There are a few basic observations (regulatory issues aside) that shape my thinking about the use of cannabis, cannabinoids, or cannabis-based medications (for simplicity, I’ll stick with “cannabis”) for pain.
- There is a significant interest among patients, especially patients with cancer, in using “cannabis” for a variety of clinical problems, with pain being the most commonly cited.
According to a recent Canadian survey, 1 in 5 surveyed patients had used cannabis within the preceding 6 months.
2. There is a substantial amount of preclinical data that shows the analgesic potential of various cannabinoids. I published the first studies that showed that in the 1970s!
Also, there is a fascinating and growing body of knowledge related to endocannabinoid system and its role in regulation of many bodily functions.
3. The existing evidence examining potential benefits of cannabis for pain is heterogenous, of poor quality, and high risk of bias that makes either supporting or refuting the use of “cannabis” for pain, impossible. This leaves both patients and their clinicians in the dark!
The journal PAIN has just published a new rigorous systematic review and meta-analysis of cannabinoids, cannabis, and cannabis-based medicines for pain.
4. Cannabis use is not without a risk, especially with heavy use.
5. There is growing global and multi-billion dollar industry surrounding cannabis – something both patients and the clinicians need to be aware of.
See the editorial here.
What should patients and clinicians do, then?
Personally, I still believe cannabis, cannabinoids or CBM have the potential to be useful in pain management, but the lack of high-quality evidence makes advising the patients challenging. One approach is to start with the “why.“