Neuropathic pain

Neuropathic pain arises from lesion or disease of the somatosensory nervous system, including postherpetic neuralgia, painful diabetic neuropathy, HIV-associated sensory neuropathy, post-traumatic neuropathy, and multiple sclerosis–related central pain. NASEM (2017) included neuropathic pain within its substantial evidence finding for chronic pain in adults. The Mücke et al. Cochrane review (Cochrane Database Syst Rev 2018) pooled 16 RCTs (n=1,750) of herbal cannabis, nabiximols, nabilone, and dronabinol, reporting a number needed to treat (NNT) of ~20 (95% CI 11–100) for ≥50% pain relief versus placebo and a number needed to harm (NNH) of ~25 for withdrawal due to adverse events; authors judged quality of evidence as very low to moderate and concluded potential benefits were largely outweighed by harms ⚠️. Nabiximols (Sativex) is licensed in several jurisdictions for MS neuropathic pain. → See also: Nabiximols, Sativex, Nabilone, MS, Chronic pain.