• Mellar P Davis.
• Director of Research The Harry R Horvitz Center for Palliative Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, R35, Cleveland OH 44195, USA. davism6@ccf.org
• Expert Opin Investig Drugs. 2008 Jan 1;17(1):85-95.

BackgroundNabilone has been approved to treat chemotherapy-induced nausea and vomiting. Recent studies have explored cannabinoids in pain management.ObjectivesTo review the evidence for the use of cannabinoids in general and nabilone in particular; i) in managing chemotherapy-induced nausea and vomiting; and ii) in treating pain.MethodA systematic review of published English literature used the terms: cancer, cannabinoid, nabilone, nausea, pain, tetrahydrocannabinol and vomiting as search terms. Reviews, meta-analyses and treatment trials were reviewed.Results/ConclusionsNabilone is superior to placebo, domperidone and prochlorperazine but not metoclopramide or chlorpromazine. Cannabinoids do not add to benefits of 5-HT(3) receptor antagonists. Side effects are greater for nabilone than for prochlorperazine, in most studies patients prefered nabilone over prochlorperazine. Nabilone is ineffective in acute pain but benefits in neuropathic pain and central hypersensitization. Recent guidelines place nabilone as a second to fourth line drug for neuropathic pain.

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