Cannabis and chronic pain

Question 1

Cannabis and chronic pain

Answer 1

• Cannabis has been used for medical purposes across the world for centuries.
• As states and countries implement medical and recreational cannabis policies, increasing numbers of people are using cannabis pharmacotherapy for pain.
• While cannabis has been deployed medicinally for myriad medical conditions, the scientific rationale for its efficacy for these conditions is, in many cases, not clear.
• Four thousand years later, scientists are still trying to determine the exact medical conditions, if any, cannabis is effective in treating.
• 45-80% of those seeking medical cannabis do so for pain management
• Pain relief is the most commonly cited reason for the use of medical use of cannabis

Question 2

Research results

Answer 2

• Some evidence that cannabis may alleviate neuropathic pain in some patients” (Nugent, 2017)
• Limited or insufficient evidence that cannabis may alleviate other types of chronic pain
• Although results of experimental studies with adults are mixed, there is converging evidence to support the notion that cannabis can produce acute pain-inhibitory effects among individuals with chronic pain (Hill, 2017).

Question 3

Adverse effects: limited research on harms…

Answer 3

• Nugent (2017) notes most reported adverse events were mild (e.g. dizziness, lightheadedness) but some were severe (e.g. suicide attempts, paranoia, agitation)
• Cognitive impairment can occur with acute or chronic use
• Cannabis intoxication associated with increase in MVA risk
• Regular cannabis use is associated with an increased risk of anxiety, depression and psychotic illness, and cannabis can worsen the course of these disorders (Hill, 2017)
• Chronic cannabis use associated with cannabinoid hyperemesis syndrome, infectious diseases (e.g. aspergillosis and TB)

Question 4

Conclusions re. cannabis use

Answer 4

• More research is needed to better understand the efficacy, dose–response effects, routes of administration, and side effect profiles for cannabis products that are commonly used.
• Whether cannabis is the best tx for pain or not, many patients around the world believe that cannabis has helped them with their pain.
• Many patients currently use cannabis to treat a host of medical problems and do so without contacting their healthcare provider.
• Healthcare professionals need to be prepared to answer questions regarding cannabis use and the potential effect it would have on each patient’s treatment.

Question 5

Recommendations re. cannabis use

Answer 5

• Evidence-based nonpharmacological and nonopioid pharmacologic therapies are the preferred initial methods for treating chronic pain
• When cannabis is considered risk-benefit discussions are recommended