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Pharmacotherapeutic considerations for use of cannabinoids to relieve pain in patients with malignant diseases

Authors Darkovska-Serafimovska M, Serafimovska T, Arsova-Sarafinovska Z, Stefanoski S, Keskovski Z, Balkanov T

Received 21 December 2017

Accepted for publication 23 February 2018

Published 23 April 2018 Volume 2018:11 Pages 837—842

DOI https://doi.org/10.2147/JPR.S160556

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Justinn Cochran

Peer reviewer comments 2

Editor who approved publication: Dr Katherine Hanlon


Marija Darkovska-Serafimovska,1 Tijana Serafimovska,2 Zorica Arsova-Sarafinovska,1 Sasho Stefanoski,3 Zlatko Keskovski,3 Trajan Balkanov4

1Department of Pharmacology, Faculty of Medical Sciences, Goce Delcev University, Stip, Republic of Macedonia; 2Faculty of Pharmacy, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia; 3NYSK Holdings, Skopje, Republic of Macedonia; 4Department of Pharmacology and Toxicology, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia

Purpose: The aim of this review was to assess the efficacy of cannabis preparations for relieving pain in patients with malignant diseases, through a systematic review of randomized controlled trials (RCTs), which were predominantly double-blind trials that compared cannabis preparation to a placebo.
Methods: An electronic search of all literature published until June 2017 was made in MEDLINE/PubMed, Embase, The Cochrane Controlled Trials Register and specific web pages devoted to cannabis.
Results: Fifteen of the 18 trials demonstrated a significant analgesic effect of cannabinoids as compared to placebo. The most commonly reported adverse effects were generally well tolerated, mild to moderate. The main side effects were drowsiness, nausea, vomiting and dry mouth. There is evidence that cannabinoids are safe and modestly effective in neuropathic pain and also for relieving pain in patients with malignant diseases. The proportion of “responders” (patients who at the end of 2 weeks of treatment reported ≥30% reduction in pain intensity on a scale of 0–10, which is considered to be clinically important) was 43% in comparison with placebo (21%).
Conclusion: The target dose for relieving pain in patients with malignant diseases is most likely about 10 actuations per day, which is about 27 mg tetrahydrocannabinol (THC) and 25 mg cannabidiol (CBD), and the highest approved recommended dose is 12 actuations per day (32 mg THC/30 mg CBD). Further large studies of cannabinoids in homogeneous populations are required.

Keywords: cancer management, chronic pain, cannabidiol, tetrahydrocannabinol, medical marihuana, nabiximols, cannabinoid receptors

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