Turri Mara, Teatini Francesco, Donato Francesco, Zanette Giampietro, Tugnoli Valeria, Deotto Luciano, Bonetti Bruno, Squintani Giovanna
Department of Neurology, Central Hospital of Bolzano, 39100 Bolzano, Italy.
Department of Neurology, SS Giovanni e Paolo Hospital, 30122 Venice, Italy.
Medicines (Basel). 2018 Jun 21;5(3):59. doi: 10.3390/medicines5030059.
Delta-9-tetrahydrocannabinol (THC)/cannabidiol (CBD) (nabiximols or Sativex) is an oromucosal spray formulation containing THC and CBD at an approximately 1:1 fixed ratio. Its administration for the treatment of pain in patients with multiple sclerosis (MS) has been established. MS patients generally complain of different kinds of pain, including spasticity-related and neuropathic pain. In this study, we compared and evaluated pain modulation and thermal/pain threshold of MS patients before and after THC/CBD administration. 19 MS patients underwent clinical examination, numerical rating scale (NRS), quantitative sensory testing (QST), and laser-evoked potentials (LEPs) before and after 1 month of therapy. Psychophysiological and neurophysiological data were compared to sex- and age-matched controls. Patients reported a significant reduction in pain. We found statistically significant differences in LEP parameters between patients and controls but no significant change in LEP measures after THC/CBD therapy. Cold and heat detection thresholds were altered in patients but did not change after THC/CBD therapy. There was a significant increase in cold pain threshold by hand stimulation and a significant reduction in abnormal cold perception thresholds. Our results indicate that Sativex therapy provides pain relief in MS patients and suggest that it might modulate peripheral cold-sensitive TRP channels.
Δ9-四氢大麻酚（THC）/大麻二酚（CBD）（纳布西莫尔或萨替维克斯）是一种口腔黏膜喷雾剂制剂，其中THC和CBD的固定比例约为1:1。其用于治疗多发性硬化症（MS）患者疼痛的作用已得到证实。MS患者通常会抱怨各种疼痛，包括与痉挛相关的疼痛和神经性疼痛。在本研究中，我们比较并评估了MS患者在服用THC/CBD前后的疼痛调节以及热/痛阈值。19名MS患者在治疗1个月前后接受了临床检查、数字评定量表（NRS）、定量感觉测试（QST）和激光诱发电位（LEP）检查。将心理生理学和神经生理学数据与性别和年龄匹配的对照组进行比较。患者报告疼痛显著减轻。我们发现患者与对照组之间的LEP参数存在统计学显著差异，但THC/CBD治疗后LEP测量值无显著变化。患者的冷觉和热觉检测阈值发生了改变，但THC/CBD治疗后未发生变化。通过手部刺激，冷痛阈值显著升高，异常冷觉阈值显著降低。我们的结果表明，萨替维克斯疗法可缓解MS患者的疼痛，并表明其可能调节外周冷敏性瞬时受体电位通道。
