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Margaret Haney - One of the best experts on this subject based on the ideXlab platform.
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varenicline and Nabilone in tobacco and cannabis co users effects on tobacco abstinence withdrawal and a laboratory model of cannabis relapse
Addiction Biology, 2019Co-Authors: Evan S Herrmann, Gillinder Bedi, Ziva D Cooper, Sandra D Comer, Richard W Foltin, Divya Ramesh, Stephanie Collins Reed, Margaret HaneyAbstract:Tobacco and cannabis co-users (T+CUs) have poor cannabis cessation outcomes, but the mechanisms underlying this are not well understood. This laboratory study examined the effects of (1) the partial nicotinic agonist, varenicline, on tobacco cessation among T+CUs, and (2) varenicline, alone, and when combined with the cannabinoid agonist Nabilone, on cannabis withdrawal and a laboratory model of cannabis relapse. Non-treatment-seeking T+CUs were randomized to active-varenicline or placebo-varenicline, and completed a 15-day outpatient phase; varenicline was titrated to 1 mg BID during days 1-8, and participants were instructed to abstain from tobacco during days 9-15. Participants then moved inpatient for 16 days, where they continued their outpatient medication and tobacco abstinence. Inpatient testing included two, 8-day medication periods, where active-Nabilone and placebo-Nabilone were administered in counterbalanced order, and measures of acute cannabis effects (days 1-2), withdrawal (days 4-5) and 'relapse' (days 6-8) were collected. Participants in the active-varenicline group were more likely to achieve cotinine-verified tobacco abstinence during the outpatient period versus placebo-varenicline group (46 percent versus 24 percent, respectively), and also reported less mood disturbance and cigarette craving while inpatient. Active-Nabilone attenuated cannabis withdrawal in both groups but did not affect cannabis relapse. Regression analyses revealed that two tobacco-related variables, i.e. age of first cigarette use, and cigarette craving while inpatient, were independent predictors of cannabis relapse outcomes. Thus, varenicline holds promise in this population, as a tool to examine the effects of tobacco abstinence on cannabis use outcomes, and as a component of smoking cessation treatments targeting T+CUs.
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effects of zolpidem alone and in combination with Nabilone on cannabis withdrawal and a laboratory model of relapse in cannabis users
Psychopharmacology, 2016Co-Authors: Evan S Herrmann, Gillinder Bedi, Ziva D Cooper, Sandra D Comer, Richard W Foltin, Divya Ramesh, Stephanie Collins Reed, Margaret HaneyAbstract:Each year, over 300,000 individuals in the USA enter treatment for cannabis use disorder (CUD). The development of effective pharmacotherapy for CUD is a priority. This placebo-controlled study examined the effects of zolpidem alone and in combination with Nabilone on cannabis withdrawal and a laboratory measure of relapse. Eleven daily, non-treatment-seeking cannabis users completed three, 8-day inpatient phases; each phase tested a different medication condition in counter-balanced order. On the first day of each phase, participants were administered placebo capsules t.i.d. and smoked experimenter-administered active cannabis (5.6 % Δ9-tetrahydrocannabinol (THC)). On days 2–8, the participants were administered capsules containing either placebo (0 mg at 0900, 1800, and 2300 hours), zolpidem (0 mg at 0900 and 1800, and 12.5 mg at 2300), or zolpidem (12.5 mg at 2300) and Nabilone (3 mg at 0900 and 1800). Cannabis withdrawal, subjective capsule effects, and cognitive performance were examined on days 3–4, when only inactive cannabis (0.0 % THC) was available for self-administration. “Relapse” was measured on days 5–8, when participants could self-administer active cannabis. Both medication conditions decreased withdrawal-related disruptions in sleep, but only zolpidem in combination with Nabilone decreased withdrawal-related disruptions in mood and food intake relative to placebo. Zolpidem in combination with Nabilone, but not zolpidem alone, decreased self-administration of active cannabis. Zolpidem in combination with Nabilone also produced small increases in certain abuse-related subjective capsule ratings, while zolpidem alone did not. Neither medication condition altered cognitive performance. Clinical testing of Nabilone, either alone, or in combination with zolpidem is warranted.
