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J Pain Res. 2020 Feb 14;13:399-410. doi: 10.2147/JPR.S240011. eCollection 2020.

A Review of Scientific Evidence for THC:CBD Oromucosal Spray (Nabiximols) in the Management of Chronic Pain.

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Institute of Neurological Sciences, Nürnberg, Germany.


The 20% prevalence of chronic pain in the general population is a major health concern given the often profound associated impairment of daily activities, employment status, and health-related quality of life in sufferers. Resource utilization associated with chronic pain represents an enormous burden for healthcare systems. Although analgesia based on the World Health Organization's pain ladder continues to be the mainstay of chronic pain management, aside from chronic cancer pain or end-of-life care, prolonged use of non-steroidal anti-inflammatory drugs or opioids to manage chronic pain is rarely sustainable. As the endocannabinoid system is known to control pain at peripheral, spinal, and supraspinal levels, interest in medical use of cannabis is growing. A proprietary blend of cannabis plant extracts containing delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) as the principal cannabinoids is formulated as an oromucosal spray (USAN name: nabiximols) and standardized to ensure quality, consistency and stability. This review examines evidence for THC:CBD oromucosal spray (nabiximols) in the management of chronic pain conditions. Cumulative evidence from clinical trials and an exploratory analysis of the German Pain e-Registry suggests that add-on THC:CBD oromucosal spray (nabiximols) may have a role in managing chronic neuropathic pain, although further precise clinical trials are required to draw definitive conclusions.


THC:CBD oromucosal spray; chronic pain; nabiximols; neuropathic pain

Conflict of interest statement

Michael A Überall has received direct and/or indirect financial support in form of research grants, honorarium for consultancy, scientific advice, and/or lecture activities from Almirall, Aristo Pharma, Berlin Chemie, Bionorica, Esanum, Glaxo Smith Kline, Grünenthal, Hapa Medical, Hexal, Kyowa-Kirin, Lilly, Menarini, Mucos, Mundipharma, Novartis, Pfizer, Pharm Allergan, Servier, SGP Pharma, Shionogi, Teva, and Tilray. The author reports no other conflicts of interest in this work.

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