Understanding the evidence for medical cannabis and cannabis-based medicines for the treatment of chronic non-cancer pain
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The use of medical cannabis and cannabis-based medicines has received increasing interest in recent years; with a corresponding surge in the number of studies and reviews conducted in the field. Despite this growth in evidence, the findings and conclusions of these studies have been inconsistent. In this paper, we outline the current evidence for medical cannabis and cannabis-based medicines in the treatment and management of chronic non-cancer pain. We discuss limitations of the current evidence, including limitations of randomised control trials in the field, limits on generalisability of previous findings and common issues such as problems with measurements of dose and type of cannabinoids. We discuss future directions for medicinal cannabinoid research, including addressing limitations in trial design; developing frameworks to monitor for use disorder and other unintended outcomes; and considering endpoints other than 30% or 50% reductions in pain severity.
KeywordsCannabis Chronic pain Medical cannabis Cannabis-based medicines
No direct funding was received to write this article. SN, ES and GC are supported by NHMRC research fellowships (#1132433, #1104600 and #1119992). The National Drug and Alcohol Research Centre at the University of New South Wales is supported by funding from the Australian Government under the Substance Misuse Prevention and Service Improvements Grant Fund.
Compliance with ethical standards
Conflict of interest
SN has been an investigator on untied investigator-driven educational grants funded by Indivior and Reckitt-Benckiser and has had travel costs covered and honoraria paid to her institution to provide training on identification and management of codeine dependence by Indivior. GC has been an investigator on untied investigator driven educational grants from Reckitt-Benckiser. ES declares no conflicts of interest.
- 1.National Academies of Sciences Engineering and Medicine (2017) The health effects of cannabis and cannabinoids: the current state of evidence and recommendations for research. The National Academies Press, Washington, DCGoogle Scholar
- 2.Hauser W, Fitzcharles MA, Radbruch L, Petzke F (2017) Cannabinoids in pain management and palliative medicine. Deutsch Arztebl Int 114(38):627–634Google Scholar
- 5.Stockings E, Campbell G, Hall WD et al (2018) Cannabis and cannabinoids for the treatment of people with chronic non-cancer pain conditions: a systematic review and meta-analysis of controlled and observational studies. PainGoogle Scholar
- 6.Aviram J, Samuelly-Leichtag G (2017) Efficacy of cannabis-based medicines for pain management: a systematic review and meta-analysis of randomized controlled trials. Pain Phys 20(6):E755–E796Google Scholar
- 10.Allan GM, Finley CR, Ton J et al (2018) Systematic review of systematic reviews for medical cannabinoids: pain, nausea and vomiting, spasticity, and harms. Can Fam Phys (Med Fam Can) 64(2):e78–e94Google Scholar
- 11.Deshpande A, Mailis-Gagnon A, Zoheiry N, Lakha SF (2015) Efficacy and adverse effects of medical marijuana for chronic noncancer pain: systematic review of randomized controlled trials. Can Fam Phys 61(8):e372–e381Google Scholar
- 12.International Association for the Study of Pain (IASP) (2018) IASP terminology. http://www.iasp-pain.org/terminology?navItemNumber=576#Neuropathicpain. Accessed 30 July 2018
- 15.Allan GM, Ramji J, Perry D et al (2018) Simplified guideline for prescribing medical cannabinoids in primary care. Can Fam Phys (Med Fam Can) 64(2):111–120Google Scholar
- 25.Pinsger M, Schimetta W, Volc D, Hiermann E, Riederer F, Pölz W (2006) Nutzen einer add-on-therapie mit dem synthetischen cannabinomimetikum nabilone bei patienten mit chronischen Schmerzzuständen—eine randomisierte kontrollierte studie. Wien Klin Wochenschr 118(11):327–335CrossRefPubMedGoogle Scholar
- 26.National Academies of Sciences, Engineering, and Medicine (2017) The health effects of cannabis and cannabinoids: the current state of evidence and recommendations for research. National Academies Press, WashingtonGoogle Scholar
- 33.Hauser W, Fitzcharles MA (2018) The perils of overestimating the efficacy of cannabis-based medicines for chronic pain management. Pain Phys 21(1):E79–E80Google Scholar
- 34.Vos T, Barber RM, Bell B et al (2016) Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 386(9995):743–800CrossRefGoogle Scholar
- 50.Schuermeyer J, Salomonsen-Sautel S, Price RK et al (2014) Temporal trends in marijuana attitudes, availability and use in Colorado compared to non-medical marijuana states: 2003–11. Drug Alcohol Depend 140:145–155Google Scholar
- 55.Bradford AC, Bradford W, Abraham A, Bagwell Adams G (2018) Association between us state medical cannabis laws and opioid prescribing in the medicare part D population. JAMA Intern MedGoogle Scholar
- 62.Campbell G, Hall W, Nielsen S (2018) What does the ecological and epidemiological evidence indicate about the potential for cannabinoids to reduce opioid use and harms? A comprehensive review. Int Rev Psychiatry (in press, accepted 6 Aug 2018)Google Scholar
- 65.NSW Health (2018) Chronic pain management: information for medical practitioners. https://www.health.nsw.gov.au/pharmaceutical/doctors/Pages/chronic-pain-medical-practitioners.aspx. Accessed 29 Oct 2018