Proof of Concept Trial of Cannabis Derivatives in Neuropathic Pain (CAN)

Chronic neuropathic pain (CNP) is disabling. Research on frontline treatments for CNP, shows inconsistent outcomes and dissatisfaction among Veterans. Veterans and clinicians have shown significant interest in cannabis derivatives (THC, CBD) for neuropathic pain control, but there are no well-controlled trials guiding expectations for benefit and adverse outcomes associated with cannabis for CNP. Because Veterans are likely to present with pain and pain-related polymorbidity significantly differing from that of civilians, a well-structured clinical trial of cannabinoids for Veterans with CNP is vital.

Study Overview

• Status: Recruiting
• Conditions: Neuropathic Pain; Peripheral Neuropathic Pain
• Intervention / Treatment: Drug: Placebo; Drug: CBD (Epidolex); Drug: THC + CBD (Nabiximols); Drug: THC (Syndros)

Detailed Description

Chronic pain is a significant burden to United States Veterans and is a particular concern for Veterans. One of the causes of pain is chronic neuropathic pain (CNP). Frontline treatment for CNP, show inconsistent outcomes and have significant side effects. The ongoing opioid crisis has led to significant interest in safe and effective alternatives for pain control, and there is a significant need for research on desirable options for pain control that are likely to improve treatment adherence and outcomes. Veterans groups and Veterans Affairs clinicians have expressed significant interest in cannabis and its principal constituents (delta-9-tetrahydrocannabinol, THC; cannabidiol, CBD) for pain management, but the extant research describing the potential risks and benefits of cannabis for pain is weak. This randomized trial was developed as a proof of concept study to determine if cannabis constituents (THC, CBD, and THC+CBD) are superior to placebo in reducing pain in Veterans with CNP. The study is to recruit a sample of 320 adult Veterans who meet diagnostic criteria for high-impact CNP, are on stable treatment(s) for CNP, are not current cannabis users and who do not meet diagnostic criteria for Cannabis Use Disorder. This randomized phase II, 4-arm clinical trial aims to determine if cannabis constituents (THC, CBD) or their combination (THC+CBD) are superior to placebo in reducing pain in Veterans with CNP. This trial will offer the first evidence describing the potential benefits and adverse effects of cannabinoids for CNP in Veterans.

• Study Type: Interventional
• Enrollment (Estimated): 320
• Phase: Phase 2

Contacts and Locations

• Study Contact: Name: Courtney C DiCocco; Phone Number: (203) 932-5711; Email: Courtney.DiCocco@va.gov
• Study Contact Backup: Name: Mohini Ranganathan, MD; Phone Number: (203) 932-5711; Email: Mohini.Ranganathan@va.gov

Study Locations

• United States
  • California
    • San Diego, California, United States, 92161-0002
      • Recruiting
      • VA San Diego Healthcare System, San Diego, CA
      • Contact: Albert Leung, MD; Phone Number: 858-642-3029; Email: albert.leung@va.gov
    • West Los Angeles, California, United States, 90073-1003
      • Active, not recruiting
      • VA Greater Los Angeles Healthcare System, West Los Angeles, CA
  • Connecticut
    • West Haven, Connecticut, United States, 06516-2770
      • Recruiting
      • VA Connecticut Healthcare System West Haven Campus, West Haven, CT
      • Principal Investigator: Deepak D'Souza, MD MBBS
      • Contact: Deepak D'Souza, MD MBBS; Phone Number: 2594 (203) 932-5711; Email: Deepak.DSouza@va.gov
  • Rhode Island
    • Providence, Rhode Island, United States, 02908-4734
      • Recruiting
      • Providence VA Medical Center, Providence, RI
      • Contact: Jane Metrik, PhD; Phone Number: 3400 401-273-7100; Email: jane.metrik@va.gov
  • Texas
    • San Antonio, Texas, United States, 78229-4404
      • Recruiting
      • South Texas Health Care System, San Antonio, TX
      • Contact: Muhammad Baig, MD; Phone Number: 18244 210-617-5300; Email: muhammad.baig@va.gov
  • Washington
    • Seattle, Washington, United States, 98108-1532
      • Terminated
      • VA Puget Sound Health Care System Seattle Division, Seattle, WA

