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Comparison of analgesic effects and patient tolerability of nabilone and dihydrocodeine for chronic neuropathic pain: randomised, crossover, double blind study.
BMJ. 2008 Jan 26; 336(7637):199-201.BMJ

Abstract

OBJECTIVE

To compare the analgesic efficacy and side effects of the synthetic cannabinoid nabilone with those of the weak opioid dihydrocodeine for chronic neuropathic pain.

DESIGN

Randomised, double blind, crossover trial of 14 weeks' duration comparing dihydrocodeine and nabilone.

SETTING

Outpatient units of three hospitals in the United Kingdom.

PARTICIPANTS

96 patients with chronic neuropathic pain, aged 23-84 years.

MAIN OUTCOME MEASURES

The primary outcome was difference between nabilone and dihydrocodeine in pain, as measured by the mean visual analogue score computed over the last 2 weeks of each treatment period. Secondary outcomes were changes in mood, quality of life, sleep, and psychometric function. Side effects were measured by a questionnaire.

INTERVENTION

Patients received a maximum daily dose of 240 mg dihydrocodeine or 2 mg nabilone at the end of each escalating treatment period of 6 weeks. Treatment periods were separated by a 2 week washout period. Results Mean baseline visual analogue score was 69.6 mm (range 29.4-95.2) on a 0-100 mm scale. 73 patients were included in the available case analysis and 64 patients in the per protocol analysis. The mean score was 6.0 mm longer for nabilone than for dihydrocodeine (95% confidence interval 1.4 to 10.5) in the available case analysis and 5.6 mm (10.3 to 0.8) in the per protocol analysis. Side effects were more frequent with nabilone.

CONCLUSION

Dihydrocodeine provided better pain relief than the synthetic cannabinoid nabilone and had slightly fewer side effects, although no major adverse events occurred for either drug.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN15330757 controlled-trials.com] .

Authors+Show Affiliations

Pain Management Unit, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP. bernhard.frank@ncl.ac.ukNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18182416

Citation

Frank, B, et al. "Comparison of Analgesic Effects and Patient Tolerability of Nabilone and Dihydrocodeine for Chronic Neuropathic Pain: Randomised, Crossover, Double Blind Study." BMJ (Clinical Research Ed.), vol. 336, no. 7637, 2008, pp. 199-201.
Frank B, Serpell MG, Hughes J, et al. Comparison of analgesic effects and patient tolerability of nabilone and dihydrocodeine for chronic neuropathic pain: randomised, crossover, double blind study. BMJ. 2008;336(7637):199-201.
Frank, B., Serpell, M. G., Hughes, J., Matthews, J. N., & Kapur, D. (2008). Comparison of analgesic effects and patient tolerability of nabilone and dihydrocodeine for chronic neuropathic pain: randomised, crossover, double blind study. BMJ (Clinical Research Ed.), 336(7637), 199-201. https://doi.org/10.1136/bmj.39429.619653.80
Frank B, et al. Comparison of Analgesic Effects and Patient Tolerability of Nabilone and Dihydrocodeine for Chronic Neuropathic Pain: Randomised, Crossover, Double Blind Study. BMJ. 2008 Jan 26;336(7637):199-201. PubMed PMID: 18182416.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of analgesic effects and patient tolerability of nabilone and dihydrocodeine for chronic neuropathic pain: randomised, crossover, double blind study. AU - Frank,B, AU - Serpell,M G, AU - Hughes,J, AU - Matthews,J N S, AU - Kapur,D, Y1 - 2008/01/08/ PY - 2008/1/10/pubmed PY - 2008/2/12/medline PY - 2008/1/10/entrez SP - 199 EP - 201 JF - BMJ (Clinical research ed.) JO - BMJ VL - 336 IS - 7637 N2 - OBJECTIVE: To compare the analgesic efficacy and side effects of the synthetic cannabinoid nabilone with those of the weak opioid dihydrocodeine for chronic neuropathic pain. DESIGN: Randomised, double blind, crossover trial of 14 weeks' duration comparing dihydrocodeine and nabilone. SETTING: Outpatient units of three hospitals in the United Kingdom. PARTICIPANTS: 96 patients with chronic neuropathic pain, aged 23-84 years. MAIN OUTCOME MEASURES: The primary outcome was difference between nabilone and dihydrocodeine in pain, as measured by the mean visual analogue score computed over the last 2 weeks of each treatment period. Secondary outcomes were changes in mood, quality of life, sleep, and psychometric function. Side effects were measured by a questionnaire. INTERVENTION: Patients received a maximum daily dose of 240 mg dihydrocodeine or 2 mg nabilone at the end of each escalating treatment period of 6 weeks. Treatment periods were separated by a 2 week washout period. Results Mean baseline visual analogue score was 69.6 mm (range 29.4-95.2) on a 0-100 mm scale. 73 patients were included in the available case analysis and 64 patients in the per protocol analysis. The mean score was 6.0 mm longer for nabilone than for dihydrocodeine (95% confidence interval 1.4 to 10.5) in the available case analysis and 5.6 mm (10.3 to 0.8) in the per protocol analysis. Side effects were more frequent with nabilone. CONCLUSION: Dihydrocodeine provided better pain relief than the synthetic cannabinoid nabilone and had slightly fewer side effects, although no major adverse events occurred for either drug. TRIAL REGISTRATION: Current Controlled Trials ISRCTN15330757 controlled-trials.com] . SN - 1756-1833 UR - https://www.unboundmedicine.com/medline/citation/18182416/Comparison_of_analgesic_effects_and_patient_tolerability_of_nabilone_and_dihydrocodeine_for_chronic_neuropathic_pain:_randomised_crossover_double_blind_study_ L2 - https://www.bmj.com/lookup/pmidlookup?view=long&pmid=18182416 DB - PRIME DP - Unbound Medicine ER -