In a new paper, a panel of international experts makes a weak recommendation for a trial of non-inhaled medical cannabis or cannabinoids (chemicals found in cannabis) for people living with chronic pain, if standard care is not sufficient.
The recommendation applies to adults and children living with all types of moderate to severe chronic pain.
It does not apply to smoked or vaporized forms of cannabis, recreational cannabis, or patients receiving end-of-life care.
Medical cannabis is increasingly used to manage chronic pain, particularly in jurisdictions that have enacted policies to reduce the use of opioids.
However, existing guideline recommendations are inconsistent, and cannabis remains illegal for therapeutic use in many countries.
Today’s recommendation is based on systematic reviews of 32 studies exploring the benefits and harms of medical cannabis or cannabinoids for chronic pain, 39 observational studies exploring long-term harms, 17 studies of cannabis substitution for opioids, and 15 studies of patient values and preferences.
After thoroughly reviewing this evidence, the team was confident that non-inhaled medical cannabis or cannabinoids result in small to very small improvements in self-reported pain intensity, physical functioning, and sleep quality, and no improvement in the emotional, role, or social functioning.
The panel found no evidence linking psychosis to the use of medical cannabis or cannabinoids, but say they do carry a small to the modest risk of mostly self-limited and transient harms, such as loss of concentration, vomiting, drowsiness, and dizziness.
The panel was less confident about whether the use of medical cannabis or cannabinoids resulted in reduced use of opioids.
They found that potential serious harms including cannabis dependence, falls, suicidal ideation or suicide were uncommon, but this evidence was only very low certainty.
The recommendation is weak because of the close balance between the benefits and harms of medical cannabis for chronic pain.
However, the panel issued strong support for shared decision-making to ensure patients make choices that reflect their values and personal context.
And they suggest further research should explore uncertainties such as optimal dose and formulation of therapy, and benefits and harms of inhaled medical cannabis, which may alter this recommendation.
If you care about pain management, please read studies about this pain medicine for headache may effectively reduce high blood pressure and findings of this pain medication may increase your hip fracture risk.
For more information about pain and your health, please see recent studies about a new method to help relieve back pain and results showing that almost 1 in 4 U.S. adults with chronic pain use prescription opioids.
The study is published in The BMJ.
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