Study register · detailRCT · Neuropathic Pain · 2007
Cannabis in painful HIV-associated sensory neuropathy
Abrams et al.·NeurologyImpact 1.0
Clear benefitGRADEModerate595 citations
Samplen = 50 Pat.
Duration5 days
ControlPlacebo cigarettes
EndpointDaily pain intensity
Blindingdoppelblind
DesignRCT
Cannabinoidthc
Routeinhalativ
”Key finding
Smoked cannabis reduced daily pain by 34% vs. 17% with placebo (p=0,03) and showed greater pain reduction of >30% in 52% vs. 24% of the placebo group (p=0,04).
Summary
n=50 HIV-associated sensory neuropathy, smoked cannabis (3,56% THC) vs. placebo, significant pain reduction on 0-100 scale (mean difference -3.3 points, p=0.03), 52% responders with ≥30% pain reduction vs. 24% placebo, well tolerated.
P
PopulationAdults with painful HIV-associated sensory neuropathy, n=50 (intent-to-treat completion)
I
InterventionSmoked cannabis (3,56% THC), 3× daily over 5 days
C
ControlPlacebo cigarettes (identical, but cannabinoid-extracted)
O
OutcomeMedian pain reduction 34% vs. 17% placebo (p=0,03); ≥30% pain reduction in 52% vs. 24% (p=0,04); first cigarette: 72% vs. 15% (p<0,001)
Confidence in the evidence
Very lowLowModerateHigh
Moderate
The third of four GRADE levels, the effect estimate is probably reliable.
Objective: To determine the effect of smoked cannabis on the neuropathic pain of HIV-associated sensory neuropathy and an experimental pain model.
Methods: Prospective randomized placebo-controlled trial conducted in the inpatient General Clinical Research Center between May 2003 and May 2005 involving adults with painful HIV-associated sensory neuropathy. Patients were randomly assigned to smoke either cannabis (3.56% tetrahydrocannabinol) or identical placebo cigarettes with the cannabinoids extracted three times daily for 5 days. Primary outcome measures included ratings of chronic pain and the percentage achieving >30% reduction in pain intensity. Acute analgesic and anti-hyperalgesic effects of smoked cannabis were assessed using a cutaneous heat stimulation procedure and the heat/capsaicin sensitization model.
Results: Fifty patients completed the entire trial. Smoked cannabis reduced daily pain by 34% (median reduction; IQR = -71, -16) vs 17% (IQR = -29, 8) with placebo (p = 0.03). Greater than 30% reduction in pain was reported by 52% in the cannabis group and by 24% in the placebo group (p = 0.04). The first cannabis cigarette reduced chronic pain by a median of 72% vs 15% with placebo (p < 0.001). Cannabis reduced experimentally induced hyperalgesia to both brush and von Frey hair stimuli (p < or = 0.05) but appeared to have little effect on the painfulness of noxious heat stimulation. No serious adverse events were reported.
Conclusion: Smoked cannabis was well tolerated and effectively relieved chronic neuropathic pain from HIV-associated sensory neuropathy. The findings are comparable to oral drugs used for chronic neuropathic pain.