APS Press Room
News Highlights from The Journal of Pain • February 2008
The Peer Review Journal of the American Pain Society
|For immediate release||Contact: Chuck Weber
Study Shows Marijuana-based Drug Reduces Fibromyalgia Pain
GLENVIEW, Feb. 15, 2008—Patients with fibromyalgia treated with a synthetic form of marijuana, nabilone, showed significant reductions in pain and anxiety in a first-of-its-kind study, published in The Journal of Pain.
Fibromyalgia syndrome has no cure, is difficult to diagnose, and effective pain management strategies are a must to help patients cope with the disease. An estimated 12 million Americans have fibromyalgia, which is characterized by widespread muscle and joint pain and myriad other symptoms. The condition is far more prevalent in women and the incidence increases with age, reaching 7 percent among women 65 years and older.
Forty subjects were selected for the nabilone trial, conducted by researchers at the University of Manitoba Rehabilitation Hospital. They were divided into nabilone and placebo groups and were treated for four weeks. The authors noted this was the first randomized, controlled-access trial to evaluate nabilone for pain reduction and quality of life improvement in fibromyalgia patients. Nabilone is one of two oral marijuana-based compounds, known as cannabinoids, available in Canada, and is approved for treatment of nausea and vomiting during chemotherapy.
Results of the Manitoba study showed that the nabilone group had significant reductions in pain and anxiety, measured by comparisons with baseline scores on the visual analogue scale for pain, the Fibromyalgia Impact Questionnaire (FIQ) and the FIQ anxiety score. From the data, the researchers concluded that nabilone has significant benefits for pain relief and functional improvement in fibromyalgia patients. Although the improvement was significant, none of the nabilone-treated subjects had complete relief of their fibromyalgia symptoms.
Nabilone was well tolerated by treated patients, which the authors characterized as reassuring since fibromyalgia patients are sensitive to most medications and have difficulty tolerating side effects. The downside, however, is cost. In Canada, nabilone would cost about $4,000 for a year’s supply.
The study concluded the findings of the study warrant consideration of nabilone as an adjunct to current medical management of fibromyalgia.
Source: Nabilone for Treatment of Pain in Fibromyalgia; Ryan Quinlan Skrabek, Lena Galimova, Karen Ethans and Daryl Perry, University of Manitoba Rehabilitation Hospital
Studies Should Relate Clinical Importance of Treatment Outcomes
A prestigious group of 40 pain researchers participated in a consensus meeting, called Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT), to provide recommendations for interpreting treatment outcomes in clinical trails for the efficacy and effectiveness of chronic pain treatments.
The meeting had two goals: 1) Develop general recommendations for determining clinically important changes for chronic pain outcome measures and 2) Propose provisional benchmarks for identifying clinically important changes in specific outcome measures for chronic pain trails previously recommended by the IMMPACT group.
Relatively few studies have systematically asked chronic pain patients to identify changes, both improvement and worsening, in their pain intensity. The group concluded such studies are a priority for pain research for determining what patients consider important. IMMPACT previously recommended four core outcome criteria: pain intensity, physical functioning, emotional functioning and participant ratings of overall improvement. In this article, the group suggested two additional criteria be used: patient characteristics (age, sex, and education) and whether changes in pain outcomes considered important by patients vary by clinical condition, i.e. low back pain vs. spinal injury pain.
The participants believe that systematically collecting and reporting the recommended information will allow validation of proposed benchmarks and provide more meaningful comparisons of chronic pain treatments.
Source: Interpreting the Clinical Importance of Treatment Outcomes in Chronic Pain Clinical Trials: IMMPACT Recommendations; Robert A. Dworkin, Dennis Turk and 38 co-authors