Abstract
Background: Cannabinoids (nabiximols) have been legalized for medical use in Australia in 2016. Despite the growing support for its use in chronic pain and spasticity along with the current scientific evidence, data on real-world patient experience is scarce.
Objective: To review the use of nabiximols, self-reported efficacy and drug tolerability in refractory chronic neuropathic pain and/or spasticity in a single neurological institution in Western Australia.
Methods: Data of patients with refractory chronic neuropathic pain and/or spasticity who received nabiximols between July 2018 to July 2020 were analyzed. 20 patients who had effectively exhausted most consensus therapies received cannabis oil containing 1:1 ratio of cannabidiol and delta9-tetrahydrocannabinol. The indications for cannabis oil included chronic neuropathic pain and/or spasticity in a group of patients with MS (n=18), traumatic spinal cord injury (n=1), and vascular myelopathy (n=1).
Results: Fifteen of 18 (83%) patients found nabiximols effective for chronic neuropathic pain, and 7 (70%) patients found it effective for spasticity. Of the patients who responded to nabiximols, 7 (44%) patients were able to stop or reduce concomitant analgesia use, including opioids. 7 (35%) patients discontinued the drug, with a majority of them due to adverse effects and/or no perceived benefit. 8 (40%) patients experienced adverse effects from nabiximols.
Conclusion: This audit demonstrated the potential benefit of cannabis oil in treating patients with treatment-resistant chronic neuropathic pain and/or spasticity. Overall, cannabis oil appears to be well-tolerated by most patients.