Recent data have demonstrated that cannabinoid-based medicines (CBMs) provide a "moderate benefit" in the management of chronic pain. Based on these findings, a team of researchers from several medical schools in Canada have formulated and published clinical practice guidelines for CBMs.1

A literature review of peer-reviewed articles published between 2001 and 2019 identified 47 relevant studies, including 22 randomized controlled trials. Most studies (38/47) reported at least moderate benefits of CBMs for treating chronic pain.

The analysis included 8 systematic reviews that reported a "good" quality rating, representing the lowest risk for bias, whereas 7 reviews demonstrated cannabinoids to provide pain relief, with an effect described as either "moderate" or "small." Adverse events associated with CBMs included drowsiness, dizziness, and dry mouth.

The guidelines derived from these findings strongly recommend, based on "moderate quality evidence," that CBMs be used as monotherapy, replacement, or adjunct treatment for people living with chronic pain to manage chronic pain, including central and/or peripheral neuropathic pain.

In addition, CBMs may be beneficial for managing comorbidities. The researchers recommended use for sleep problems, anxiety, appetite suppression, and for managing symptoms of chronic conditions associated with pain, including HIV, multiple sclerosis, fibromyalgia, and arthritis.

In addition, CBMs may be used as an adjunct treatment to manage chronic migraine or chronic headache in patients who have not obtained pain relief from other treatments. Further recommendations for use of CBMs include management of chronic pain in patients unsatisfied with analgesia from opioid treatment, especially for those prescribed greater than 50 morphine equivalents not only as adjunct therapy but for opioid-sparing effect.

However, adverse events due to combustion and exposure to secondhand smoke make smoked CBMs less effective than other forms of administration, such as vaping, oral capsule, oral oil, and oromucosal sprays.

The authors also found that reductions in pain severity and intensity added improvements in secondary outcomes such as better quality of life, functionality, and mood.

Conclusions reached notes that patients who are considering taking CBMs should be educated on the risks and potential adverse events, and should work with clinicians to identify appropriate dosing, titration, and administration route. (Adapted with permission from an article by Myles Star in Pain Medicine News and Anesthesiology News, May 23, 2023.)

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