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subjective cognitive and cardiovascular dose effect profile of Nabilone and dronabinol in marijuana smokers
Addiction Biology, 2013Co-Authors: Gillinder Bedi, Ziva D Cooper, Margaret HaneyAbstract:: Marijuana dependence is a substantial public health problem, with existing treatments showing limited efficacy. In laboratory and clinical studies, the cannabinoid receptor 1 agonist oral Δ9tetrahydrocannabinol (THC; dronabinol) has been shown to decrease marijuana withdrawal but not relapse. Dronabinol has poor bioavailability, potentially contributing to its failure to decrease relapse. The synthetic THC analogue, Nabilone, has better bioavailability than dronabinol. We therefore aimed to characterize Nabilone's behavioral and physiological effects across a range of acute doses in current marijuana smokers and compare these with dronabinol's effects. Participants (4 female; 10 male) smoking marijuana 6.6 (standard deviation = 0.7) days/week completed this outpatient, within-subjects, double-blind, randomized protocol. Over seven sessions, the time-dependent subjective, cognitive and cardiovascular effects of Nabilone (2, 4, 6, 8 mg), dronabinol (10, 20 mg) and placebo were assessed. Nabilone (4, 6, 8 mg) and dronabinol (10, 20 mg) increased ratings of feeling a good effect, a strong effect and/or 'high' relative to placebo; Nabilone had a slower onset of peak subjective effects than dronabinol. Nabilone (6, 8 mg) modestly lowered psychomotor speed relative to placebo and dronabinol. There were dose-dependent increases in heart rate after Nabilone, and Nabilone (2 mg) and dronabinol (10 mg) decreased systolic blood pressure. Thus, Nabilone produced sustained, dose-related increases in positive mood, few cognitive decrements and lawful cardiovascular alterations. It had a longer time to peak effects than dronabinol, and effects were more dose-related, suggesting improved bioavailability. Nabilone was well tolerated by marijuana smokers, supporting further testing as a potential medication for marijuana dependence.
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Nabilone decreases marijuana withdrawal and a laboratory measure of marijuana relapse
Neuropsychopharmacology, 2013Co-Authors: Margaret Haney, Gillinder Bedi, Ziva D Cooper, Suzanne K Vosburg, Sandra D Comer, Richard W FoltinAbstract:Few individuals seeking treatment for marijuana use achieve sustained abstinence. The cannabinoid receptor agonist, Δ(9)-tetrahydrocannabinol (THC; dronabinol), decreases marijuana withdrawal symptoms, yet does not decrease marijuana use in the laboratory or clinic. Dronabinol has poor bioavailability, which may contribute to its poor efficacy. The FDA-approved synthetic analog of THC, Nabilone, has higher bioavailability and clearer dose-linearity than dronabinol. This study tested whether Nabilone administration would decrease marijuana withdrawal symptoms and a laboratory measure of marijuana relapse relative to placebo. Daily, nontreatment-seeking marijuana smokers (8 men and 3 women), who reported smoking 8.3±3.1 marijuana cigarettes/day completed this within-subject study comprising three, 8-day inpatient phases; each phase tested a different Nabilone dose (0, 6, 8 mg/day, administered in counter-balanced order on days 2-8). On the first inpatient day, participants took placebo capsules and smoked active marijuana (5.6% THC) at six timepoints. For the next 3 days, they had the opportunity to self-administer placebo marijuana (0.0% THC; withdrawal), followed by 4 days in which active marijuana was available for self-administration (5.6% THC; relapse). Both Nabilone dose conditions decreased marijuana relapse and reversed withdrawal-related irritability and disruptions in sleep and food intake (p<0.05). Nabilone (8 mg/day) modestly worsened psychomotor task performance. Neither dose condition increased ratings of capsule 'liking' or desire to take the capsules relative to placebo. Thus, Nabilone maintenance produced a robust attenuation of marijuana withdrawal symptoms and a laboratory measure of relapse even with once per day dosing. These data support testing of Nabilone for patients seeking marijuana treatment.
