Dronabinol for Neuropathic Pain in Palliative Care.

Boogaerts G.; Rego A.; Freeman H.; Baumrucker S.; Rashid S. · Journal of pain & palliative care pharmacotherapy · 2026

**Background & Methods** This is a comprehensive narrative review examining the efficacy of dronabinol (synthetic THC) for managing neuropathic pain in palliative care patients. The review synthesized evidence on neuropathic pain mechanisms, the endocannabinoid system, dronabinol's pharmacological actions, clinical efficacy, and safety profile compared to traditional analgesics. **Key Findings** • Dronabinol modulates pain pathways through CB1/CB2 receptor activation, reducing nociceptive transmission and neuroinflammation in patients with neuropathic pain from cancer, neurodegenerative diseases, and diabetes. • Clinical studies demonstrate modest analgesic effects with additional benefits including improved nausea, sleep disturbances, and potential opioid-sparing properties that may reduce overall opioid requirements in palliative care settings. • Dronabinol exhibits a generally favorable safety profile compared to traditional neuropathic pain treatments, supporting its consideration as a potential multimodal therapeutic option for palliative care patients. **Dosage & Administration** Not reported. The review does not specify optimal dosing regimens, routes of administration, or titration schedules for dronabinol use in neuropathic pain management. **Safety & Adverse Effects** Not reported. While the abstract notes a "generally favorable safety profile," specific adverse effects, contraindications, or drug interaction data are not detailed in the provided summary. **Evidence Quality** This review is limited by several factors affecting the strength of recommendations. The evidence base is characterized as "limited and heterogeneous," indicating variability in study designs, patient populations, and outcome measures across included studies. As a narrative review (rather than systematic/meta-analysis), it may be subject to selection bias in literature inclusion. Key gaps include lack of head-to-head comparisons with established neuropathic pain treatments, insufficient long-term safety data, and undefined optimal dosing parameters. The authors acknowledge these limitations and call for further rigorous research to better characterize dronabinol's efficacy relative to standard-of-care medications, establish appropriate dosing protocols, and assess long-term safety profiles in palliative populations. Overall, current evidence supports dronabinol as a potential adjunctive consideration but does not yet provide sufficient evidence for definitive clinical recommendations.

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