
2016
Received in revised form:
April 18,
2016
Received:
January 27,
2016
Footnotes
The research reported in this publication was supported by the National Institute of Drug Abuse (R01DA030424). The project was also supported by the National Center for Advancing Translational Sciences, National Institutes of Health (NIH), through grant number UL1 TR000002. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH, Department of Veterans Affairs, or US Government. This material is the result of work supported with resources and the use of facilities at the Sacramento VA Medical Center.
The authors have no conflicts of interest to declare.
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© 2016 by the American Pain Society
