The Pharmaceutical Journal
Vol 280 No 7484 p6
5/12 January 2008

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Neuropathic pain study

Dihydrocodeine provides better neuropathic pain relief than the synthetic cannabinoid nabilone, according to a study published online in the BMJ this week (8 January 2008). The authors admit that the clinical significance of the difference is small and neither drug was particularly effective.

Researchers randomised 96 patients with chronic neuropathic pain to receive either dihydrocodeine then nabilone, or vice versa, over two escalating treatment periods of six weeks separated by a two-week washout. Patients received a maximum daily dose of 240mg dihydrocodeine or 2mg nabilone.

Dihydrocodeine was better than nabilone, with a mean pain score of 6.0mm shorter on a 0–100mm scale (95 per cent confidence interval 1.4–10.5; P=0.01). Three patients in the per protocol analysis had a clinically relevant response to nabilone compared with 12 patients on dihydrocodeine, say the researchers.

The author of an accompanying editorial highlights several weaknesses in the study, including that it was not powered to identify subgroups that may have benefited from nabilone and that the treatment period was too short.

Nevertheless, he says that given the poor analgesic effect and high incidence of adverse effects, cannabinoids should not be used as first-line treatment in patients who present with uncategorised pain.