Skip to main content
SpringerLink
Log in

Low dose treatment with the synthetic cannabinoid Nabilone significantly reduces spasticity-related pain

A double-blind placebo-controlled cross-over trial

  • ORIGINAL COMMUNICATION
  • Published:
Journal of Neurology Aims and scope Submit manuscript

Abstract

About 30% of patients with chronic upper motor neuron syndrome (UMNS) suffer from disabling spasticity-related pain not sufficiently correctable by conventional treatment. Delta9-tetrahydrocannabinol (Δ9-THC) was reported to add benefit in the treatment of pain in patients with multiple sclerosis (MS). The question arose whether synthetic cannabinoids with lower potential for psychotropic side effects could be effective as well. To evaluate the safety and efficacy of low dose treatment with the synthetic cannabinoid Nabilone (1 mg per day) on spasticity-related pain a placebo-controlled double-blind crossover trial was performed.

11 out of 13 included patients completed the study. The 11-Point-Box-Test showed a significant decrease of pain under Nabilone (p < 0.05), while spasticity, motor function and activities of daily living did not change. 5 patients reported side effects: one moderate transient weakness of the lower limbs (Nabilone phase, drop out), three mild drowsiness (two Nabilone, one placebo) and one mild dysphagia (placebo). One patient was excluded from the study due to an acute relapse of multiple sclerosis (Nabilone phase, drop out).

Nabilone 1 mg per day proved to be a safe and easily applicable option in the care of patients with chronic UMNS and spasticity-related pain otherwise not controllable.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Shakespeare DT, Boggild M, Young C (2003) Anti-spasticity agents for multiple sclerosis. Cochrane Database Syst RevCD001332

  2. Beard S, Hunn A, Wight J (2003) Treatments for spasticity and pain in multiple sclerosis: a systematic review. Health Technol Assess 7:iii, ix–iii, 111

    Google Scholar 

  3. Iversen L (2003) Cannabis and the brain. Brain 126:1252–1270

    Article  PubMed  Google Scholar 

  4. Baker D, Pryce G, Croxford JL, Brown P, Pertwee RG, Makriyannis A, Khanolkar A, Layward L, Fezza F, Bisogno T, Di MV (2001) Endocannabinoids control spasticity in a multiple sclerosis model. FASEB J 15:300–302

    PubMed  CAS  Google Scholar 

  5. Diana G, Malloni M, Pieri M (2003) Effects of the synthetic cannabinoid nabilone on spatial learning and hippocampal neurotransmission. Pharmacol Biochem Behav 75:585–591

    Article  PubMed  CAS  Google Scholar 

  6. Rubin A, Lemberger L, Warrick P, Crabtree RE, Sullivan H, Rowe H, Obermeyer BD (1977) Physiologic disposition of nabilone, a cannabinol derivative, in man. Clin Pharmacol Ther 22:85–91

    PubMed  CAS  Google Scholar 

  7. Ahmedzai S, Carlyle DL, Calder IT, Moran F (1983) Anti-emetic efficacy and toxicity of nabilone, a synthetic cannabinoid, in lung cancer chemotherapy. Br J Cancer 48:657–663

    PubMed  CAS  Google Scholar 

  8. Ward A, Holmes B (1985) Nabilone. A preliminary review of its pharmacological properties and therapeutic use. Drugs 30:127–144

    PubMed  CAS  Google Scholar 

  9. Kurzthaler I, Bodner T, Kemmler G, Entner T, Wissel J, Berger T, Fleischhacker WW (2005) The effect of nabilone on neuropsychological functions related to driving ability: an extended case series. Hum Psychopharmacol 20:291–293

    Article  PubMed  CAS  Google Scholar 

  10. Wissel J, Muller J, Dressnandt J, Heinen F, Naumann M, Topka H, Poewe W (2000) Management of spasticity associated pain with botulinum toxin A. J Pain Symptom Manage 20:44–49

    Article  PubMed  CAS  Google Scholar 

  11. Maurer M, Henn V, Dittrich A, Hofmann A (1990) Delta-9-tetrahydrocannabinol shows antispastic and analgesic effects in a single case double-blind trial. Eur Arch Psychiatry Clin Neurosci 240:1–4

    Article  PubMed  CAS  Google Scholar 

  12. Martyn CN, Illis LS, Thom J (1995) Nabilone in the treatment of multiple sclerosis. Lancet 345:579

    Article  PubMed  CAS  Google Scholar 

  13. Hamann W, di Vadi PP (1999) Analgesic effect of the cannabinoid analogue nabilone is not mediated by opioid receptors. Lancet 353:560

    Article  PubMed  CAS  Google Scholar 

  14. Zajicek J, Fox P, Sanders H, Wright D, Vickery J, Nunn A, Thompson A (2003) Cannabinoids for treatment of spasticity and other symptoms related to multiple sclerosis (CAMS study): multicentre randomised placebo-controlled trial. Lancet 362:1517–1526

