From the Guidelines
Nabilone should not be considered a first-line treatment for abdominal pain, and its use should be reserved for patients who have failed conventional treatments. The provided evidence does not support the use of nabilone as a primary treatment for abdominal pain, and it is not mentioned as a recommended treatment in the guidelines for irritable bowel syndrome (IBS) management 1. The most recent and highest quality study on the management of IBS does not mention nabilone as a treatment option, instead recommending other medications such as tricyclic antidepressants, selective serotonin reuptake inhibitors, and linaclotide for the treatment of abdominal pain and other IBS symptoms 1. Additionally, the AGA clinical practice update on pain management in inflammatory bowel disease emphasizes the importance of addressing underlying causes of pain and using a multidisciplinary approach to manage chronic abdominal pain, but does not mention nabilone as a treatment option 1. Therefore, nabilone should only be considered for patients with abdominal pain who have failed other treatments and should be used with caution due to its potential side effects. Some key points to consider when prescribing nabilone include:
- Starting with a low dose (0.5 mg once or twice daily) and gradually increasing as needed and tolerated
- Regularly reassessing benefits and side effects
- Cautioning patients about driving or operating machinery due to sedative properties
- Contraindicating in patients with severe liver or kidney disease, history of psychosis, or substance abuse disorders
- Using nabilone as part of a comprehensive pain management approach that includes addressing underlying causes of pain.
From the Research
Nabilone for Abdominal Pain
- Nabilone is a synthetic cannabinoid that has been approved for the treatment of chemotherapy-induced nausea and vomiting, and recent studies have explored its use in pain management 2, 3.
- The evidence suggests that nabilone is ineffective in acute pain but may be beneficial in neuropathic pain and central hypersensitization 2.
- A systematic review of published English literature found that nabilone is superior to placebo, domperidone, and prochlorperazine in managing chemotherapy-induced nausea and vomiting, but not metoclopramide or chlorpromazine 2.
- Nabilone has been used as an adjunctive therapy for various types of pain, including cancer pain, chronic noncancer pain, neuropathic pain, fibromyalgia, and pain associated with spasticity, and has led to small but significant reductions in pain 3.
- The most common adverse drug reactions associated with nabilone include euphoria, drowsiness, and dizziness, and the likelihood of abuse is thought to be low 3.
- Clinical practice guidelines consider nabilone as a second to fourth line drug for neuropathic pain, and as a third-line agent for other types of pain 2, 3.
Comparison with Other Treatments
- Selective serotonin reuptake inhibitors (SSRIs) have been studied for the treatment of irritable bowel syndrome (IBS) symptoms, including abdominal pain, but the evidence is conflicting 4.
- Fluoxetine, citalopram, and paroxetine have been shown to improve abdominal pain, bloating, and stool consistency in some studies, but not in others 4.
- SSRIs are commonly used to treat major depressive disorder, and have been shown to be effective in reducing symptoms of depression, but their use in treating abdominal pain is not well established 5, 6.