Nabilone and THC/CBD for the Treatment of FBSS Refractory Pain
Condition: FBSS
MeSH terms: Pain, Intractable
Study type: Observational

Summary: 
      The aim of this study is to evaluate the efficacy of oral administration of nabilone or
      THC/CBD administration in combination with spinal cord stimulation (SCS) in FBSS patients
      refractory to other available therapeutic strategies.
    

Detailed description: 
      Failed Back Surgery Syndrome (FBSS) is defined as: spinal pain of unknown origin either
      persisting despite surgical intervention or appearing after surgical intervention for spinal
      pain originally in the same topographical location.

      Several conditions have been identified as causes of FBSS: epidural fibrosis, canal stenosis
      (global or lateral), foraminal stenosis, retained disc fragment, recurrent disc herniation or
      degeneration, spinal instability, facet joint pain, sacroiliac joint pain, discitis, adhesive
      arachnoiditis and others.

      Can involve 20% to 40% of patients who have undergone lumbar spine surgery and 0.02% to 2% of
      the general population suffer from this syndrome.

      In FBSS symptoms are the persistence of low back pain, deterioration or recurrence of
      radiculopathy, sensory and/or motor deficit, sphincter dysfunction.

      Chronic opioid therapy does not improve long-term pain management. Similar issues can occur
      with conservative measures like peridural injections of steroids, intrathecal analgesic
      infusion and local anesthetics injections. Despite a large part of FBSS patients benefit of
      radio-frequency treatment and/or spinal cord stimulation (SCS), a small percentage of them
      doesn't report benefits.

      Pain could be treated by drugs modulating endocannabinoid system and it could represent a
      pharmacological option in a multimodal treatment approach for neuropathic pain.

      Authors present a retrospective case series documenting the efficacy and safety of oral
      administration of cannabinoids agonists (THC/CBD and nabilone) in 20 FBSS patients,
      presenting moderate to severe chronic pain that not responding to other treatment regimens.

      Cannabinoids agonists were administered in association with the practice of spinal cord
      stimulation (SCS).

      Other analgesic therapies were discontinued before the beginning of the treatment.

      The study was performed during the period between September 2014 and January 2016 and the
      duration was up to 12 months.

      Characteristics and severity of neuropathic pain were measured using the Douleur
      Neuropathique 4 questionnaire. The Brief Pain Inventory allows patients to rate the severity
      of their pain and the degree to which pain interferes with common dimensions of feeling and
      function.

      Patients aged between 45 and 69. All patients received a fixed dose of cannabinoid agonists:
      treatment was initiated with nabilone 1mg/day or an oleic suspension for oral administration
      of THC/CBD 25mg/day.

      The basal dose was increased depending on effects on pain control. Adverse reactions were
      treated by decreasing the subscripted dose. If adverse events required the suspension of the
      administration of the initially prescribed drug, the same was switched with the other
      available in the study.
    

Intervention name(s): Nabilone; THC/CBD
Intervention type(s): Drug; Drug
Other intervention name(s): Spinal Cord Stimulation; Spinal Cord Stimulation
Intervention MeSH terms: Nabilone
Observational model: Cohort
Time perspective: Retrospective
Sampling method: Probability Sample
Study population: 
        Patients that comes to the pain unit, suffer from FBSS refractory pain
      
Keywords: Cannabinoids, nabilone, FBSS, THC/CBD, refractory pain