    Article  PubMed  CAS  Google Scholar 

  15. Petro DJ, Ellenberger C Jr. (1981) Treatment of human spasticity with delta 9-tetrahydrocannabinol. J Clin Pharmacol 21:413S–416S

    PubMed  CAS  Google Scholar 

  16. Meinck HM, Schonle PW, Conrad B (1989) Effect of cannabinoids on spasticity and ataxia in multiple sclerosis. J Neurol 236:120–122

    Article  PubMed  CAS  Google Scholar 

  17. Brenneisen R, Egli A, Elsohly MA, Henn V, Spiess Y (1996) The effect of orally and rectally administered delta 9-tetrahydrocannabinol on spasticity: a pilot study with 2 patients. Int J Clin Pharmacol Ther 34:446–452

    PubMed  CAS  Google Scholar 

  18. Ungerleider JT, Andyrsiak T, Fairbanks L, Ellison GW, Myers LW (1987) Delta-9-THC in the treatment of spasticity associated with multiple sclerosis. Adv Alcohol Subst Abuse 7:39–50

    PubMed  CAS  Google Scholar 

  19. Greenberg HS, Werness SA, Pugh JE, Andrus RO, Anderson DJ, Domino EF (1994) Short-term effects of smoking marijuana on balance in patients with multiple sclerosis and normal volunteers. Clin Pharmacol Ther 55:324–328

    Article  PubMed  CAS  Google Scholar 

  20. Kogel RW, Johnson PB, Chintam R, Robinson CJ, Nemchausky BA (1995) Treatment of Spasticity in Spinal Cord Injury with Dronabinol, a Tetrahydrocannabinol Derivative. Am J Ther 2:799–805

    Article  PubMed  Google Scholar 

  21. Killestein J, Hoogervorst EL, Reif M, Kalkers NF, Van Loenen AC, Staats PG, Gorter RW, Uitdehaag BM, Polman CH (2002) Safety, tolerability, and efficacy of orally administered cannabinoids in MS. Neurology 58:1404–1407

    PubMed  CAS  Google Scholar 

  22. Killestein J, Uitdehaag BM, Polman CH (2004) Cannabinoids in multiple sclerosis: do they have a therapeutic role? Drugs 64:1–11

    Article  PubMed  CAS  Google Scholar 

  23. Okie S (2005) Medical Marijuana and the Supreme Court. N Engl J Med 353:648–651

    Article  PubMed  CAS  Google Scholar 

  24. Pertwee RG (2002) Cannabinoids and multiple sclerosis. Pharmacol Ther 95:165–174

    Article  PubMed  CAS  Google Scholar 

  25. Consroe P (1998) Brain cannabinoid systems as targets for the therapy of neurological disorders. Neurobiol Dis 5:534–551

    Article  PubMed  CAS  Google Scholar 

  26. Baker D, Pryce G, Giovannoni G, Thompson AJ (2003) The therapeutic potential of cannabis. Lancet Neurol 2:291–298

    Article  PubMed  CAS  Google Scholar 

  27. Pertwee RG (2001) Cannabinoid receptors and pain. Prog Neurobiol 63:569–611

    Article  PubMed  CAS  Google Scholar 

  28. Consroe P (1998) Brain cannabinoid systems as targets for the therapy of neurological disorders. Neurobiol Dis 5:534–551

    Article  PubMed  CAS  Google Scholar 

  29. Campbell FA, Tramer MR, Carroll D, Reynolds DJ, Moore RA, McQuay HJ (2001) Are cannabinoids an effective and safe treatment option in the management of pain? A qualitative systematic review. BMJ 323:13–16

    Article  PubMed  CAS  Google Scholar 

  30. Attal N, Brasseur L, Guirimand D, Clermond-Gnamien S, Atlami S, Bouhassira D (2004) Are oral cannabinoids safe and effective in refractory neuropathic pain? Eur J Pain 8:173–177

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Dept. of Neurology, University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria

    Jörg Wissel MD, Tanja Haydn MD, Jörg Müller MD, Christian Brenneis MD, Thomas Berger MD & Werner Poewe MD

  2. Kantonsspital Münsterlingen, 8596 , Münsterlingen, Switzerland

    Ludwig D. Schelosky MD

  3. Neurologische Rehabilitationsklinik, Kliniken Beelitz GmbH, Paracelsusring 6a, 14547, Beelitz-Heilstätten, Germany

    Jörg Wissel MD

Authors
  1. Jörg Wissel MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tanja Haydn MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jörg Müller MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Christian Brenneis MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Thomas Berger MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Werner Poewe MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ludwig D. Schelosky MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jörg Wissel MD.

Additional information

Received in revised form: 28 February 2006

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wissel, J., Haydn, T., Müller, J. et al. Low dose treatment with the synthetic cannabinoid Nabilone significantly reduces spasticity-related pain. J Neurol 253, 1337–1341 (2006). https://doi.org/10.1007/s00415-006-0218-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00415-006-0218-8

Keywords

Search

Navigation