Cannabis-Based Medicinal Products for Chronic Non-Cancer Pain: Reading the Evidence Against the Demand
DOI:
https://doi.org/10.5281/zenodo.22549055Keywords:
Cannabis, Cannabinoids, Chronic pain, Medical marijuana, Neuropathic pain, Evidence-based medicineAbstract
Patient and public demand for cannabis-based medicinal products in chronic non-cancer pain has grown
substantially, driven in part by changing legal status and high-profile advocacy, yet the accumulated
systematic review and meta-analysis evidence base consistently describes modest average effect sizes, a
meaningful adverse-event burden, and, for most pooled pain outcomes, low-to-moderate certainty
evidence by standard grading criteria. Clinical practice guidelines produced from this same evidence
base have reached divergent conclusions, ranging from cautious conditional endorsement to explicit
recommendation against routine use. This review synthesises the systematic review, randomised trial,
guideline, and cohort literature on cannabis-based medicinal products for chronic non-cancer pain,
examining the gap between the modest and uncertain evidence base and the scale of current patient
demand and clinical prescribing.
References
Stockings E, Campbell G, Hall WD, et al. "Cannabis and cannabinoids for the treatment of people with chronic noncancer pain conditions: a systematic review and meta-analysis of controlled and observational studies". Pain 159(2018):1932-1954.
Mucke M, Phillips T, Radbruch L, Petzke F, Hauser W. "Cannabis-based medicines for chronic neuropathic pain in adults". Cochrane Database Syst Rev 3(2018):CD012182.
Whiting PF, Wolff RF, Deshpande S, et al. "Cannabinoids for medical use: a systematic review and meta-analysis". JAMA 313(2015):2456-2473.
Nugent SM, Morasco BJ, ONeil ME, et al. "The effects of cannabis among adults with chronic pain and an overview of general harms: a systematic review". Ann Intern Med 167(2017):319-331.
Fisher E, Moore RA, Fogarty AE, et al. "Cannabinoids, cannabis, and cannabis-based medicine for pain management: a systematic review of randomised controlled trials". Pain 162(2021):S45-S66.
Wang L, Hong PJ, May C, et al. "Medical cannabis or cannabinoids for chronic non-cancer and cancer related pain: a systematic review and meta-analysis of randomised clinical trials". BMJ 374(2021):n1034.
National Academies of Sciences, Engineering, and Medicine. "The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research". Washington, DC: National Academies Press; 2017.
Hauser W, Petzke F, Fitzcharles MA. "Efficacy, tolerability and safety of cannabis-based medicines for chronic pain management - an overview of systematic reviews". Eur J Pain 22(2018):455-470.
Allan GM, Finley CR, Ton J, et al. "Systematic review of systematic reviews for medical cannabinoids". Can Fam Physician 64(2018):e78-e94.
Campbell FA, Tramer MR, Carroll D, Reynolds DJ, Moore RA, McQuay HJ. "Are cannabinoids an effective and safe treatment option in the management of pain? A qualitative systematic review". BMJ 323(2001):13-16.
Boehnke KF, Litinas E, Clauw DJ. "Medical cannabis use is associated with decreased opiate medication use in a retrospective cross-sectional survey of patients with chronic pain". J Pain 17(2016):739-744.
Bhaskar A, Bell A, Boivin M, et al. "Consensus recommendations on dosing and administration of medical cannabis to treat chronic pain: results of a modified Delphi process". J Cannabis Res 3(2021):22.
Fitzcharles MA, Baerwald C, Ablin J, Hauser W. "Efficacy, tolerability and safety of cannabinoids in chronic pain associated with rheumatic diseases (fibromyalgia syndrome, back pain, osteoarthritis, rheumatoid arthritis): a systematic review of randomized controlled trials". Schmerz 30(2016):47-61.
Petzke F, Enax-Krumova EK, Hauser W. "Efficacy, tolerability and safety of cannabinoids for chronic neuropathic pain: a systematic review of randomized controlled studies". Schmerz 30(2016):62-88.
Meng H, Johnston B, Englesakis M, Moulin DE, Bhatia A. "Selective cannabinoids for chronic neuropathic pain: a systematic review and meta-analysis". Anesth Analg 125(2017):1638-1652.
Aviram J, Samuelly-Leichtag G. "Efficacy of cannabis-based medicines for pain management: a systematic review and meta-analysis of randomized controlled trials". Pain Physician 20(2017):E755-E796.
Gedin F, Blome S, Ponten M, et al. "Placebo response and media attention in randomized clinical trials assessing cannabis-based therapies for pain: a systematic review and meta-analysis". JAMA Netw Open 5(2022):e2243848.
Zeraatkar D, Cooper MA, Agarwal A, et al. "Long-term and serious harms of medical cannabis and cannabinoids for chronic pain: a systematic review of non-randomised studies". BMJ Open 12(2022):e054282.
Busse JW, Vankrunkelsven P, Zeng L, et al. "Medical cannabis or cannabinoids for chronic pain: a clinical practice guideline". BMJ 374(2021):n2040.
Moore RA, Fisher E, Finn DP, et al. "Cannabinoids, cannabis, and cannabis-based medicines for pain management: an overview of systematic reviews". Pain 162(2021):S67-S79.
Vuckovic S, Srebro D, Vujovic KS, Vucetic C, Prostran M. "Cannabinoids and pain: new insights from old molecules". Front Pharmacol 9(2018):1259.
Deshpande A, Mailis-Gagnon A, Zoheiry N, Lakha SF. "Efficacy and adverse effects of medical marijuana for chronic noncancer pain: systematic review of randomized controlled trials". Can Fam Physician 61(2015):e372-e381.
Andreae MH, Carter GM, Shaparin N, et al. "Inhaled cannabis for chronic neuropathic pain: a meta-analysis of individual patient data". J Pain 16(2015):1221-1232.
Wilsey B, Marcotte T, Deutsch R, Gouaux B, Sakai S, Donaghe H. "Low-dose vaporized cannabis significantly improves neuropathic pain". J Pain 14(2013):136-148.
Ware MA, Wang T, Shapiro S, et al. "Smoked cannabis for chronic neuropathic pain: a randomized controlled trial". CMAJ 182(2010):E694-E701.
Ware MA, Wang T, Shapiro S, Collet JP. "Cannabis for the management of pain: assessment of safety study (COMPASS)". J Pain 16(2015):1233-1242.
Campbell G, Hall WD, Peacock A, et al. "Effect of cannabis use in people with chronic non-cancer pain prescribed opioids: findings from a 4-year prospective cohort study". Lancet Public Health 3(2018):e341-e350.
Olfson M, Wall MM, Liu SM, Blanco C. "Cannabis use and risk of prescription opioid use disorder in the United States". Am J Psychiatry 175(2018):47-53.
Hauser W, Fitzcharles MA, Radbruch L, Petzke F. "Cannabinoids in pain management and palliative medicine". Dtsch Arztebl Int 114(2017):627-634.
Abrams DI. "The therapeutic effects of cannabis and cannabinoids: an update from the National Academies of Sciences, Engineering and Medicine report". Eur J Intern Med 49(2018):7-11.