Mark A Ware - One of the best experts on this subject based on the ideXlab platform.
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the abuse potential of the synthetic cannabinoid Nabilone
Addiction, 2010Co-Authors: Mark A Ware, Emmanuelle St ArnaudtrempeAbstract:Aim Nabilone is a synthetic cannabinoid prescription drug approved in Canada since 1981 to treat chemotherapy‐induced nausea and vomiting. In recent years, off‐label use of Nabilone for chronic pain management has increased, and physicians have begun to express concerns about Nabilone becoming a drug of abuse. This study evaluates the evidence for abuse of Nabilone, which is currently ill‐defined. Study design Scientific literature, popular press and internet databases were searched extensively for evidence of Nabilone abuse. Focused interviews with medical professionals and law enforcement agencies across Canada were also conducted. Findings The scientific literature and popular press reviews found very little reference to Nabilone abuse. Nabilone is perceived to produce more undesirable side effects, to have a longer onset of action and to be more expensive than smoked cannabis. The internet review revealed rare and isolated instances of recreational use of Nabilone. The database review yielded little evidence of Nabilone abuse, although Nabilone seizures and thefts have occurred in Canada in the past few years, especially in Ontario. Most law enforcement officers reported no instances of Nabilone abuse or diversion, and the drug has no known street value. Medical professionals reported that Nabilone is not perceived to be a matter of concern with respect to its abuse potential. Conclusions Reports of Nabilone abuse are extremely rare. However, follow‐up of patients using Nabilone for therapeutic purposes is prudent and should include assessment of tolerance and dependence. Prospective studies are also needed to definitively address the issue of Nabilone abuse.
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the effects of Nabilone on sleep in fibromyalgia results of a randomized controlled trial
Anesthesia & Analgesia, 2010Co-Authors: Mark A Ware, Maryann Fitzcharles, Lawrence Joseph, Yoram ShirAbstract:BACKGROUND:Sleep disorders affect many patients with chronic pain conditions. Cannabis has been reported by several patient populations to help sleep. We evaluated the safety and efficacy of Nabilone, a synthetic cannabinoid, on sleep disturbance in fibromyalgia (FM), a disease characterized by wide
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a review of Nabilone in the treatment of chemotherapy induced nausea and vomiting
Therapeutics and Clinical Risk Management, 2008Co-Authors: Mark A Ware, Paul Daeninck, Vincent MaidaAbstract:Chemotherapy-induced nausea and vomiting (CINV) in cancer patients places a significant burden on patients' function and quality of life, their families and caregivers, and healthcare providers. Despite the advances in preventing CINV, a substantial proportion of patients experience persistent nausea and vomiting. Nabilone, a cannabinoid, recently received Food and Drug Administration approval for the treatment of the nausea and vomiting in patients receiving cancer chemotherapy who fail to achieve adequate relief from conventional treatments. The cannabinoids exert antiemetic effects via agonism of cannabinoid receptors (CB1 and CB2). Clinical trials have demonstrated the benefits of Nabilone in cancer chemotherapy patients. Use of the agent is optimized with judicious dosing and selection of patients.
