Clinical Experience: 15 of 20 Chronic Pain Patients Reported Improvement With Synthetic Cannabinoid Nabilone
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.
Quick Facts
What This Study 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.
Key Numbers
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 They Did This
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.
Why This Research 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 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.
What This Study Doesn't 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.
Questions This Raises
- ?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?
Trust & Context
- Key Stat:
- 15 of 20 chronic pain patients reported improvement, mainly in sleep and nausea rather than pain alone
- Evidence Grade:
- Uncontrolled clinical case series with small sample and retrospective assessment. Provides real-world clinical insight but cannot establish efficacy.
- Study Age:
- Published in 2006. Subsequent randomized controlled trials have provided stronger evidence on nabilone for chronic pain.
- Original Title:
- Experience with the synthetic cannabinoid nabilone in chronic noncancer pain.
- Published In:
- Pain medicine (Malden, Mass.), 7(1), 25-9 (2006)
- Authors:
- Berlach, David M, Shir, Yoram(6), Ware, Mark A(14)
- Database ID:
- RTHC-00216
Evidence Hierarchy
Describes what happened to one person or a small group.
What do these levels mean? →Frequently Asked 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.
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Cite This Study
https://rethinkthc.com/research/RTHC-00216APA
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.
MLA
Berlach, David M, et al. "Experience with the synthetic cannabinoid nabilone in chronic noncancer pain.." Pain medicine (Malden, 2006.
RethinkTHC
RethinkTHC Research Database. "Experience with the synthetic cannabinoid nabilone in chroni..." RTHC-00216. Retrieved from https://rethinkthc.com/research/berlach-2006-experience-with-the-synthetic
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.