Smoking Marijuana Eases Chronic Neuropathic Pain

Fran Lowry

August 30, 2010

August 30, 2010 — Smoking cannabis reduces chronic neuropathic pain and also improves sleep, according to new research published today in the Canadian Medical Association Journal.

A single inhalation of 25 mg of 9.4% tetrahydrocannabinol herbal cannabis 3 times a day for 5 days was sufficient to achieve these outcomes, lead study author Mark A. Ware, MBBS, from McGill University Health Center, Montreal, Canada, told Medscape Medical News in an interview.

"Patients have been reporting that cannabis helps control their pain, and they have been saying so for a long time," Dr. Ware said. "At the time that we had secured the funding and began the trial, there had been no clinical trials that had established this or investigated it."

In addition, a large body of scientific knowledge is emerging abound the role of cannabinoid receptors and cannabinoid ligands in the human body, providing a potential scientific explanation as to why cannabinoids would be analgesic, he added. "So the 2 main supports came together, and in Canada at the time, there was an environment where we were able to secure funding sufficient for studies of this."

Posttraumatic and Postsurgical Neuropathy

The study included 21 individuals older than 18 years (mean age, 45.4 years) with posttraumatic or postsurgical neuropathic pain lasting for at least 3 months. They were randomly assigned to receive cannabis at 4 potencies — 0%, 2.5%, 6%, and 9.4% tetrahydrocannabinol — during 4 periods in a crossover design. Each period lasted 14 days and began with 5 days of cannabis use followed by a 9-day washout period.

The cannabis doses were delivered in a single smoked inhalation using a titanium pipe. Patients self-administered the first dose of each period under supervision and were instructed to inhale for 5 seconds while the cannabis was lit, hold the smoke in their lungs for 10 seconds, and then exhale. They self-administered the remaining doses for each period at home.

The participants were allowed to continue their routine medications, and the use of acetaminophen as breakthrough analgesia was also permitted.

Pain intensity was measured using an 11-item numeric rating scale that used "no pain" and "worst pain possible" as anchors.

The study found that the higher dose of cannabis was the most efficient in reducing pain. The average daily pain intensity was 5.4 with the 9.4% tetrahydrocannabinol cannabis dose compared with 6.1 with the 0% or placebo dose (95% confidence interval, 0.02 – 1.4; P = .023).

In addition, participants reported significantly more drowsiness and reported getting to sleep more easily, faster, and with fewer periods of wakefulness when taking the 9.4% dose than when taking the 0% dose (P < .05). The higher dose also improved anxiety and depression compared with the placebo dose.

Blind Held; Studies Feasible

"It was feared that participants would know right away if they were smoking cannabis because of the acute psychoactive effects of the drug, but our results do not support this," Dr. Ware noted. "They do show that short-term placebo-controlled trials of smoked cannabis are feasible."

He would like his study to act as a stimulus for other studies on cannabis and pain relief.

"Studies of this kind can be done. Ours was difficult to do because it was the first time we had done anything like this. We were breaking new ground with regard to regulations and so on, but it is possible. Having done it once, it's not as difficult to do it again. So our results raise the possibility of extending the study for a longer duration, or being able to look at safety issues, and so on. It is possible to do a scientific trial with this compound. Your political views shouldn't matter. This is just good science," Dr. Ware said.

In a related commentary, Henry J. McQuay, DM, from Balliol College, Oxford, United Kingdom, writes that the study authors should be congratulated for tackling the question of whether cannabis helps in neuropathic pain, "particularly given that the regulatory hurdles for their trial must have been a nightmare."

He concludes that the study "adds to the trickle of evidence that cannabis may help some of the patients who are struggling at present."

Dr. Ware has disclosed no relevant financial relationships. Dr. McQuay reports financial relationships with Reckitt Benckiser, Pfizer Data Safety and Monitoring Board, Archimedes, Esteve, Sanofi, Ratiopharm, Sandoz, and Grunenthal. He has received royalties for a textbook on the subject of pain.

CMAJ. Published online August 30, 2010.


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