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A review of Nabilone in the treatment of chemotherapy-induced nausea and vomiting
Dove Medical Press, 2008Co-Authors: Mark A Ware, Paul Daeninck, Vincent MaidaAbstract:Mark A Ware1, Paul Daeninck2, Vincent Maida31Pain Center, McGill University Health Center, Montréal, Quebec, Canada; 2Pain and Symptom Clinic, CancerCare Manitoba, Winnipeg, Manitoba, Canada; 3University of Toronto, Toronto, Ontario, CanadaAbstract: Chemotherapy-induced nausea and vomiting (CINV) in cancer patients places a significant burden on patients’ function and quality of life, their families and caregivers, and healthcare providers. Despite the advances in preventing CINV, a substantial proportion of patients experience persistent nausea and vomiting. Nabilone, a cannabinoid, recently received Food and Drug Administration approval for the treatment of the nausea and vomiting in patients receiving cancer chemotherapy who fail to achieve adequate relief from conventional treatments. The cannabinoids exert antiemetic effects via agonism of cannabinoid receptors (CB1 and CB2). Clinical trials have demonstrated the benefits of Nabilone in cancer chemotherapy patients. Use of the agent is optimized with judicious dosing and selection of patients.Keywords: Nabilone, chemotherapy-induced nausea/vomiting, pai
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experience with the synthetic cannabinoid Nabilone in chronic noncancer pain
Pain Medicine, 2006Co-Authors: David M Berlach, Yoram Shir, Mark A WareAbstract:Chronic noncancer pain includes a heterogenous group of disorders and is often refractory to treatment. Cannabis products have historically been used for chronic pain and are attracting renewed pharmaceutical interest. Nabilone is a synthetic cannabinoid licensed in Canada for the treatment of severe nausea and vomiting associated with cancer chemotherapy. We have used Nabilone off-label for the treatment of chronic noncancer pain since 1999. In this article, we review our clinical experience of 20 adult patients with chronic noncancer pain who had been treated with Nabilone and followed up for an average of 1.5 years. Prior to Nabilone therapy, patients had used a wide range of therapies, including 11 who had used cannabis. Fifteen patients reported subjective overall improvement with Nabilone, and nine reported reduced pain intensity. Beneficial effects on sleep and nausea were the main reasons for continuing use. Intolerable side effects were experienced in three patients (palpitations, urinary retention, dry mouth). Nabilone may be a useful addition to pain management and should be further evaluated in randomized controlled trials.
Werner Poewe - One of the best experts on this subject based on the ideXlab platform.
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Nabilone for non motor symptoms of parkinson s disease a randomized placebo controlled double blind parallel group enriched enrolment randomized withdrawal study the nms nab study
Journal of Neural Transmission, 2019Co-Authors: Marina Peball, Werner Poewe, Atbin Djamshidian, Hansgunther Knaus, Mario Werkmann, Philipp Ellmerer, Dora Valent, Raphaela Stolz, Hanno Ulmer, Klaus SeppiAbstract:Although open-label observations report a positive effect of cannabinoids on non-motor symptoms (NMS) in Parkinson’s disease (PD) patients, these effects remain to be investigated in a controlled trial for a broader use in NMS in PD patients. Therefore, we decided to design a proof-of-concept study to assess the synthetic cannabinoid Nabilone for the treatment of NMS. We hypothesize that Nabilone will improve NMS in patients with PD and have a favorable safety profile. The NMS-Nab Study is as a mono-centric phase II, randomized, placebo-controlled, double-blind, parallel-group, enriched enrollment withdrawal study. The primary efficacy criterion will be the change in Movement Disorders Society-Unified Parkinson’s Disease-Rating Scale Part I score between baseline (i.e. randomization) and week 4. A total of 38 patients will have 80% power to detect a probability of 0.231 that an observation in the treatment group is less than an observation in the placebo group using a Wilcoxon rank-sum test with a 0.050 two-sided significance level assuming a true difference of 2.5 points between Nabilone and placebo in the primary outcome measure and a standard deviation of the change of 2.4 points. The reduction of harm through an ineffective treatment, the possibility of individualized dosing, the reduction of sample size, and the possible evaluation of the influence of the placebo effect on efficacy outcomes justify this design for a single-centered placebo-controlled investigator-initiated trial of Nabilone. This study should be the basis for further evaluations of long-term efficacy and safety of the use of cannabinoids in PD patients.
