Randomized, Controlled Trial of Cannabis-Based Medicine in Central Pain in Multiple Sclerosis

Neurology. 2005 Sep 27;65(6):812-9. doi: 10.1212/01.wnl.0000176753.45410.8b.

Abstract

Background: Central pain in multiple sclerosis (MS) is common and often refractory to treatment.

Methods: We conducted a single-center, 5-week (1-week run-in, 4-week treatment), randomized, double-blind, placebo-controlled, parallel-group trial in 66 patients with MS and central pain states (59 dysesthetic, seven painful spasms) of a whole-plant cannabis-based medicine (CBM), containing delta-9-tetrahydrocannabinol:cannabidiol (THC:CBD) delivered via an oromucosal spray, as adjunctive analgesic treatment. Each spray delivered 2.7 mg of THC and 2.5 of CBD, and patients could gradually self-titrate to a maximum of 48 sprays in 24 hours.

Results: Sixty-four patients (97%) completed the trial, 34 received CBM. In week 4, the mean number of daily sprays taken of CBM (n = 32) was 9.6 (range 2 to 25, SD = 6.0) and of placebo (n = 31) was 19.1 (range 1 to 47, SD = 12.9). Pain and sleep disturbance were recorded daily on an 11-point numerical rating scale. CBM was superior to placebo in reducing the mean intensity of pain (CBM mean change -2.7, 95% CI: -3.4 to -2.0, placebo -1.4 95% CI: -2.0 to -0.8, comparison between groups, p = 0.005) and sleep disturbance (CBM mean change -2.5, 95% CI: -3.4 to -1.7, placebo -0.8, 95% CI: -1.5 to -0.1, comparison between groups, p = 0.003). CBM was generally well tolerated, although more patients on CBM than placebo reported dizziness, dry mouth, and somnolence. Cognitive side effects were limited to long-term memory storage.

Conclusions: Cannabis-based medicine is effective in reducing pain and sleep disturbance in patients with multiple sclerosis related central neuropathic pain and is mostly well tolerated.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Oral
  • Adult
  • Aged
  • Analgesics / administration & dosage*
  • Analgesics / adverse effects
  • Cannabinoids / administration & dosage*
  • Cannabinoids / adverse effects
  • Central Nervous System / drug effects
  • Central Nervous System / physiopathology
  • Disorders of Excessive Somnolence / chemically induced
  • Dizziness / chemically induced
  • Dose-Response Relationship, Drug
  • Double-Blind Method
  • Dronabinol / administration & dosage
  • Female
  • Humans
  • Male
  • Memory Disorders / chemically induced
  • Middle Aged
  • Multiple Sclerosis / complications*
  • Pain Measurement / drug effects
  • Pain Threshold / drug effects
  • Pain Threshold / physiology
  • Pain, Intractable / drug therapy*
  • Pain, Intractable / etiology
  • Pain, Intractable / physiopathology
  • Phytotherapy*
  • Placebos
  • Plant Preparations / administration & dosage*
  • Plant Preparations / adverse effects
  • Sleep Wake Disorders / drug therapy
  • Sleep Wake Disorders / etiology
  • Treatment Outcome

Substances

  • Analgesics
  • Cannabinoids
  • Placebos
  • Plant Preparations
  • Dronabinol