USE OF SYNTHETIC AND PHYTOCANNABINOIDS IN THE TREATMENT OF NEUROPATHIC PAIN: A REVIEW BASED ON RANDOMIZED CLINICAL TRIALS

Abstract

Neuropathic pain (NP) is a highly prevalent and disabling condition, often refractory to standard pharmacological treatments. Given the limitations of currently available therapies, cannabinoids have gained attention due to their and neuroimmunomodulatory properties. However, clinical evidence supporting their efficacy remains controversial. This paper reviews evidence on the efficacy and safety of synthetic and phytocannabinoids for the treatment of NP. We conducted a literature search in Embase, Scopus, Web of Science, PubMed/MEDLINE, and Cochrane Central Register of Controlled Trials, including randomized clinical trials (RCT) published since 2000. Eligible studies assessed cannabinoids as monotherapy or adjunctive treatment for NP, with outcomes evaluated using validated assessment tools. Data was analyzed using the PICOT framework. The results demonstrated substantial heterogeneity regarding cannabinoid type, formulation, dose, administration route, pain etiology, and outcome measures. Cannabinoids were not superior to placebo when used as monotherapy; modest analgesic benefits, improved sleep quality, or opioid-sparing effects were detected particularly when used as adjunctive therapy or administered via inhalation. Current evidence from RCT does not suggest the use of cannabinoids as monotherapy for NP. While selected patient subgroups may benefit from adjunctive cannabinoid-based therapies, the large heterogeneity of clinical protocols and assessments limit generalizable conclusions.