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m6 Nabilone in huntington s disease a case series of five patients
Journal of Neurology Neurosurgery and Psychiatry, 2016Co-Authors: Beatrice Heim, Werner Poewe, Sweta Bajaj, Roberto De Marzi, Stephanie Mangesius, Atbin Djamshidian, Klaus SeppiAbstract:Background and objective There is limited evidence about the efficacy and safety of cannabinoids in the treatment of patients with Huntington’s disease (HD). Five patients with HD were treated with Nabilone, a synthetic cannabinoid, in order to alleviate therapy-resistant symptoms. Methods All patients and caregivers were informed about the off-label use of Nabilone and gave written informed consent. A Clinical Global Impression Scale (CGI) and the Unified Huntington9s Disease Rating Scale (UHDRS) were applied prior, after one and four weeks to decide on the continuation of Nabilone treatment. Case reports Patient 1 is a 20-year-old male who presented with disabling tics, generalised chorea and increased irritability. He developed severe parkinsonism during therapy with amisulpiride and olanzapine. Amisulpiride was stopped and he was treated with Nabilone 1 mg/d. Patient 2 is a 48-year-old female with 10 years history of HD and chronic pain. Multiple treatment trials were ineffective. Nabilone 2 mg/d was introduced. Patient 3 is a 62-year-old female with disabling chorea and increased irritability. She developed severe akathisia as a side effect of several antidopaminergic therapies. Treatment with Nabilone 1.5 mg/d was commenced. Patient 4 is a 46-year-old female who had parkinsonism and depression under therapy with tetrabenazine. Treatment with Nabilone 3 mg/d was introduced as monotherapy. Patient 5 is a 67-year-old female with disabling chorea and increased irritability. She developed parkinsonism during therapy with tetrabenazine. Medication was changed to 2 mg/d Nabilone. Results Transient mild sedation during titration occurred in patients 3, 4 and 5, mild non-disturbing xerostomia in patient 3. All patients reported improved symptoms as assessed by the CGI. UHDRS and Chorea-scores improved in all patients. A reduction of tics without worsening of parkinsonism with Nabilone was seen in patient 1. Patient 2 reported that her pain completely subsided. Irritability substantially improved with Nabilone in patients 1, 3 and 5. Moreover, tetrabenazine could be stopped in patients 3, 4 and 5. This resulted in a remission of akathisia in patient 3, in improved parkinsonism in patients 4 and 5 as well as in ameliorated mood in patient 4. Conclusions These case series suggest that Nabilone may be an effective and well tolerated adjunct to the drug treatment of HD. However, larger controlled trials are needed to confirm these preliminary open-label observations.
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low dose treatment with the synthetic cannabinoid Nabilone significantly reduces spasticity related pain
Journal of Neurology, 2006Co-Authors: Jorg Wissel, Tanja Haydn, Jorg Muller, Christian Brenneis, Thomas Berger, Werner Poewe, Ludwig ScheloskyAbstract:About 30% of patients with chronic upper motor neuron syndrome (UMNS) suffer from disabling spasticity-related pain not sufficiently correctable by conventional treatment. Delta9-tetrahydrocannabinol (Δ9-THC) was reported to add benefit in the treatment of pain in patients with multiple sclerosis (MS). The question arose whether synthetic cannabinoids with lower potential for psychotropic side effects could be effective as well. To evaluate the safety and efficacy of low dose treatment with the synthetic cannabinoid Nabilone (1 mg per day) on spasticity-related pain a placebo-controlled double-blind crossover trial was performed.
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low dose treatment with the synthetic cannabinoid Nabilone significantly reduces spasticity related pain
Journal of Neurology, 2006Co-Authors: Jorg Wissel, Tanja Haydn, Jorg Muller, Christian Brenneis, Thomas Berger, Werner Poewe, Ludwig ScheloskyAbstract:About 30% of patients with chronic upper motor neuron syndrome (UMNS) suffer from disabling spasticity-related pain not sufficiently correctable by conventional treatment. Delta9-tetrahydrocannabinol (Δ9-THC) was reported to add benefit in the treatment of pain in patients with multiple sclerosis (MS). The question arose whether synthetic cannabinoids with lower potential for psychotropic side effects could be effective as well. To evaluate the safety and efficacy of low dose treatment with the synthetic cannabinoid Nabilone (1 mg per day) on spasticity-related pain a placebo-controlled double-blind crossover trial was performed. 11 out of 13 included patients completed the study. The 11-Point-Box-Test showed a significant decrease of pain under Nabilone (p < 0.05), while spasticity, motor function and activities of daily living did not change. 5 patients reported side effects: one moderate transient weakness of the lower limbs (Nabilone phase, drop out), three mild drowsiness (two Nabilone, one placebo) and one mild dysphagia (placebo). One patient was excluded from the study due to an acute relapse of multiple sclerosis (Nabilone phase, drop out). Nabilone 1 mg per day proved to be a safe and easily applicable option in the care of patients with chronic UMNS and spasticity-related pain otherwise not controllable.
