Cannabis, Pain, and Sleep: Lessons from Therapeutic Clinical Trials of Sativex®, a Cannabis‐Based Medicine

  title={Cannabis, Pain, and Sleep: Lessons from Therapeutic Clinical Trials of Sativex{\textregistered}, a Cannabis‐Based Medicine},
  author={Ethan B Russo and Geoffrey W. Guy and Philip J. Robson},
  journal={Chemistry \& Biodiversity},
Cannabis sativa L. has been utilized for treatment of pain and sleep disorders since ancient times. This review examines modern studies on effects of Δ9‐tetrahydrocannabinol (THC) and cannabidiol (CBD) on sleep. It goes on to report new information on the effects on sleep in the context of medical treatment of neuropathic pain and symptoms of multiple sclerosis, employing standardized oromucosal cannabis‐based medicines containing primarily THC, CBD, or a 1 : 1 combination of the two (Sativex… 
Cannabinoid derivatives and the pharmacological management of pain
Further understanding of endocannabinoid system pharmacology, together with study results involving pain management with cannabinoid substances may be very useful for the development of drugs allowing a significant advance in the treatment of patients with painful syndromes.
Cannabinoids in the management of difficult to treat pain
Cannabinoid analgesics have generally been well tolerated in clinical trials with acceptable adverse event profiles, and their adjunctive addition to the pharmacological armamentarium for treatment of pain shows great promise.
Cannabinoids in the management of diffi cult to treat pain
This article reviews recent research on cannabinoid analgesia via the endocannabinoid system and non-receptor mechanisms, as well as randomized clinical trials employing canna- binoids in pain
Review Article: Sleep, Pain and Cannabis
A general review of sleep, pain and cannabis with a view to identifying gaps in knowledge that could be addressed in further research.
Cannabis for Pain and Headaches: Primer
Phytocannabinoids have been identified as key compounds involved in analgesia and anti-inflammatory effects and other compounds found in cannabis such as flavonoids and terpenes are also being investigated as to their individual or synergistic effects.
Prospects for the Use of Cannabinoids in Psychiatric Disorders
The prospects of using the psychoactive effects of cannabinoids in treating mental and psychiatric disorders are discussed, however, this evidence is weak for some clinical conditions and well-designed randomized controlled trials are currently lacking.
Plant-Based Cannabinoids for the Treatment of Chronic Neuropathic Pain
Animal data suggests that cannabidiol and low dose nabiximols warrant consideration for clinical studies, at least as adjuvants to current drugs.
The Efficacy of Cannabis on Multiple Sclerosis-Related Symptoms
Oromucosal spray and oral cannabis are mainly used for treating patients with MS and have positive effects on treating the most common symptoms of MS, such as pain and spasticity, whereas the other MS symptoms indicated slight improvement, for which further studies are needed.
State of the science: cannabis and cannabinoids in palliative medicine—the potential
The integration into medicine and routine clinical use of cannabis is fraught with information gaps, regulatory issues and scarcity of research, so patients should have a comprehensive assessment and risk–benefit discussion before any cannabis-based intervention to avoid possible complications such as hallucinations, psychosis and potential cardiac harm.
Opportunities for cannabis in supportive care in cancer
There is a reasonable amount of evidence to consider cannabis for nausea and vomiting, loss of appetite, and pain as a supplement to first-line treatments, and promising evidence to treat chemotherapy-induced peripheral neuropathy, gastrointestinal distress, and sleep disorders, but the literature is thus far too limited to recommend cannabis for these symptoms.


Initial experiences with medicinal extracts of cannabis for chronic pain: Results from 34 ‘N of 1’ studies
A total of 34 ‘N of 1’ studies were undertaken using this novel therapy for patients with chronic, mainly neuropathic, pain and associated symptoms to explore efficacy, tolerability, safety and dosages of CBME.
Preliminary assessment of the efficacy, tolerability and safety of a cannabis-based medicine (Sativex) in the treatment of pain caused by rheumatoid arthritis.
In the first ever controlled trial of a CBM in RA, a significant analgesic effect was observed and disease activity was significantly suppressed following Sativex treatment.
Combined cannabinoid therapy via an oromucosal spray.
Clinical assessment of this combined cannabinoid medicine has demonstrated efficacy in patients with intractable pain, rheumatoid arthritis and multiple sclerosis (bladder problems, spasticity and central pain), with no significant intoxication-like symptoms, tolerance or withdrawal syndrome.
Sativex®: clinical efficacy and tolerability in the treatment of symptoms of multiple sclerosis and neuropathic pain
  • M. Barnes
  • Medicine
    Expert opinion on pharmacotherapy
  • 2006
Positive results in placebo-controlled trials of the use of Sativex as an add-on therapy in multiple sclerosis and neuropathic pain demonstrate that SativeX is efficacious and well tolerated in the treatment of these symptoms.
Cannabis in painful HIV-associated sensory neuropathy
Smoked cannabis was well tolerated and effectively relieved chronic neuropathic pain from HIV-associated sensory neuropathy and the findings are comparable to oral drugs used for chronic Neuropathic pain.
Do cannabis-based medicinal extracts have general or specific effects on symptoms in multiple sclerosis? A double-blind, randomized, placebo-controlled study on 160 patients
Spasticity VAS scores were significantly reduced by CBME (Sativex) in comparison with placebo (P- 0.001), there were no significant adverse effects on cognition or mood and intoxication was generally mild.
Randomized, controlled trial of cannabis-based medicine in central pain in multiple sclerosis
CBM was generally well tolerated, although more patients on CBM than placebo reported dizziness, dry mouth, and somnolence, and Cognitive side effects were limited to long-term memory storage.
Long-term use of a cannabis-based medicine in the treatment of spasticity and other symptoms in multiple sclerosis
It is concluded that long-term use of an oromucosal CBM (Sativex) maintains its effect in those patients who perceive initial benefit, and the precise nature and rate of risks with long- term use, especially epilepsy, will require larger and longer-term studies.