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Clinical question What is the role of medical cannabis or cannabinoids for people living with chronic pain due to cancer or non-cancer causes? Current practice Chronic pain is common and distressing and associated with considerable socioeconomic burden globally. Medical cannabis is increasingly used to manage chronic pain, particularly in jurisdictions that have enacted policies to reduce use of opioids; however, existing guideline recommendations are inconsistent, and cannabis remains illegal for therapeutic use in many countries. Recommendation The guideline expert panel issued a weak recommendation to offer a trial of non-inhaled medical cannabis or cannabinoids, in addition to standard care and management (if not sufficient), for people living with chronic cancer or non-cancer pain. How this guideline was created An international guideline development panel including patients, clinicians with content expertise, and methodologists produced this recommendation in adherence with standards for trustworthy guidelines using the GRADE approach. The MAGIC Evidence Ecosystem Foundation (MAGIC) provided methodological support. The panel applied an individual patient perspective. The evidence This recommendation is informed by a linked series of four systematic reviews summarising the current body of evidence for benefits and harms, as well as patient values and preferences, regarding medical cannabis or cannabinoids for chronic pain. Understanding the recommendation The recommendation is weak because of the close balance between benefits and harms of medical cannabis for chronic pain. It reflects a high value placed on small to very small improvements in self reported pain intensity, physical functioning, and sleep quality, and willingness to accept a small to modest risk of mostly self limited and transient harms. Shared decision making is required to ensure patients make choices that reflect their values and personal context. Further research is warranted and may alter this recommendation.

The actual and ideal self-concepts of handicapped children, adolescents and adults were studied with the help of questionnaires to compare their responses to body image, skills/abilities, life experience, and social interaction. Results indicated that children had a more positive self-concept than adults and adolescents. Men had a more positive self-concept than females. Further, social interaction and abilities were rated more positively than body image and life experience. Correlations between the actual and ideal selves revealed a positive relation between the actual self and the desired ideal self for all the groups and there were no gender differences. Narrative analysis of the groups revealed that adults held a more positive view of life as compared to adolescents or children. The positive views of the self were a consequence of factors that are largely internal to the respondent, such as the use of mature ways of thinking and maintaining one's self-respect. The negative views of the self were rooted in external factors over which the individual had little or no control such as poverty and negative attitudes of others. Although the female disabled group had a lower selfconcept than males, there was a positive relationship between their actual and ideal selves indicating acceptance of their congenital defects as a challenge to integrate into the mainstream.

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Background Cognitive behavior therapy (CBT) is an evidence based therapy and is now recommended by national organizations in many high income countries. CBT is underpinned by the European values and therefore for it to be effective in other cultures it needs to be adapted. Aims This paper describes an evidence based approach to culturally adapt CBT in Asian context, areas of focus for such adaptation and lessons learned. Methods An environmental scan of the literature, description of local CBT associations and perspectives from these organizations. Results Cultural adaptation of CBT focuses on three main areas; 1 awareness of culture and related issues, 2 assessment and 3 adjustment in therapy techniques. Conclusions The last decade has seen an increase in culturally adapted CBT in Asia, however, more work needs to be done to improve access to CBT in Asia.