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 21 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Able to provide written consent
• Veterans 21 years and older at the date of screening
• Meet diagnostic criteria for neuropathic pain as defined by the Neuropathic Pain Special Interest Group of the International Association for the Study of Pain (NeuPSIG)
• Meet criteria for persistent, high-impact pain criteria.
• Presence of allodynia confirmed by one of the screening dynamic brush tests
• women of childbearing potential who agree to abide by contraceptive requirements

Exclusion Criteria:

• Actively engaged in or planning to enter a program of non-pharmacological invasive intervention for pain at the time of enrollment
• Peripheral neuropathy is not a primary source of neuropathic pain
• Hypersensitivity to THC, CBD, or THC/CBD
• Self-report of cannabis use during screening phase confirmed by positive urine toxicology for THC-COOH as measured and resulted at visit 5 before randomization
• Unwilling to refrain from using cannabis or cannabis-based products through the entire duration of the study
• Diagnosis of DSM-5 Cannabis Use Disorder in the past 6 months
• Current DSM-5 diagnosis of cannabis use disorder, substance use disorder or serious psychiatric disorders
• Actual change or intent to change is greater than a 20% change (increase or decrease) in any other medication for pain or non-pharmacological treatment from 4 weeks before the screening appointment until completion of study (i.e., visit 13)
• Opioid doses > 400 mg MME (morphine milligram equivalent)
• Women who are pregnant or breastfeeding, or who intend to become pregnant in the 12 weeks from enrollment
• Any current unstable or concerning medical condition that would place the patient at increased risk, including hepatic, respiratory, immunological, cardiovascular, endocrine, or renal disease, or in the opinion of the investigator, prevents adherence with the protocol
• Need for immediate psychiatric hospitalization
• Enrolled in a medical marijuana program
• Federal employee

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Quadruple

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: CBD (Epidolex); Target dose of 800 mg per day.	Drug: Placebo; Placebo; Drug: CBD (Epidolex); Participants will receive a target dose of 800 mg per day of CBD (Epidolex).
Active Comparator: THC + CBD (Nabiximols); Target dose of 10.8 mg / 10 mg per day.	Drug: Placebo; Placebo; Drug: THC + CBD (Nabiximols); Participants will receive a target dose of 10.8 mg / 10 mg per day of THC + CBD (Nabiximols).
Placebo Comparator: Placebo; Identical in appearance to the three active comparators.	Drug: Placebo; Placebo
Active Comparator: THC (Syndros); Target dose of 10mg per day.	Drug: Placebo; Placebo; Drug: THC (Syndros); Participants will receive a target dose of 10mg per day of THC (Syndros).

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
To compare the short-term efficacy of THC, CBD, or THC+CBD vs Placebo on Neuropathic Pain as measured by the Numeric Rating Scale of Pain	The mean change in the weekly average of daily Numeric Rating Scale (NRS) pain score (0-10 scale; 0=no pain, 10=worst possible pain) from baseline to week 6.	Baseline, Week 6

