Cannabis in painful HIV-associated sensory neuropathy: a randomized placebo-controlled trial

Neurology. 2007 Feb 13;68(7):515-21. doi: 10.1212/01.wnl.0000253187.66183.9c.

Abstract

Objective: To determine the effect of smoked cannabis on the neuropathic pain of HIV-associated sensory neuropathy and an experimental pain model.

Methods: Prospective randomized placebo-controlled trial conducted in the inpatient General Clinical Research Center between May 2003 and May 2005 involving adults with painful HIV-associated sensory neuropathy. Patients were randomly assigned to smoke either cannabis (3.56% tetrahydrocannabinol) or identical placebo cigarettes with the cannabinoids extracted three times daily for 5 days. Primary outcome measures included ratings of chronic pain and the percentage achieving >30% reduction in pain intensity. Acute analgesic and anti-hyperalgesic effects of smoked cannabis were assessed using a cutaneous heat stimulation procedure and the heat/capsaicin sensitization model.

Results: Fifty patients completed the entire trial. Smoked cannabis reduced daily pain by 34% (median reduction; IQR = -71, -16) vs 17% (IQR = -29, 8) with placebo (p = 0.03). Greater than 30% reduction in pain was reported by 52% in the cannabis group and by 24% in the placebo group (p = 0.04). The first cannabis cigarette reduced chronic pain by a median of 72% vs 15% with placebo (p < 0.001). Cannabis reduced experimentally induced hyperalgesia to both brush and von Frey hair stimuli (p < or = 0.05) but appeared to have little effect on the painfulness of noxious heat stimulation. No serious adverse events were reported.

Conclusion: Smoked cannabis was well tolerated and effectively relieved chronic neuropathic pain from HIV-associated sensory neuropathy. The findings are comparable to oral drugs used for chronic neuropathic pain.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Affect
  • Cannabis* / adverse effects
  • Female
  • HIV Infections / complications*
  • Hot Temperature
  • Humans
  • Hyperalgesia / physiopathology
  • Male
  • Middle Aged
  • Pain / physiopathology
  • Pain Management
  • Palliative Care
  • Peripheral Nervous System Diseases / physiopathology
  • Peripheral Nervous System Diseases / psychology
  • Peripheral Nervous System Diseases / therapy*
  • Peripheral Nervous System Diseases / virology*
  • Physical Stimulation
  • Phytotherapy*
  • Sensation Disorders / physiopathology
  • Sensation Disorders / psychology
  • Sensation Disorders / therapy*
  • Sensation Disorders / virology*
  • Smoking