Is Pain Control by Cannabis an Option? Save

An Annals of Internal Medicine review has shown that clinical trials and cohort studies of cannabinoids use for chronic pain may be associated with short-term improvements in chronic pain but come with an increased risk for dizziness and sedation. Studies of long-term outcomes and product formulation effects are lacking.

Literature review identified 18 randomized, placebo-controlled trials (n = 1740 patients) and 7 cohort studies (n = 13 095 patients that looked at the effects of cannabinoids. on short term pain (1 to 6 months) and half (56%) included patients with neuropathic pain. Cannabinoids were categorized by THC-to-CBD ratio (high, comparable, or low) and source (synthetic, extract or purified, or whole plant). Takeaway points included:

• Synthetic products with high THC-to-CBD ratios (>98% THC) showed moderate improvement in pain responses (≥30% improvement) and an increased risk for sedation and dizziness.
• Extracted products with high THC-to-CBD ratios (range, 3:1 to 47:1) showed higher rates of study withdrawal due to adverse events and dizziness.
• Sublingual spray with lower THC-to-CBD ratios showed lesser improvements in pain and function but also had a large risk for dizziness, sedation and nausea. 

These studies are important as chronic pain affects approximately 100 million persons in the USA, and its management has been tainted by ethical or safety shifts away from NSAIDs, tramadol and stronger narcotics. Unfortunately, many of our patients with chronic pain have few therapeutic options and the growing availability of cannabis products in the United States implicates its future utility in management.

An accompanying editorial suggests by Boehnke and Clauw suggests these data may have clinical implications. Author quotes from this article can be found here.