<p>A Review of Scientific Evidence for THC:CBD Oromucosal Spray (Nabiximols) in the Management of Chronic Pain</p>

Abstract

The 20% prevalence of chronic pain in the general population is a major health concern given the often profound associated impairment of daily activities, employment status, and health-related quality of life in sufferers. Resource utilization associated with chronic pain represents an enormous burden for healthcare systems. Although analgesia based on the World Health Organization's pain ladder continues to be the mainstay of chronic pain management, aside from chronic cancer pain or end-of-life care, prolonged use of non-steroidal anti-inflammatory drugs or opioids to manage chronic pain is rarely sustainable. As the endocannabinoid system is known to control pain at peripheral, spinal, and supraspinal levels, interest in medical use of cannabis is growing. A proprietary blend of cannabis plant extracts containing delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) as the principal cannabinoids is formulated as an oromucosal spray (USAN name: nabiximols) and standardized to ensure quality, consistency and stability. This review examines evidence for THC:CBD oromucosal spray (nabiximols) in the management of chronic pain conditions. Cumulative evidence from clinical trials and an exploratory analysis of the German Pain e-Registry suggests that add-on THC:CBD oromucosal spray (nabiximols) may have a role in managing chronic neuropathic pain, although further precise clinical trials are required to draw definitive conclusions.

3 Jahre Cannabis als Medizin – Zwischenergebnisse der Cannabisbegleiterhebung

“…Die fehlenden wissenschaftlichen Daten zu Wirksamkeit und Sicherheit von Cannabisarzneimitteln [17][18][19][20][21][22][23][24][25][26][27][28][29] in Verbindung mit einer vergleichsweise hohen Nebenwirkungsrate und dem nicht seltenen Auftreten potenziell schwerwiegender Nebenwirkungen lassen eine Anwendung dieser Arzneimittel nur im Ausnahmefall zu. Insofern muss die gesetzliche Anforderung nochmals bekräftigt werden, Cannabisarzneimittel nur anzuwenden, wenn andere Arzneimittel nicht wirksam sind oder aus anderen Gründen nicht angewendet werden können.…”

Cannabis: are there any benefits?

“…A large systematic review 20 of over 10 000 such conflated studies, made over 100 recommendations which largely influenced the Australian TGA to be ‘moderately confident’ to support prescription for specific approved conditions. The review found evidence for the use of medicinal cannabis in: spasticity and neuropathic pain in multiple sclerosis, 21 chronic noncancer pain, 22,23 chemotherapy‐induced nausea and vomiting 22,24 and medication resistant epilepsy 25 . However, other systematic reviews have been inconclusive and often contradictory.…”

A Case of Toxicity from Cannabidiol Gummy Ingestion

“…It can now be found in baked goods and candies, infused into coffees, and on the shelves of stores in cosmetics and oils. Benefits have been found for specific seizure disorders such as Lennox-Gastaut syndrome and Dravet syndrome; it is also being studied for its role in neuropathic pain [1][2]. The excitement over these treatments has spurred the production of a multitude of CBD-containing products that advertise a broad spectrum of clinical benefits such as improving arthritis-related pain, potential curative effects on cancers, to an overall improvement in well-being.…”