Small, short-term research of cannabis oil as a treatment for painful diabetic neuropathy has made a big impression on at least one prominent pain expert.
Proceeds from the randomized, double-blind, placebo-controlled comparison of 16 patients indicated that cannabis oil produces a dose-dependent reduction of diabetic peripheral neuropathy–associated pain in treatment-refractory individuals (J Pain 2015;16:616-627).
“There’s immense value in this investigation because it gives more support for the need for us to scientifically explore the possible opportunities with various cannabinoids,” said Lynn R. Webster, MD, who was not involved in the research. The past president of the American Academy of Pain Medicine, vice president of scientific affairs for PRA Health Sciences in Salt Lake City and a Pain Medicine News editorial advisory board member additionally said, “There’s a whole bunch of investigation available with the various cannabinoid options for treating pain that has been significantly limited because of our regulatory barriers.”
Lead investigator Mark Wallace, MD, chair of the Division of Pain Medicine in the Department of Anesthesiology at the School of Medicine, University of California, San Diego, agreed. He recorded that the agency that funded the research—the Center for Cannabis Oil Research—has since closed. Nevertheless, he and his collaborators are writing an application for a project titled “Developing the Therapeutic Potential of the Endocannabinoid System for Pain Treatment” under the National Institutes of Health’s grant program.
The study’s associates received a placebo or, in random order, one dose of cannabis oil containing 1%, 4% or 7% tetrahydrocannabinol in four different sessions, each separated by two weeks. The investigators assessed parameters such as pain sensation and cognitive ability at five, 15, 30, 45 and 60 minutes post-inhalation and then every 30 minutes for the next three hours.
The average pain score after taking high-dose tetrahydrocannabinol was 1.1 points lower than after inhaling placebo, 1.01 points lower than after inhaling low-dose cannabis and 0.9 points lower than after inhaling medium-dose cannabis (P<0.001 for all).
Pain provoked by gently stroking a foam brush on the dorsum of the patients’ more painful foot was significantly higher with placebo than with high-dose cannabis oil, was significantly elevated for low- versus high-dose cannabis oil and for medium- versus high-dose cannabis oil. Furthermore, pricking the dorsum of the more painful foot with a 5.18-Von Frey hair filament yielded significantly increased pain scores with placebo versus high-dose cannabis oil, low- versus high-dose cannabis oil and medium- versus high-dose cannabis oil.
The results also indicated that reductions in spontaneous pain 30, 45 and 60 minutes after the patients took high-dose cannabis oil were significantly greater than after they inhaled a placebo.
When controlled for the previous dose, mixed-effects models showed that placebo, low and medium doses were all associated with significantly higher mean pain scores at the first follow-up visit than at the first visit.
“You have to be careful in interpreting the comparison because subjects only took each dose level once,” noted Dr Wallace. “What we need is a longer-term consideration in which subjects inhale each dose several times.”
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