Background and aims Chronic pain is notoriously difficult to treat, placing significant stress on resources. We discuss the case of 43-year-old gentleman sent to the pain clinic following persisting pain for 7 weeks following thoracotomy for empyema. Described as ‘shooting pain’, non-radiating, 7–8/10 in severity. Initial treatment with paracetamol, codeine and NSAID provided little benefit. Subsequent addition of oramorph, oxynorm followed by addition of amitryptilline and tramadol provided little benefit. Patient was quite distressed with quality of life and side effects of polypharmacy. Due to suboptimal pain control, we decided to give a trial with synthetic cannabinoid. After reviewing existing literature, we decided to use nabilone.
Methods We started with 0.5 mg BD titrated to 1 mg BD over a period of 2 weeks.
Results The patient reported much better pain relief after the 2nd week, with pain score 3–4/10, and not needing breakthrough analgesia after 3rd week. Reported dry mouth and light-headedness for first 2 weeks that subsequently decreased. Subsequent follow up at 3 months and 6 months where patient reported minimal pain with occasional dry mouth. Currently on paracetamol, amitryptilline and nabilone. All investigations throughout were normal.
Conclusions This was our first opportunity to do extensive study about cannabinoids in respect to their mechanism of action, side effects and use. In future we would like to conduct larger studies over longer period of time in different patient groups to identify the patient groups likely to benefit and more knowledge of its effects and long and short-term side effects.
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