Vincent Maida - One of the best experts on this subject based on the ideXlab platform.
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Nabilone for the treatment of paraneoplastic night sweats a report of four cases
Journal of Palliative Medicine, 2008Co-Authors: Vincent MaidaAbstract:ABSTRACT Night sweats are one of many symptoms experienced by patients with advanced cancer. The prevalence of night sweats ranges from 10%–48% in cancer patients. Persistent night sweats tend to decrease quality of life through interference with sleep. A recent study has demonstrated that night sweats occur as part of a symptom pattern, and are associated with the anorexia–cachexia symptom cluster. In addition, night sweats represent one of the symptoms that displays a tendency not to improve as patients with advanced cancer approach end of life. This paper serves to report on the successful management of four patients suffering from persistent paraneoplastic night sweats using the synthetic orally administered cannabinoid Nabilone. The four patients had been referred to a regional consultative palliative medicine program and identified night sweats as one of their most significant symptomatic concerns reported on their Edmonton Symptom Assessment System (ESAS) questionnaires.
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adjunctive Nabilone in cancer pain and symptom management a prospective observational study using propensity scoring
The journal of supportive oncology, 2008Co-Authors: Vincent Maida, Marguerite Ennis, Shiraz Irani, Mario Corbo, Michael DolzhykovAbstract:A prospective observational study assessed the effectiveness of adjuvant Nabilone (Cesamet) therapy in managing pain and symptoms experienced by advanced cancer patients. The primary outcomes were the differences between treated and untreated patients at 30 days' follow-up, in Edmonton Symptom Assessment System (ESAS) pain scores, and in total morphine-sulfate-equivalent (MSE) use after adjusting for baseline discrepancies using the propensity-score method. Secondary outcomes included other ESAS parameters and frequency of other drug use. Data from 112 patients (47 treated, 65 untreated) met criteria for analyses.The propensity-adjusted pain scores and total MSE use in Nabilone-treated patients were significantly lower than were those found in untreated patients (both P < 0.0001). Other ESAS parameters that improved significantly in patients receiving Nabilone were nausea (P < 0.0001), anxiety (P = 0.0284) and overall distress (total ESAS score; P = 0.0208). The Nabilone group showed borderline improvement in appetite (P = 0.0516). When compared with those not taking Nabilone, patients using this cannabinoid had a lower rate of starting nonsteroidal anti-inflammatory agents, tricyclic antidepressants, gabapentin, dexamethasone, metoclopramide, and ondansetron and a greater tendency to discontinue these drugs.
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a review of Nabilone in the treatment of chemotherapy induced nausea and vomiting
Therapeutics and Clinical Risk Management, 2008Co-Authors: Mark A Ware, Paul Daeninck, Vincent MaidaAbstract:Chemotherapy-induced nausea and vomiting (CINV) in cancer patients places a significant burden on patients' function and quality of life, their families and caregivers, and healthcare providers. Despite the advances in preventing CINV, a substantial proportion of patients experience persistent nausea and vomiting. Nabilone, a cannabinoid, recently received Food and Drug Administration approval for the treatment of the nausea and vomiting in patients receiving cancer chemotherapy who fail to achieve adequate relief from conventional treatments. The cannabinoids exert antiemetic effects via agonism of cannabinoid receptors (CB1 and CB2). Clinical trials have demonstrated the benefits of Nabilone in cancer chemotherapy patients. Use of the agent is optimized with judicious dosing and selection of patients.
