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Medicines (Basel). 2018 Jun 21;5(3). pii: E59. doi: 10.3390/medicines5030059.

Pain Modulation after Oromucosal Cannabinoid Spray (SATIVEX®) in Patients with Multiple Sclerosis: A Study with Quantitative Sensory Testing and Laser-Evoked Potentials.

Author information

1
Department of Neurology, Central Hospital of Bolzano, 39100 Bolzano, Italy. turrimara@gmail.com.
2
Department of Neurology, Central Hospital of Bolzano, 39100 Bolzano, Italy. francesco.teatini@sabes.it.
3
Department of Neurology, SS Giovanni e Paolo Hospital, 30122 Venice, Italy. donato.fnc@gmail.com.
4
Department of Neurology, Casa di Cura Pederzoli, 37019 Peschiera del Garda, VR, Italy. gi.zanette@libero.it.
5
Neurology Unit, Department of Neuroscience and Rehabilitation, S. Anna Hospital, 44124 Ferrara, Italy. v.tugnoli@ospfe.it.
6
Neurology Unit, Department of Neuroscience, AOUI Verona, 37126 Verona, Italy. luciano.deotto@gmail.it.
7
Neurology Unit, Department of Neuroscience, AOUI Verona, 37126 Verona, Italy. bruno.bonetti@univr.it.
8
Neurology Unit, Department of Neuroscience, AOUI Verona, 37126 Verona, Italy. giovannamaddalena.squintani@aovr.veneto.it.

Abstract

Background. Delta-9-tetrahydrocannabinol (THC)/cannabidiol (CBD) (nabiximols or Sativex®) is an oromucosal spray formulation containing THC and CBD at an approximately 1:1 fixed ratio. Its administration for the treatment of pain in patients with multiple sclerosis (MS) has been established. MS patients generally complain of different kinds of pain, including spasticity-related and neuropathic pain. In this study, we compared and evaluated pain modulation and thermal/pain threshold of MS patients before and after THC/CBD administration. Methods. 19 MS patients underwent clinical examination, numerical rating scale (NRS), quantitative sensory testing (QST), and laser-evoked potentials (LEPs) before and after 1 month of therapy. Psychophysiological and neurophysiological data were compared to sex- and age-matched controls. Results. Patients reported a significant reduction in pain. We found statistically significant differences in LEP parameters between patients and controls but no significant change in LEP measures after THC/CBD therapy. Cold and heat detection thresholds were altered in patients but did not change after THC/CBD therapy. There was a significant increase in cold pain threshold by hand stimulation and a significant reduction in abnormal cold perception thresholds. Conclusions. Our results indicate that Sativex® therapy provides pain relief in MS patients and suggest that it might modulate peripheral cold-sensitive TRP channels.

KEYWORDS:

laser-evoked potentials; multiple sclerosis; oromucosal cannabinoid spray; pain; quantitative sensory testing

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