Nanocrystal Formulation of Meloxicam Effective After Bunionectomy
A randomized, double-blind, placebo-controlled study of 59 patients evaluated the safety and efficacy of an IV nanocrystal formulation of meloxicam (either 30 mg or 60 mg) compared with placebo.1 Subjects had moderate to severe pain after standardized unilateral bunionectomy.
Efficacy was evaluated according to summed pain intensity differences over 48 hours as well as need for opioid rescue medications.
Adverse events were mild to moderate and equal across all groups.
Both treatment groups achieved significantly greater pain reductions versus placebo (P = 0.05) at all evaluated times and intervals during the study period. The number of patients with 30% and 50% overall reduction in pain from baseline after 6 and 24 hours was significantly higher with meloxicam IV 30 mg doses versus placebo, but not with meloxicam IV 60 mg doses.
The time to first use of rescue medication was significantly longer versus placebo with meloxicam IV 60 mg (P < 0.05), but not with meloxicam IV 30 mg.
Once-daily administration of meloxicam IV 30 mg and 60 mg exhibited rapid onset of analgesia (as early as 15 minutes) with maintenance of analgesic effect for two consecutive 24-hour periods.
The authors concluded that meloxicam IV is generally safe and well tolerated in subjects with moderate to severe pain after bunionectomy.
1. Gottlieb IJ, Tunick DR, Mack RJ, et al Evaluation of the safety and efficacy of an intravenous nanocrystal formulation of meloxicam in the management of moderate-to-severe pain after bunionectomy. J Pain Res. 2018 Feb 16;11:383-393. doi: 10.2147/JPR.S149879. [Context Link]
Cannabis and Use in Chronic Pain: A Review
A Cochrane review1 of cannabis and chronic pain trials concluded that potential benefits of cannabis-based medicine in chronic neuropathic pain might be outweighed by potential harm. These medications include herbal cannabis, plant-derived or synthetic THC, and THC/CBD oromucosal spray.
The prevalence of chronic pain ranges from 6% to 10%. Many drugs and other interventions have been advocated, often with limited success. Cannabis has been used for millennia for pain relief and is strongly promoted by many patients.
A Cochrane database search was conducted in November 2017 to identify published and ongoing trials to assess the efficacy, tolerability, and safety of cannabis-based medicines. The reviewers identified 16 studies with 1750 patients.
Analysis of the data concluded that cannabis-based medicines may increase the number of people achieving 50% or greater pain relief compared with placebo (21% versus 17%; risk difference [RD] 0.05 (95% confidence interval [CI], 0.00 to 0.09).
Evidence for improvement in Patient Global Impression of Change (PGIC) with cannabis was of very low quality (26% versus 21%; RD 0.09; 95% CI 0.01-0.17).
More participants withdrew from the studies due to adverse events with cannabis-based medicines (10% of participants) than with placebo (5% of participants; RD 0.04; 95% CI 0.02-0.07). Cannabis-based medicines may increase nervous system adverse events compared with placebo (61% versus 29%; RD 0.38; 95% CI 0.18-0.58), Psychiatric disorders were reported in 17% of participants using cannabis-based medicines and in 5% using placebo (RD 0.10; 95% CI 0.06-0.15). Long-term risks in the studies were not determined.
1. Mucke M, Phillips T, Radbruch L, et al Cannabis-based medicines for chronic neuropathic pain in adults. Cochrane Database Syst Rev. 2018 Mar 7;3:CD012182. doi: 10.1002/14651858. [Context Link]