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A review of Nabilone in the treatment of chemotherapy-induced nausea and vomiting
Dove Medical Press, 2008Co-Authors: Mark A Ware, Paul Daeninck, Vincent MaidaAbstract:Mark A Ware1, Paul Daeninck2, Vincent Maida31Pain Center, McGill University Health Center, Montréal, Quebec, Canada; 2Pain and Symptom Clinic, CancerCare Manitoba, Winnipeg, Manitoba, Canada; 3University of Toronto, Toronto, Ontario, CanadaAbstract: Chemotherapy-induced nausea and vomiting (CINV) in cancer patients places a significant burden on patients’ function and quality of life, their families and caregivers, and healthcare providers. Despite the advances in preventing CINV, a substantial proportion of patients experience persistent nausea and vomiting. Nabilone, a cannabinoid, recently received Food and Drug Administration approval for the treatment of the nausea and vomiting in patients receiving cancer chemotherapy who fail to achieve adequate relief from conventional treatments. The cannabinoids exert antiemetic effects via agonism of cannabinoid receptors (CB1 and CB2). Clinical trials have demonstrated the benefits of Nabilone in cancer chemotherapy patients. Use of the agent is optimized with judicious dosing and selection of patients.Keywords: Nabilone, chemotherapy-induced nausea/vomiting, pai
Ludwig Schelosky - One of the best experts on this subject based on the ideXlab platform.
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low dose treatment with the synthetic cannabinoid Nabilone significantly reduces spasticity related pain
Journal of Neurology, 2006Co-Authors: Jorg Wissel, Tanja Haydn, Jorg Muller, Christian Brenneis, Thomas Berger, Werner Poewe, Ludwig ScheloskyAbstract:About 30% of patients with chronic upper motor neuron syndrome (UMNS) suffer from disabling spasticity-related pain not sufficiently correctable by conventional treatment. Delta9-tetrahydrocannabinol (Δ9-THC) was reported to add benefit in the treatment of pain in patients with multiple sclerosis (MS). The question arose whether synthetic cannabinoids with lower potential for psychotropic side effects could be effective as well. To evaluate the safety and efficacy of low dose treatment with the synthetic cannabinoid Nabilone (1 mg per day) on spasticity-related pain a placebo-controlled double-blind crossover trial was performed.
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low dose treatment with the synthetic cannabinoid Nabilone significantly reduces spasticity related pain
Journal of Neurology, 2006Co-Authors: Jorg Wissel, Tanja Haydn, Jorg Muller, Christian Brenneis, Thomas Berger, Werner Poewe, Ludwig ScheloskyAbstract:About 30% of patients with chronic upper motor neuron syndrome (UMNS) suffer from disabling spasticity-related pain not sufficiently correctable by conventional treatment. Delta9-tetrahydrocannabinol (Δ9-THC) was reported to add benefit in the treatment of pain in patients with multiple sclerosis (MS). The question arose whether synthetic cannabinoids with lower potential for psychotropic side effects could be effective as well. To evaluate the safety and efficacy of low dose treatment with the synthetic cannabinoid Nabilone (1 mg per day) on spasticity-related pain a placebo-controlled double-blind crossover trial was performed. 11 out of 13 included patients completed the study. The 11-Point-Box-Test showed a significant decrease of pain under Nabilone (p < 0.05), while spasticity, motor function and activities of daily living did not change. 5 patients reported side effects: one moderate transient weakness of the lower limbs (Nabilone phase, drop out), three mild drowsiness (two Nabilone, one placebo) and one mild dysphagia (placebo). One patient was excluded from the study due to an acute relapse of multiple sclerosis (Nabilone phase, drop out). Nabilone 1 mg per day proved to be a safe and easily applicable option in the care of patients with chronic UMNS and spasticity-related pain otherwise not controllable.
