Efficacy of Dronabinol as an Adjuvant Treatment for Chronic Pain Patients on Opioid Therapy

Narang et al. ·The Journal of Pain Impact 1.0

Clear benefit GRADE Low 253 citations

Samplen = 30 Pat.

DurationPhase I

ControlPlacebo capsules

EndpointPain intensity

Blindingdoppelblind

DesignRCT

Cannabinoidthc

Max. dose20.0 mg

Routeoral

Key finding

Dronabinol led to decreased pain intensity, increased patient satisfaction, and significant pain relief as adjuvant therapy in opioid-treated chronic pain patients.

Summary

n=30 chronic pain patients under opioid therapy, dronabinol 10–20 mg/d adjuvant vs. placebo; no significant difference in the primary endpoint (BPI pain intensity p=0.59), trend towards improved sleep quality.

PopulationAdults with chronic non-cancer pain under stable opioid therapy, n=30

InterventionDronabinol (synthetic Δ9-THC) 10 mg or 20 mg orally, Phase I: single-dose crossover; Phase II: open-label titrated as add-on

ControlPlacebo capsules (Phase I randomised, double-blind, crossover)

OutcomePhase I: significant reduction in pain intensity and increased patient satisfaction vs. placebo, no difference 10 mg vs. 20 mg; Phase II: significant pain relief vs. baseline

Confidence in the evidence

Low

The second of four GRADE levels, the effect estimate is of limited reliability.

Downgraded for

Risk of biasImprecision

Quality profile

Sample size ★★★★★

Blinding Double-blind

Effect size Clear benefit

Citations / year ★★★★★

Authors

Narang S, Gibson D, Wasan A D et al.

DOI 10.1016/j.jpain.2007.10.018↗

Design: RCT

Abstract

Perspective: This study examines the effect of adding a cannabinoid to the regimen of patients with chronic pain who report significant pain despite taking stable doses of opioids. The results of our preliminary study suggest that dronabinol, a synthetic THC, may have an additive effect on pain relief.

The impediment to action advances action. — Marcus Aurelius