Benefits and harms of cannabis-based medicines from the viewpoint of patients with chronic pain and their physicians

Böttge-Wolpers, Claudia; Bialas, Patric; Gottschling, Sven; Juckenhöfel, Stephanie; Konietzke, Dieter; Madlinger, Albrecht; Welsch, Patrick; Haüser, Winfried

doi:10.1007/s00482-022-00688-0

Cited by 5 publications

(3 citation statements)

References 15 publications

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“…This low dose corresponds to 6 drops of 0.8 mg each of THC, or less than one tablet with 5 mg per day. The median dose in the group with a higher dose was 7.2 mg/day, but this is still substantially lower than 15 mg/ day, which is the average dosage for non-palliative patients with chronic pain or other indications [10][11][12]. Moreover, the German Society for Palliative Medicine recommends between 5 and 160 mg THC per day to increase appetite [13].…”

Section: Discussionmentioning

confidence: 99%

The Use of Tetrahydrocannabinol Is Associated with an Increase in Survival Time in Palliative Cancer Patients: A Retrospective Multicenter Cohort Study

Gastmeier,

Schwab

et al. 2024

Med Cannabis Cannabinoids

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Introduction: Tetrahydrocannabinol (THC) is often prescribed for ambulatory palliative patients to improve sleep quality and appetite and to reduce anxiety, stress, and pain. However, it is not known if THC has also an effect on the mortality of these patients. Method: The objective is the impact of THC on mortality of ambulatory palliative patients. For this purpose, data from the palliative treatment documentation from 5 ambulatory palliative care teams in Brandenburg, Germany were used for this analysis. Survival time was calculated for 3 groups of patients: 1) Without THC; 2) with THC in a low dosage (4.7 mg per day); and 3) THC in higher doses (>4.7 mg per day). The analysis was done for two cohorts of patients. Cohort 1: all patients with a survival time of at least 7 days after inclusion in specialized ambulatory palliative care (SAPC) and cohort 2: a sub-group of patients with a survival time between 7 and 100 days. Kaplan Meier curves were created, and multivariate analysis was done to investigate the impact of THC on mortality. Results: A total of 9419 patients with a survival time of at least 7 days after inclusion in SAPC were included in the analysis (cohort 1). 7085 among them had a survival time between 7 and 100 days (cohort 2). In both cohorts, survival time was significantly prolonged by THC, but only when the daily THC dose was above the median of 4.7 mg. Survival time was 15 days longer in cohort 2 (40 vs. 25 days), when more than 4.7 mg THC were prescribed per day. Conclusion: Use of THC is associated with a a significant increase in survival time in ambulatory palliative patients which survive longer than 7 days the initiation of THC prescription and which use of THC >4.7 mg/d.

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Section: Discussionmentioning

confidence: 99%

The Use of Tetrahydrocannabinol Is Associated with an Increase in Survival Time in Palliative Cancer Patients: A Retrospective Multicenter Cohort Study

Gastmeier,

Schwab

et al. 2024

Med Cannabis Cannabinoids

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“…Patient-triggered motivation for cannabinoid use was even higher in the Saarland study (63%) than in our study (47%), although the dropout rate of 29.7% was independent of who initiated the therapy (41). To date, only one study in Germany has directly interviewed chronic pain patients (n = 187) about their experiences with cannabis-based medications (42), including interviews with their treating physicians. In this study, both patients and physicians agreed that cannabis-based medications were particularly beneficial in relieving chronic pain and improving function, with patients rating these effects higher than physicians (42).…”

Section: Discussionmentioning

confidence: 99%

“…To date, only one study in Germany has directly interviewed chronic pain patients (n = 187) about their experiences with cannabis-based medications (42), including interviews with their treating physicians. In this study, both patients and physicians agreed that cannabis-based medications were particularly beneficial in relieving chronic pain and improving function, with patients rating these effects higher than physicians (42). Interestingly, in a recent survey of 207 patients eligible for the Pennsylvania medical cannabis program (43), anxiety disorders were the most common underlying condition at 50.1%, followed by chronic pain (22.3%) and post-traumatic stress disorder (PTSD) (7.9%).…”

Section: Discussionmentioning

confidence: 99%

Patients’ perspectives on prescription cannabinoid therapies: a cross-sectional, exploratory, anonymous, one-time web-based survey among German patients

Fischer,

Kandil,

Katsarova

et al. 2023

Front. Med.

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IntroductionSince cannabinoids were partially legalized as prescription medicines in Germany in 2017, they are mostly used when conventional therapies do not suffice. Ambiguities remain regarding use, benefits and risks. This web-based survey explored the perspectives of patients whose experiences are not well enough known to date.MethodsIn an anonymous, exploratory, cross-sectional, one-time web-based observational study, participants receiving cannabinoid therapy on prescription documented aspects of their medical history, diagnoses, attitudes toward cannabinoids, physical symptoms, and emotional states. Participants completed the questionnaires twice here: first regarding the time of the survey and then, retrospectively, for the time before their cannabinoid therapy. Participants were recruited in a stratified manner in three German federal states.ResultsN = 216 participants (48.1% female, aged 51.8 ± 14.0) completed the survey, most of which (72%, n = 155) reported pain as their main reason for cannabinoid therapy. When comparing the current state with the retrospectively assessed state, participants reported greater satisfaction with their overall medical therapy (TSQM II: +47.9 ± 36.5, p < 0.001); improved well-being (WHO-5: +7.8 ± 5.9, p < 0.001) and fewer problems in PROMIS subscales (all p < 0.001). Patients suffering primarily from pain (72%, n = 155) reported a reduction of daily pain (NRS: −3.2 ± 2.0, p < 0.001), while participants suffering mainly from spasticity (8%, n = 17) stated decreased muscle spasticity (MSSS: −1.5 ± 0.6, p < 0.001) and better physical mobility (−0.8 ± 0.8, p < 0.001). Data suggests clinically relevant effects for most scores. Participants’ attitudes toward cannabinoids (on a 5-point scale) improved (+1.1 ± 1.1, p < 0.001). Most patients (n = 146, 69%) did not report major difficulties with the cannabinoid prescription process, while (n = 27; 19%) had their cannabinoid therapy changed due to side effects.DiscussionMost participants experienced their therapy with cannabinoids as more effective than their previous therapy. There are extensive limitations to this cross-sectional study: the originally intended representativeness of the dataset was not reached, partly due to the SARS-CoV-2 pandemic; the sample has a larger proportion of privately insured and self-paying patients. Results does not suggest that cannabinoid patients belong to a particular clientele. Effect sizes observed for pain reduction, quality of life, social participation, and other outcomes suggest a therapeutic potential, particularly in the treatment of chronic pain.

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Patient-reported outcomes in chronic diseases under treatment with cannabis medicines

Gastmeier,

Ihlenfeld,

Gastmeier

et al. 2024

Schmerz

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Benefits and harms of cannabis-based medicines from the viewpoint of patients with chronic pain and their physicians

Cited by 5 publications

References 15 publications

The Use of Tetrahydrocannabinol Is Associated with an Increase in Survival Time in Palliative Cancer Patients: A Retrospective Multicenter Cohort Study

The Use of Tetrahydrocannabinol Is Associated with an Increase in Survival Time in Palliative Cancer Patients: A Retrospective Multicenter Cohort Study

Patients’ perspectives on prescription cannabinoid therapies: a cross-sectional, exploratory, anonymous, one-time web-based survey among German patients

Patient-reported outcomes in chronic diseases under treatment with cannabis medicines

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