Combined Tetrahydrocannabinol and Cannabidiol to Treat Pain in Epidermolysis Bullosa

A Report of Three Cases

N.H.B. Schräder; J.C. Duipmans; B. Molenbuur; A.P. Wolff; M.F. Jonkman

Disclosures

The British Journal of Dermatology. 2019;180(4):922-924. 

In This Article

Abstract and Introduction

Abstract

Epidermolysis bullosa (EB) is a genetic blistering disorder characterized by intense pain related to disease pathology and care-based interventions. Opioid-based therapies underpin pain care in EB; however, they are unable to provide adequate analgesia in a significant proportion of patients. Cannabinoid-based medicines (CBMs) have been studied increasingly for pain conditions of various aetiologies and pose as a novel dimension for pain care in EB. We present three patients with EB who were prescribed pharmaceutical-grade sublingually administered CBMs comprising tetrahydrocannabinol and cannabidiol. All three patients reported improved pain scores, reduced pruritus and reduction in overall analgesic drug intake.

Introduction

Pain is the most debilitating symptom in adults with epidermolysis bullosa (EB), caused by mucocutaneous blistering, wound care and medical interventions, and in the long term is exacerbated by psychological and central sensitization. The prevalence of pain in EB is 59–93% across subtypes,[1] and leads to significant distress and poor quality of life.[2] The challenging management of pain in EB is characterized by a noteworthy consumption of pain medication. Opioids underpin EB pain care starting as early as infancy; however, they are considered problematic due to developing tolerance, dependence, opioid-induced hyperalgesia, hormonal changes and obstipation. This concerns both patients with EB and caregivers, and urges a pursuit for alternative treatments.

In the Netherlands, the prescription of pharmaceutical-grade cannabinoid-based medicines (CBMs) containing tetrahydrocannabinol (THC) and cannabidiol (CBD) for pain has continually increased since becoming medically available in 2003.[3] The use of CBMs for pain in EB is discussed increasingly,[4] yet remains unexplored territory. Here we report anecdotal outcomes of three patients with EB suffering from refractory pain who were prescribed CBMs.

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