nabilone and Pain--Postoperative

We present the case of a 56-year-old man who developed chronic pain following the excision of a facial cancer that was poorly controlled despite multiple analgesic medications. Following the starting of nabilone (a synthetic cannabinoid) his pain control was greatly improved and this had a huge impact on his quality of life. We also managed to significantly reduce his doses of opioid analgesia and ketamine. We review the current literature regarding the medicinal use of cannabinoids, with an emphasis on chronic pain, in an attempt to clarify their role and how to select patients who may benefit from this treatment.

Topics: Analgesics; Carcinoma, Squamous Cell; Chronic Pain; Dronabinol; Humans; Lip Neoplasms; Male; Middle Aged; Pain, Postoperative; Submandibular Gland Neoplasms

Cannabinoids have been shown to have analgesic properties in animal studies, but a potential role for these drugs in acute pain management has not been established. It was hypothesized that nabilone, an oral cannabinoid synthetic tetrahydrocannabinol analogue, decreases morphine consumption, pain scores, nausea and vomiting following major surgery.. A double-blind, randomized, placebo-controlled, parallel-group pilot trial compared the effects of two different doses, 1 mg (n = 11) and 2 mg (n = 9) of nabilone, ketoprofen 50 mg (n = 11) or placebo (n = 10), given at eight-hour intervals for 24 hr. Outcomes included morphine consumption, pain scores and emesis after major surgery. Secondary outcomes included patient tolerability of the study medication.. Forty-one patients (mean age 52 +/- 2 yr) undergoing gynecologic (46%), orthopedic (44%), or other (10%) surgery were recruited. Cumulative 24-hr morphine consumption was not different between the four groups, but pain scores at rest and on movement were significantly higher in the 2 mg nabilone group compared to the other groups. There were no significant differences between groups with respect to episodes of nausea and vomiting, quality of sleep, sedation, euphoria, pruritus, or the number and severity of adverse events. No serious adverse event was recorded.. Contrary to the main hypothesis, high dose nabilone in the presence of morphine patient controlled analgesia is associated with an increase in pain scores in patients undergoing major surgery.

Topics: Adolescent; Adult; Aged; Analgesia, Patient-Controlled; Analgesics; Anti-Inflammatory Agents, Non-Steroidal; Double-Blind Method; Dronabinol; Female; Gynecologic Surgical Procedures; Humans; Ketoprofen; Male; Middle Aged; Morphine; Narcotics; Orthopedic Procedures; Pain Measurement; Pain, Postoperative; Patient Satisfaction; Pilot Projects; Placebos; Postoperative Nausea and Vomiting; Sleep; Treatment Outcome

Topics: Analgesics; Dronabinol; Hip Joint; Humans; Hysterectomy; Knee Joint; Pain, Postoperative; Research Design; Treatment Outcome