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Comparison of analgesic effects and patient tolerability of nabilone and dihydrocodeine for chronic neuropathic pain: randomised, crossover, double blind study

Lookup NU author(s): Dr Bernhard Frank, Joan Hughes, Professor John MatthewsORCiD, Dr Dilip Kapur



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 two weeks of each treatment period. Secondary outcomes were changes in mood, quality of life, steep, 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 Dihydrococleine 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 ISRCTNI5330757.

Publication metadata

Author(s): Frank B, Serpell MG, Hughes J, Matthews JNS, Kapur D

Publication type: Article

Publication status: Published

Journal: British Medical Journal

Year: 2008

Volume: 336

Issue: 7637

Pages: 199-201

Date deposited: 20/05/2010

ISSN (print): 0959-535X

ISSN (electronic): 0959-8146

Publisher: BMJ Group


DOI: 10.1136/bmj.39429.619653.80


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