In this timely study, Bell et al. performed a systematic review of studies investigating the use of cannabinoid-based medicines (CBM) in the treatment of chronic pain, as well as some of the comorbidities that often accompany chronic pain (such as sleep, anxiety, and depression). Using the data accumulated, the authors were able to make some recommendations for when CBM might be appropriate and effective in patients with chronic pain. The below table summarizes their findings and recommendations. In virtually all cases, the potential benefits outweigh the risks (especially if inhalation of CBMs is avoided where possible). In addition to inhaled formulations including smoking and vaping, CBM is also available in other formulations and routes of delivery such as oral capsules, oral oils, and oromucosal sprays. Oral products may be preferred due to longer duration of action and more accurate dosage.

With CBM commonly being used by patients for a variety of health reasons (including pain), this set of guidelines should provide clinicians with much-needed information to guide their patients.

In addition to the specific practical tips provided in the above table, the authors offer some other practical considerations including: potential drug interactions (e.g., THC inhibits many of the CYP450 enzymes; cannabinoids may also bind P-gp; and pharmacodynamic interactions); adverse effects related to THC dose (e.g., dizziness, cognitive impairment, dry mouth, anxiety, drowsiness, and potential psychosis); lack of recommendation for use of CBM in children; and the lack of a need for patients to feel “high” or impaired in order to have symptom improvement. And of course, all clinicians authorizing or prescribing CBM should do so in compliance with local laws and regulations.

Reference:

Bell AD et al. Cannabis Cannabinoid Res 2023; Epub ahead of print. Abstract.