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Chronic Pain Management New Guidelines for Cannabis Use

A group of Canadian researchers, clinicians, and patients have developed new guidelines showing how cannabinoid-based medicines might help clinicians offer an effective, but less addictive, alternative to opioids for patients with chronic noncancer pain and comorbid conditions.

The guidelines were published online on the 27th of March 2023 in the journal Cannabis and Cannabinoid Research.

One of the main criticisms of cannabinoid-based medicine has always been the lack of quality research supporting its therapeutic benefits. In arriving at the current recommendations the researchers reviewed 47 pain management studies enrolling more than 11,000 patients. 

Their results showed that in 38 of the 47 included studies there was a demonstration that cannabinoid-based medicine provided at least moderate benefits for the relief of chronic pain, resulting in a “strong” recommendation for its use mainly as an adjunct or replacement treatment for individuals living with chronic pain.

As a result, the guidelines placed a high value on improving chronic pain, functionality, and addressing related conditions including insomnia, anxiety and depression, mobility, and inflammation. The guidelines also provide practical dosing and formulation tips to support the use of cannabinoid-based medicine.

The results also showed evidence demonstrating that the majority of the participants were able to reduce the use of routine pain medications when combined cannabinoid-based medicine/opioid administration was being used, while also offering secondary benefits such as improved sleep, anxiety, and mood. Most importantly this also resulted in the prevention of opioid tolerance and the resultant need to increase opioid dosage.  Conversely, the results displayed the opportunity to wean patients gradually off opioids reducing the risks of fatal overdose.

Commenting on the guidelines, Christopher Gilligan, MD, MBA, associate chief medical officer and a pain medicine physician at Brigham & Women’s Hospital in Boston, Massachusetts, who was not involved in the guidelines’ development, does mention some risks.

“When we have an opportunity to use cannabinoids in place of opioids for our patients, I think that that’s a positive thing…and a wise choice in terms of risk-benefit,” he said.

On the other hand, he cautioned that “freely prescribing” cannabinoids for chronic pain in patients who aren’t on opioids is not good practice.  He further added that “We have to take seriously the potential adverse effects of [cannabis], including marijuana use disorder, interference with learning, memory impairment, and psychotic breakthroughs,”

Whilst it would appear that cannabinoid-based medicine is still a long way from receiving endorsement by the US Food and Drug Administration, for clinicians interested in trying this treatment for chronic pain patients, these new guidelines may offer a way forward for initiation and an alternative to prescribing opioids.

A more detailed article can be viewed at Medscape.

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