Dronabinol useful for chronic pain: a case report

Abstract Title: Dronabinol useful for chronic pain: a case report

Background:

Increasingly, the prevalence and the economic burden of chronic pain has been recognized worldwide. In recent years, there has been growing interest in the use of cannabis and cannabinoid-based drugs to supplement traditional drugs used for the treatment of chronic pain. Due to the prevalence of chronic pain both nationally and globally, effective pain relief is essential. Chronic pain patients who have unsuccessfully tried other medications including NSAIDs, antidepressants, and neuropathic medications indicated for pain relief may benefit from a trial of dronabinol—a cannabis-derived pharmaceutical that is a synthetic form of delta-9-tetrahydrocannabinol (Δ⁹-THC). Dronabinol is currently approved only for use in chemotherapy induced nausea and vomiting in cancer patients and anorexia in HIV patients. Therefore, the need to synthesize evidence in human clinical and randomized control trials to determine the effectiveness of dronabinol as a potential treatment for chronic pain is not only compelling but also critical.

Purpose/Objectives:

The aim of the case report is to highlight a patient’s experience with dronabinol and its usefulness in chronic pain management. Patient is a 35-year-old male in the military who sustained multiple severe bodily injuries and fractures during military operations, requiring surgery. He started on Dronabinol (5 mg tablets x 3 per day, every 6 hours) a month later and has been taking it for over 3 years which included a 7 month break. Patient stopped taking the medication due to the risk of separation from the Army as the military only allows soldiers to take Dronabinol if they are retiring or medically discharged. 7 months later, he went back on the medication due to retirement.  

Method:

I interviewed a patient for the case report via telephone for approximately 45 minutes and reviewed his data. I created a linear plot based off a table of his Defense and Veterans Pain Rating Scale (DVPRS) scores from separate appointments over time.   

Results:

An added dose of Dronabinol helped him to quit all opioids in one day and he found more pain relief from Dronabinol than opioids. The patient’s pain severity decreased from 7 to 2/10 from 06/2019-04/2022. He found Dronabinol to be more helpful for pain in his pelvis, knees, and ankle. He reported being more flexible and was able to keep doing yoga and fitness classes to prevent his body from “locking up.” The patient experienced improved mood, sleep, and stress levels along with reduced chronic pain. Patient denied psychoactive effects, withdrawal, or cravings. The only side effect was drowsiness.  

Conclusions: Patient stated, “Dronabinol is all around very beneficial” and is “honestly better than most alternatives.” However, he had difficulty obtaining access to the medication. He stated, “the majority of installations and the VA (Veterans Affairs) does not support Dronabinol.” Although there are safety concerns over THC’s psychoactive effects, the patient did not experience any “high,” withdrawal, or "cravings" with Dronabinol. He felt more pain relief from Dronabinol than opioids long term for chronic pain and was even able to quit all opioids in one day with an extra dose of Dronabinol. Future clinical studies should evaluate prescribing Dronabinol for chronic pain management. Limited research has been done in in pediatrics or pregnant women, but caution is advised due to THC’s unknown impact on brain development.

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