Chronic Pain
Study register · detail RCT (graded-dose) · Chronic Pain · 2012

Nabiximols for Opioid-Treated Cancer Patients With Poorly-Controlled Chronic Pain: A Randomized, Placebo-Controlled, Graded-Dose Trial

Mixed GRADE High 413 citations
Samplen = 360 Pat.
Duration5 weeks
ControlPlacebo
Endpoint30% responder rate
Blindingdoppelblind
DesignRCT (graded-dose)
Cannabinoidkombination
THC:CBD1:1
Routeoromukosal
Key finding

Primary objective (30% responder rate) not significant; however secondary analyses showed significant improvement in average pain, worst pain and sleep disturbance in the low and medium dose groups compared with placebo, with dose-dependent side effects.

Summary

n=360 cancer patients with opioid-refractory tumour pain, nabiximols (Sativex) vs. placebo in three dose levels (low/medium/high); primary endpoint (30% responder rate) not significant (p=0,59); secondary continuous responder analysis significant in favour of nabiximols overall (p=0,035) as well as in the low- (p=0,008) and medium-dose group (p=0,039); mean daily pain (p=0,006), worst pain (p=0,011) and sleep disturbance (p=0,003) significantly improved in the low-dose arm; side effects dose-dependent, high-dose group less favourable compared with placebo.

P
PopulationAdults with advanced cancer and opioid-refractory chronic pain, n=360 randomised, 263 completed
I
InterventionNabiximols (Sativex) as add-on: low dose (1–4 sprays/day), medium dose (6–10 sprays/day) or high dose (11–16 sprays/day), oromucosal
C
ControlPlacebo
O
OutcomePrimary endpoint (30% responder rate) not significant (overall p=0,59); secondary continuous responder analysis showed significantly more analgesia for nabiximols overall (p=0,035), low dose (p=0,008) and medium dose (p=0,039); mean average pain significantly better at low dose (p=0,006), worst pain (p=0,011), sleep disturbance (p=0,003)
Confidence in the evidence
High

The highest of four GRADE levels, the effect estimate is very reliable.

Quality profile
Sample size
Blinding Double-blind
Effect size Mixed
Citations / year
Authors
Portenoy R K, Ganae-Motan E D, Allende S et al.
DOI 10.1016/j.jpain.2012.01.003
Design: RCT (graded-dose)
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