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
To assess the efficacy of THC, CBD, or THC+CBD vs Placebo in pain quality (allodynia) as measured by the Quantitative Sensory Testing.	Allodynia measured by Quantitative Sensory Testing (QST) (0-10 scale; 0=no pain, 10=worst possible pain)	Baseline, Week 2, Week 4, Week 6, Week 8
To assess the efficacy of THC, CBD, or THC+CBD vs Placebo in disability and function as measured by the Neuropathic Pain Scale.	Neuropathic Pain Scale (NPS) total score; 7 different questions/sensations (for each individual item 0-10 scale; 0= not present/no pain, 10= most sensation). Individual scores analyzed separately for pain quality and mean score analyzed for overall neuropathic pain).	Baseline, Week 1, Week 2, Week 3, Week 4, Week 5, Week 6, Week 7, Week 8
To assess the efficacy of THC, CBD, or THC+CBD vs Placebo in disability and function as measured by the Gait Speed Test	Distance walked (meters)/time (seconds) measured by Gait Speed Test (lower score = worse, higher score =better)	Baseline, Week 4, Week 8
To assess the efficacy of THC, CBD, or THC+CBD vs Placebo in mean changes in perceived improvement as measured by the Patient Global Impression of Change	Patient Global Impression of Change (PGIC) 1-7 point ordinal scale assessed (1 = worse, 7 = better)	Baseline, Week 2, Week 4, Week 6, Week 8
To assess the efficacy of THC, CBD, or THC+CBD vs Placebo in mean changes in perceived improvement as measured by the patient satisfaction visual analog scale.	Patient satisfaction with intervention on visual analog scale (VAS, 0-100, 0=no satisfaction, 100 = complete satisfaction).	Baseline, Week 1, Week 2, Week 3, Week 4, Week 5, Week 6, Week 7, Week 8
To assess the efficacy of THC, CBD, or THC+CBD vs Placebo in mean changes in quality of life measured by the Veterans RAND 12 Item Health Survey	Mental Component Score (MCS) and Physical Component Score (PCS) measured by Veterans RAND 12 Item Health Survey (VR-12). VR-12 is an algorithmic score with ranges from 0-100 (0 indicates worse health-related quality of life and 100 represents better health-related quality of life).	Baseline, Week 4, Week 8
To assess the efficacy of THC, CBD, or THC+CBD vs Placebo in anxiety measured by the Generalized Anxiety Disorder-7.	Generalized anxiety symptomology is measured by Generalized Anxiety Disorder-7 (GAD-7) total score. (total score ranges from 0-21; Score 0-4 = minimal anxiety, Score 5-9 = mild anxiety, Score 10-14 = moderate anxiety, Score 15-21 = severe anxiety)	Baseline, Week 1, Week 2, Week 3, Week 4, Week 5, Week 6, Week 7, Week 8
To assess the efficacy of THC, CBD, or THC+CBD vs Placebo in pain quality as measured by the Short Form McGill Pain Questionnaire (SF-MPQ-2).	Short Form McGill Pain Questionnaire (SF-MPQ-2) total score and four subscales (continuous pain, intermittent pain, predominantly neuropathic pain, affective). (0= no pain to 5= excruciating pain)	Baseline, Week 2, Week 4, Week 6, Week 8
To assess the efficacy of THC, CBD, or THC+CBD vs Placebo in mean changes in disability and function as measured by the Brief Pain Inventory-Diabetic Peripheral Neuropathy.	Brief Pain Inventory-Diabetic Peripheral Neuropathy (BPI-DPN) pain intensity score (first four items 0-10; 10= pain as bad as can imagine) (remaining items 0% (no relief)-100% (complete relief)) and pain interference score (0-10, 10= completely intense).	Baseline, Week 1, Week 2, Week 3, Week 4, Week 5, Week 6, Week 7, Week 8
To assess the efficacy of THC, CBD, or THC+CBD vs Placebo in emotional functioning (severity of depression) as measured by the Patient Health Questionnaire-9.	Severity of depression is measured by Patient Health Questionnaire-9 (PHQ-9) total score (0-27; 0=none, 27=worst).	Baseline, Week 1, Week 2, Week 3, Week 4, Week 5, Week 6, Week 7, Week 8
To assess the efficacy of THC, CBD, or THC+CBD vs Placebo in emotional functioning (PTSD symptoms) as measured by the PTSD Checklist-DSM-5 (PCL-5).	PTSD symptoms are assessed by PTSD Checklist-DSM-5 (PCL-5) total score symptom severity score (0-80; 0= not at all to 80= worst).	Baseline, Week 1, Week 2, Week 3, Week 4, Week 5, Week 6, Week 7, Week 8

Collaborators and Investigators

• Sponsor: VA Office of Research and Development
• Investigators: Principal Investigator: Deepak D'Souza, MD MBBS, VA Connecticut Healthcare System West Haven Campus, West Haven, CT; Principal Investigator: Donald McGeary, PhD, South Texas Health Care System, San Antonio, TX

Study record dates

Study Major Dates

• Study Start (Actual): June 21, 2023
• Primary Completion (Estimated): September 29, 2028
• Study Completion (Estimated): May 31, 2029

Study Registration Dates

• First Submitted: April 8, 2022
• First Submitted That Met QC Criteria: April 22, 2022
• First Posted (Actual): April 28, 2022

Study Record Updates

• Last Update Posted (Actual): February 27, 2026
• Last Update Submitted That Met QC Criteria: February 23, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Nervous System Diseases; Neuromuscular Diseases; Peripheral Nervous System Diseases; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Neuralgia; Organic Chemicals; Hydrocarbons; Terpenes; Cannabinoids; Dronabinol; nabiximols
• Other Study ID Numbers: NURP-002-20F

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No