Clinical Experience: 15 of 20 Chronic Pain Patients Reported Improvement With Synthetic Cannabinoid Nabilone | Research

The takeaway

A clinical case series of 20 chronic non-cancer pain patients treated with off-label nabilone (a synthetic cannabinoid) for an average of 1.5 years found 15 reported improvement, with sleep and nausea benefits being the main reasons for continued use.

Read this if you have chronic pain and want to know about real-world clinical experience with nabilone, a synthetic cannabinoid.

15 of 20 chronic pain patients reported improvement, mainly in sleep and nausea rather than pain alone

What the researchers found

This report described clinical experience with off-label nabilone (a synthetic cannabinoid approved only for chemotherapy nausea) for chronic non-cancer pain at a Canadian pain clinic from 1999 onward.

Twenty adult patients with chronic non-cancer pain were followed for an average of 1.5 years. Prior to nabilone, patients had used a wide range of other therapies, and 11 had previously used cannabis.

Fifteen of 20 patients (75%) reported subjective overall improvement. Nine specifically reported reduced pain intensity. However, the main reasons patients continued using nabilone were benefits for sleep and nausea rather than pain relief alone. Three patients experienced intolerable side effects: palpitations, urinary retention, and dry mouth.

Why it matters

This early clinical experience suggested nabilone might be useful for chronic pain management, but interestingly the main perceived benefits were improved sleep and reduced nausea rather than direct pain relief. This pattern, where cannabinoids improve overall symptom burden more than pain scores alone, has been seen in other studies.

The numbers in context

20 patients followed for average 1.5 years. 11 had previously used cannabis. 15/20 (75%) reported overall improvement. 9/20 reported reduced pain. 3/20 had intolerable side effects. Main benefits: sleep and nausea improvement.

How the study worked

Retrospective clinical case series of 20 adult chronic non-cancer pain patients treated with off-label nabilone at a Canadian pain clinic. Average follow-up of 1.5 years. No control group or randomization. Outcomes assessed by clinician review of medical records.

What this study cannot tell us

No control group, no randomization, no blinding. Only 20 patients. Retrospective assessment introduces bias. Subjective outcomes without standardized measures. The 75% improvement rate may reflect selection bias since patients who tolerated the drug stayed on it.

How to read the evidence

Uncontrolled clinical case series with small sample and retrospective assessment. Provides real-world clinical insight but cannot establish efficacy.

When this study was published

Published in 2006. Subsequent randomized controlled trials have provided stronger evidence on nabilone for chronic pain.

The bigger picture

Off-label use of nabilone for chronic pain became relatively common in Canada before more rigorous trial data was available. This case series reflects real-world clinical practice and the pattern of using cannabinoids when conventional treatments have failed.

Questions still open

Would nabilone show benefit in a randomized controlled trial for chronic pain? Is the sleep improvement driving the perceived overall benefit? How does nabilone compare to plant-derived cannabinoids for chronic pain?

Common questions

Does nabilone help with chronic pain?

In this small case series, 9 of 20 patients reported reduced pain intensity. However, the main benefits driving continued use were improved sleep and reduced nausea. Seventy-five percent reported overall improvement but this was an uncontrolled study.

What side effects did nabilone cause?

Three of 20 patients (15%) experienced intolerable side effects: palpitations, urinary retention, and dry mouth. These caused treatment discontinuation. Most other patients tolerated the medication over the average 1.5-year follow-up.

Read the original research

Experience with the synthetic cannabinoid nabilone in chronic noncancer pain.

Pain medicine (Malden, Mass.), 7(1), 25-9

View on PubMed ↗

Citation

Berlach, David M; Shir, Yoram; Ware, Mark A. (2006). Experience with the synthetic cannabinoid nabilone in chronic noncancer pain.. Pain medicine (Malden, Mass.), 7(1), 25-9.