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Randomized Controlled Trial
. 2023 Apr;27(4):492-506.
doi: 10.1002/ejp.2072. Epub 2023 Jan 12.

Oral capsules of tetra-hydro-cannabinol (THC), cannabidiol (CBD) and their combination in peripheral neuropathic pain treatment

Kanita Zubcevic  1   2 , Merete Petersen  3 , Flemming Winther Bach  4   5 , Aksel Heinesen  6 , Thomas Peter Enggaard  7 , Thomas Peter Almdal  8 , Jakob Vormstrup Holbech  1   2 , Lene Vase  9 , Troels Stahelin Jensen  4   5 , Christian Stevns Hansen  6 , Nanna Brix Finnerup  4   5 , Søren H Sindrup  1   2
Affiliations
Randomized Controlled Trial

Oral capsules of tetra-hydro-cannabinol (THC), cannabidiol (CBD) and their combination in peripheral neuropathic pain treatment

Kanita Zubcevic et al. Eur J Pain. 2023 Apr.

Abstract

Background: Cannabinoids are often prescribed for neuropathic pain, but the evidence-based recommendation is 'weak against'.

Objectives: The aim was to examine the effect of two cannabinoids and their combination in peripheral neuropathic pain.

Methods: This was a randomized, double-blind, trial with treatment arms for cannabidiol (CBD), tetra-hydro-cannabinol (THC), CBD and THC combination (CBD/THC), and placebo in a 1:1:1:1 ratio and flexible drug doses (CBD 5-50 mg, THC 2.5-25 mg, and CBD/THC 5 mg/2.5 mg-50 mg/25 mg). Treatment periods of 8-week duration were proceeded by 1 week for baseline observations. Patients with painful polyneuropathy, post-herpetic neuralgia and peripheral nerve injury (traumatic or surgical) failing at least one previous evidence-based pharmacological treatment were eligible for inclusion. The primary outcome was the change in weekly average of daily pain measured with a numeric rating scale (NRS). Trail Making Test (TMT) was used as one of the tests of mental functioning.

Results: In all, 145 patients were included in the study of which 118 were randomized and 115 included in the intention-to-treat analysis. None of the treatments reduced pain compared to placebo (p = 0.04-0.60). Effect sizes as estimated in week 8 (positive values worse and negative better than placebo) were CBD mean 1.14 NRS points (95% CI 0.11-2.19), THC 0.38 (CI -0.65 to 1.4) and CBD/THC -0.12 (-1.13 to 0.89).

Conclusions: CBD, THC and their combination did not relieve peripheral neuropathic pain in patients failing at least one previous evidence-based treatment for neuropathic pain.

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References

REFERENCES

    1. Bouhassira, D., Attal, N., Fermanian, J., Alchaar, H., Gautron, M., Masquelier, E., Rostaing, S., Lanteri-Minet, M., Collin, E., Grisart, J., & Boureau, F. (2004). Development and validation of the neuropathic pain symptom inventory. Pain, 108, 248-257.
    1. Demant, D. T., Lund, K., Vollert, J., Maier, C., Segerdahl, M., Finnerup, N. B., Jensen, T. S., & Sindrup, S. H. (2014). The effect of oxcarbazepine in peripheral neuropathic pain depends on pain phenotype: A randomised, double-blind, placebo-controlled phenotype-stratified study. Pain, 155, 2263-2273.
    1. Ferber, S. G., Namdar, D., Hen-Shoval, D., Eger, G., Koltai, H., Shoval, G., Shbiro, L., & Weller, A. (2020). The “entourage effect”: Terpenes coupled with cannabinoids for the treatment of mood disorders and anxiety disorders. Current Neuropharmacology, 18, 87-96.
    1. Finn, D. P., Haroutounian, S., Hohmann, A. G., Krane, E., Soliman, N., & Rice, A. S. C. (2021). Cannabinoids, the endocannabinoid system, and pain: A review of preclinical studies. Pain, 162(Suppl 1), S5-S25.
    1. Finnerup, N. B., Attal, N., Haroutounian, S., McNicol, E., Baron, R., Dworkin, R. H., Gilron, I., Haanpää, M., Hansson, P., Jensen, T. S., Kamerman, P. R., Lund, K., Moore, A., Raja, S. N., Rice, A. S. C., Rowbotham, M., Sena, E., Siddall, P., Smith, B. H., & Wallace, M. (2015). Pharmacotherapy for neuropathic pain in adults: A systematic review and meta-analysis. Lancet Neurology, 14, 162-173.

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