As time has passed we have observed many patients using nabilone and/or cannabis. The effects and side effects have been the same although the effects of cannabis have always been preferred.
From our observations the benefits can probably be divided into 3 categories with possibly a variety of mechanisms:
1. For pain directly arising from nerve damage (neuropathic) pain a direct reduction in pain was observed. Therefore effects on the receptors within the pain pathways can be proposed.
2. For muscle spasms and bladder cramps there has been a reduction, presumably by a direct effect on the neural control of muscle tension.
3. The adjuvant effects of improved sleep, "pain compressing", "pain distancing", anxiolysis, relaxation, euphoria, and relief of depression all have benefits on the patient's perception and management of pain. These will be mediated through cortical and limbic system mechanisms.
4. There are probable peripheral effects on inflammation which would influence pain although all of the patients here have visited NSAID therapy in the past.
Side effects seem to have occurred with a similar frequency to many other psychoactive drugs. Drowsiness and dysphoria have been the major problems for patients. A dry mouth has been reported. No other side-effects of nabilone have been noted.
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