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August 1st, 2008, 09:48 AM

Cannabis-Based Drug Relieves Arthritis Pain

By Michael Smith, 0
Published: November 09, 2005
Reviewed by Zalman S. Agus, MD (http://www.medpagetoday.com/reviewer.cfm?reviewerid=30); Emeritus Professor at the University of Pennsylvania School of Medicine. (http://www.medpagetoday.com/posttest.cfm?testpage=2097&TBID=2097&topicid=68)BATH, England, Nov. 9 - An oral spray containing marijuana extracts has offered pain relief to rheumatoid arthritis (RA) patients, according to British researchers. The patients did not have the typical highs achieved by smoking marijuana.

Called Sativex, the agent was tested in a five-week randomized, placebo-controlled trial that the investigators said was the first formal study using cannabis-based medications to treat rheumatoid arthritis.

"Anecdotally, of course, people have been using it for centuries," said Candy McCabe, Ph.D., of the Royal National Hospital for Rheumatic Diseases here. "We've known in our clinic that patients are using street-based cannabis."

The drug, made by GW Pharmaceuticals, of Salisbury, England, is a blend of whole plant extracts and contains two key ingredients in approximately equal amounts -- delta-tetrahydrocannabinol (THC) and cannabidiol -- that have been shown in animals to have beneficial effects for RA. Minor cannabinoids, including cannabinol, cannabichromene, and cannabigerol were also present in trace quantities.

Not approved in Britain or the U.S., the drug was licensed earlier this year in Canada for use in neuropathic pain associated with multiple sclerosis. The product is also being tested for cancer pain.

In the RA study, Dr. McCabe and colleagues reported online in the journal Rheumatology, 58 patients with active disease, not adequately controlled by standard medication, were randomized to Sativex or placebo.

Patients began with one use of the oral spray half an hour before bedtime and increased the number of uses -- to a maximum of six a day -- depending on response. Each use of the Sativex spray delivered 2.7 mg of THC and 2.5 mg of cannabidiol. Dosing was restricted to the evening hours.

The main efficacy measure was morning pain on movement on a one-to-10 scale. Secondary outcomes were morning pain at rest, morning stiffness, sleep quality, the Short-Form McGill Pain Questionnaire (SF-MPQ) and the 28-joint disease activity score (DAS 28).

The study found:

For those in the treatment group, morning pain on movement was reduced significantly compared with placebo, as was pain at rest. The results were significant at p=0.044 and p=0.018, respectively.
There was no significant difference in morning stiffness.
Quality of sleep was significantly improved for those getting Sativex, at p=0.027.
The DAS 28 scores for the treatment group were also significantly improved, at p=0.002.
On the McGill pain questionnaire, patients getting the drug rated their pain as significantly less intense than did the placebo patients, at p=0.016.
On two other aspects of the McGill questionnaire, there was no significant difference.

PLEASE NOTE: this info was in a side bar on this story:

<LI class=APP>Explain to rheumatoid arthritis patients who ask that this small preliminary study suggests that Sativex significantly relieves pain but not morning stiffness and improves disease activity. Larger and more prolonged studies are needed for corroboration.

FOR the complete article see here:http://www.medpagetoday.com/Rheumatology/Arthritis/tb/2097

For further study sources:
Primary source: Rheumatology
Source reference:
Blake DR et al. Preliminary assessment of the efficacy, tolerability and safety of a cannabis-based medicine (Sativex) in the treatment of pain caused by rheumatoid arthritis. Rheumatology online 2005. Click here for the abstract. (http://rheumatology.oxfordjournals.org/cgi/reprint/kei183v1)