particularly neuropathic pain (Fabre and McLendon 1981; Priestman et al 1984, 1987; Kalant 2001; Croxford 2003; Ben Amar 2006; Berlach et al 2006; Wissel et al 2006). The efﬁcacy of dronabinol to treat cachexia/wasting in AIDS patients suggested that cannabinoids may be useful for treat- ing this syndrome in cancer patients, although this has not been demonstrated in a recent trial (Strasser et al 2006). Pain is a common symptom among cancer patients, affect- ing 18% to 49% at diagnosis and nearly 75% of those patients with advanced disease (Daut and Cleeland 1982; Bonica 1990). Preclinical data support the efﬁcacy of cannabinoids in a broad range of pain models, including neuropathic and chronic pain, for which there is signiﬁcant evidence (Mack and Joy 2001). Up-regulation of CB1 receptors are key to the analgesic effects of cannabinoids in both chronic and neuropathic pain, and CB2 receptors also appear to play an important role (Croxford 2003). Data are accumulating for the efﬁcacy of pain manage- ment in humans. Notcutt and colleagues reported that can- nabinoid therapy reduced either one or both of two primary symptoms by 50% in 34 patients with chronic pain, most of which was neuropathic pain (Notcutt 2004). Although a retrospective chart review was conducted in patients with chronic non-cancer pain, the ﬁndings suggest nabilone might be a useful adjunct in the treatment of chronic pain, as well as other symptoms, in a variety of chronic pain patients (Berlach et al 2006). Nearly 1 of every 2 patients experienced pain relief, and complete pain relief was documented in one fourth of the study cohort. Of note, only one patient had tried fewer than 5 different regimens to treat pain prior to receiving nabilone. Additional beneﬁts of nabilone therapy observed in this study included decreased sleep disturbances, reduced severity of nausea and frequency of vomiting, and improved appetite. Neuropathic pain poses substantial treatment challenges as it is often unresponsive to conventional therapy (Shake- speare et al 2003). Efﬁcacy of cannabinoids in the treatment of non-malignant neuropathic pain might indicate the useful- ness of nabilone therapy in cancer patients with neuropathic pain syndromes. Recently, Wissel and associates reported a signiﬁcant (p 0.05) decrease in spasticity-associated pain with nabilone therapy when compared with placebo in patients with upper motor neuron syndrome. (Wissel et al 2006). All patients suffered from chronic spasticity-related pain refractory to medications frequently used to treat neu- ropathic pain. Nabilone was initiated at a dosage of 0.5 mg daily, which was increased to 1 mg per day after 1 week. Patients continued therapy at this dosage for 3 additional Therapeutics and Clinical Risk Management 2008:4(1) Role of nabilone in CINV weeks. At the end of 4 weeks of nabilone therapy, patients experienced a median decrease of 2 points on the 11-Point- Box-Text. Nabilone was well tolerated, and most side effects were mild in intensity. The investigators point to the anti-inﬂammatory and neuroprotective effects as a possible explanation for the beneﬁts of nabilone in their study. Several studies are currently underway, examining the efﬁcacy and safety of nabilone for the treatment of neu- ropathic pain in various patient populations, as well as its effects on sleep and other symptoms. Results of these stud- ies may further the understanding of nabilone and its role in cancer patients. Summary Cannabinoids have been shown to have effects in a variety of clinical syndromes, including CINV. Nabilone, a newly approved synthetic cannabinoid agonist, has a long history of use as an anti-emetic agent has proven to be effective in patients with CINV. Nabilone may have a role in those patients whose nausea and emesis is not adequately controlled by 5-HT3 receptor antagonists and aprepitant. Nabilone may also be considered in patients with anticipatory nausea, as seen in pre-clinical studies. Further study of nabilone as rescue or adjuvant therapy is warranted in these areas. There is also a growing body of literature to suggest additional beneﬁts in cancer patients, including pain control. Continued study of this class of drugs may yield more indications, not only in patients with malignancies, but also in the wider ﬁeld of non-malignant diseases. Acknowledgments We thank Diann Peterson for her preparation of an early draft of this manuscript. References Aapro M, Molassiotis A, Oliver I. 2005. Anticipatory nausea and vomiting. Support Care Cancer, 13:117–21. Abrahm JL. 2005. A physician’s guide to pain and symptom manage- ment in cancer patients. 2nd ed. Baltimore, MD: The Johns Hopkins University Press. Ahmedzai S, Carlyle DL, Calder IT, et al. 1983. Anti-emetic efﬁcacy and toxicity of nabilone, a synthetic cannabinoid, in lung cancer chemo- therapy. Br J Cancer, 48:657–63. Andrews PLR, Naylor RJ, Joss RA. 1998. Neuropharmacology of emesis and its relevance to anti-emetic therapy. Consensus and controversies. Support Care Cancer, 6:197–203. Aprepitant (Emend®). 2005. [package insert]. Merck and Co., Inc. Ben Amar M. 2006. Cannabinoids in medicine: a review of their therapeutic potential. J Ethnopharmacol, 105:1–25. Berlach DM, Shir Y, Ware MA. 2006. Experience with the synthetic can- nabinoid in chronic noncancer pain. Pain Med, 7:25–29. Bonica JJ. 1990. Evolution and current status of pain programs. J Pain Symptom Manage, 5:368–74. 105