Introduction: Neuropathy plays a large role in the pathogenesis of gastroparesis. Neuropathic pain in gastroparesis is an often difficult—to—treat symptom of the disease, despite 80—90% of patients with gastroparesis reporting abdominal pain as a symptom. Treatment for gastroparesis—related pain is especially limited. Neuromodulators are used for this purpose despite a lack of evidence supporting their effectiveness. Cannabinoids, primarily delta—9—tetrahydrocannabinol (THC) and cannabidiol (CBD), are increasingly utilized for medicinal purposes. In New York medical marijuana is approved for the treatment of neuropathy with severe pain. Similarly, Dronabinol (a synthetic THC analogue) has been used for nausea vomiting and anorexia for years. We showed that cannabinoids are effective in the treatment of gastroparesis—related abdominal pain.
Methods: The effects of prescribed cannabinoids on gastroparesis symptoms were assessed in 24 patients (Table 1, baseline characteristics). All patients' symptoms were refractory to standard therapies for gastroparesis. Patients were prescribed either Dronabinol, medical cannabis, or both for symptom management. Patients who received both treatments were prescribed them sequentially (Dronabinol then marijuana) if Dronabinol did not adequately relieve symptoms. Medical marijuana was prescribed as needed at varying THC: CBD ratios and was taken via vaporized inhalation or sublingual drops. Dosage of Dronabinol ranged from 2—10mg twice daily to four times daily. Patients filled out a ‘Gastroparesis Cardinal Symptom Index’ (GCSI) questionnaire before and after treatment. Additionally, patients rated their abdominal pain before and after cannabinoid use, using a 1—5 analog scale.
Results: Six patients were prescribed Dronabinol, ten were prescribed marijuana and eight were prescribed Dronabinol followed by marijuana. Paired sample T—tests were performed and statistically significant improvement in abdominal pain score was seen in patients who received either cannabinoid treatment. When analyzed individually, both marijuana and Dronabinol showed statistically significant improvement in abdominal pain scores as well (Table 2, Figure 1).
Conclusion: Our study shows that cannabinoids may play an important role in the management of gastroparesis—related abdominal pain. There are currently no treatments shown to be effective for gastroparetic pain in clinical trials, and cannabinoids may serve a niche for this under—treated symptom.