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J Pain Res. 2019 May 20;12:1577-1604. doi: 10.2147/JPR.S192174. eCollection 2019.

Effectiveness and tolerability of THC:CBD oromucosal spray as add-on measure in patients with severe chronic pain: analysis of 12-week open-label real-world data provided by the German Pain e-Registry.

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Institute of Neurological Sciences, 90411 Nuernberg, Germany.
O.Meany Consultancy, 22339 Hamburg, Germany.
Interdisciplinary Centre for Pain and Palliative Care Medicine, 73033 Goeppingen, Germany.


Objective: To evaluate effectiveness, tolerability and safety of an oromucosal spray containing Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD), as add-on treatment in patients with severe chronic pain (SCP). Methods: Exploratory analysis of anonymized 12-week routine/open-label data provided by the German Pain e-Registry (GPR) on adult SCP patients treated with THC:CBD oromucosal spray in 2017. Results: Among those 30.228 cases documented in the GPR in 2017, 800 (2.6%; 57% female, mean ± SD age: 46.3±9.7 years) received a treatment with THC:CBD. All patients fulfilled the legislative preconditions for a treatment with cannabis as medicine as defined by the German Act Amending Narcotics and Other Regulations. THC:CBD-treatment was followed by an aggregated nine-factor symptom relief (ASR-9) improvement at end of week 12 vs baseline of 39.0±26.5% (95%-CI: 36.9-41.1, median: 42, range -41 to 85). A full ASR-9 response (ie, a 50%-improvement in all 9 factors) was found for 123 patients (15.4%), while 488 patients (56.0%) presented with an ≥50% improvement in at least 5 of 9 ASR factors. With a 54.9±17.2% (median: 56%, range: -6 to 85) improvement was significantly superior in the neuropathic pain subgroup (n=497, 62.1%) vs those with mixed (n=249, 31.1%; ASR-9: 18.2±12.0, median: 19, range: -12 to 42%) or nociceptive pain (n=54, 6.8%; ASR-9: -11.9±10.5, median: -11, range: -41% to 12%; p<0.001 for each). 159 patients (19.9%) reported at least one of 206 TEAEs, most of them of mild intensity (n=81.6%). Most frequently reported TEAEs were increased appetite (n=50, 6.3%) and dysgeusia (n=23, 2.9%). TEAE-related discontinuations were reported for 32 patients (4.0%). 113 (14.1%) patients discontinued due to inadequate pain relief, most of them with nociceptive pain (n=40, 74.1%), least with neuropathic pain (n=1, 0.2%; p<0.001). Conclusion: THC:CBD oromucosal spray proved to be an effective and well-tolerated add-on treatment for patients with elsewhere refractory chronic pain - especially of neuropathic origin.


German pain e-Registry; THC:CBD spray; add-on treatment; neuropathic pain; retrospective analysis; severe chronic pain

Conflict of interest statement

MAU received financial support and/or expenses in form of research money, consultancy fees, and/or remunerations for lecture activities from Almirall, Archimedes, Aristo pharma, Bene-Arzneimittel, Grünenthal, HAPA Medical, Janssen-Cilag, Kyowa Kirin, Lilly, Menarini, MSD, Mucos, Mundipharma, Omnia Med, Pfizer, PharmAllergan, ProStrakan, Servier, Shionogi, TEVA, and Tilray. UE received financial support and/or expenses in form of consultancy fees from Roche, Almirall, MedDay, and Granzer Regulatory Consulting & Services. GHHM-S received financial support and/or expenses in the form of research money, consultancy fees and/or remunerations for lecture activities from Allergan Ltd., Almirall, Grünenthal, Mundipharma, Pfizer, PharmAllergan, ProStrakan, and TEVA. The authors report no other conflicts of interest in this work.

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