Effect profile of paracetamol, Δ9‐THC and promethazine using an evoked pain test battery in healthy subjects

• Published in: European journal of pain 2018-08, Vol.22 (7), p.1331-1342
• Main Authors: Amerongen, G., Siebenga, P., Kam, M.L., Hay, J.L., Groeneveld, G.J.
• Format: Article
• Language: English
• ISSN: 1090-3801; 1532-2149
• DOI: 10.1002/ejp.1222

Background A battery of evoked pain tasks (PainCart) was developed to investigate the pharmacodynamic properties of novel analgesics in early‐phase clinical research. As part of its clinical validation, compounds with different pharmacological mechanisms of actions are investigated. The aim was to investigate the analgesic effects of classic and nonclassic analgesics compared to a sedating negative control in a randomized placebo‐controlled crossover study in 24 healthy volunteers using the PainCart. Methods The PainCart consisted of pain tasks eliciting electrical, pressure, heat, cold and inflammatory pain. Subjective scales for cognitive functioning and psychotomimetic effects were included. Subjects were administered each of the following oral treatments: paracetamol (1000 mg), Δ9‐THC (10 mg), promethazine (50 mg) or matching placebo. Pharmacodynamic measurements were performed at baseline and repeated up to 10 h postdose. Results Paracetamol did not show a significant reduction in pain sensation or subjective cognitive functioning compared to placebo. Promethazine induced a statistically significant reduction in PTT for cold pressor and pressure stimulation. Furthermore, reduced subjective alertness was observed. Δ9‐THC showed a statistically significant decrease in PTT for electrical and pressure stimulation. Δ9‐THC also demonstrated subjective effects, including changes in alertness and calmness, as well as feeling high and psychotomimetic effects. Conclusions This study found a decreased pain tolerance due to Δ9‐THC and promethazine, or lack thereof, using an evoked pain task battery. Pain thresholds following paracetamol administration remained unchanged, which may be due to insufficient statistical power. We showed that pain thresholds determined using this pain test battery are not driven by sedation. Significance The multimodal battery of evoked pain tasks utilized in this study may play an important role in early‐phase clinical drug development. This battery of pain tasks is not sensitive to the effects of sedation alone, and thus suitable to investigate the analgesic potential of novel analgesic compounds.