Medical Cannabis for the Management of Pain and Quality of Life in Chronic Pain Patients: A Prospective Observational Study

Abstract

Objective To evaluate the short-term and long-term effects of plant-based medical cannabis in a chronic pain population over the course of one year. Design A longitudinal, prospective, 12-month observational study. Setting Patients were recruited and treated at a clinic specializing in medical cannabis care from October 2015 to March 2019. Subjects A total of 751 chronic pain patients initiating medical cannabis treatment. Methods Study participants completed the Brief Pain Inventory and the 12-item Short Form Survey (SF-12), as well as surveys on opioid medication use and adverse events, at baseline and once a month for 12 months. Results Medical cannabis treatment was associated with improvements in pain severity and interference (P < 0.001) observed at one month and maintained over the 12-month observation period. Significant improvements were also observed in the SF-12 physical and mental health domains (P < 0.002) starting at three months. Significant decreases in headaches, fatigue, anxiety, and nausea were observed after initiation of treatment (P ≤ 0.002). In patients who reported opioid medication use at baseline, there were significant reductions in oral morphine equivalent doses (P < 0.0001), while correlates of pain were significantly improved by the end of the study observation period. Conclusions Taken together, the findings of this study add to the cumulative evidence in support of plant-based medical cannabis as a safe and effective treatment option and potential opioid medication substitute or augmentation therapy for the management of symptoms and quality of life in chronic pain patients.

Consensus recommendations on dosing and administration of medical cannabis to treat chronic pain: results of a modified Delphi process

“…Chronic pain affects close to 2 billion people worldwide and is associated with impairment in physical and emotional function, reduced participation in social and vocational activities, and lower perceived quality of life (Dueñas et al 2016;Hylands-White et al 2017;Vos et al 2017). In patients with chronic pain, medical cannabis treatment has been associated with an improvement in pain-related outcomes, increased quality of life, improved function, and a reduced requirement for opioid analgesia (Abrams et al 2011;Haroutounian et al 2016;National Academies of Sciences 2017;Cooper et al 2018;Rod 2019;Sagy et al 2019;Johal et al 2020;Safakish et al 2020;Okusanya et al 2020).…”

“…Despite the increased global use of medical cannabis to manage pain, systematic reviews and meta-analyses report low to substantial levels of evidence to support the use of cannabis and cannabinoids for the treatment of chronic pain (Russo 2007;Whiting et al 2015;Allan et al 2018;National Academies of Sciences 2017;Stockings et al 2018;Mücke et al 2018;Häuser et al 2018;Johal et al 2020;Safakish et al 2020;Okusanya et al 2020). Explanations as to why some describe the level of evidence is low may include limited availability of investigational products due to legal status, lack of standardization of cannabis products, lack of standardization of product administration, and overemphasis on pain scores to define efficacy.…”

The impact of non-medical cannabis legalization and other exposures on retention in longitudinal cannabis research: a survival analysis of a prospective study of Canadian medical cannabis patients

“…While recruiting participants with greater capacity could improve retention in future medical cannabis studies, it might also lead to recruitment bias and ultimately confound findings. Additionally, since such a significant portion of medical cannabis patients also use opioids (Campbell et al 2018;Chen et al 2019;Lucas et al 2019;Safakish et al 2020), it would be hard to justify excluding these patients from future research. Therefore, a better option to improve retention would be find ways to reduce study burden on this vulnerable patient population.…”

A Systematic Review of Fibromyalgia and Recent Advancements in Treatment: Is Medicinal Cannabis a New Hope?

“…Given the fact that we are in the era COVID-19 pandemic and an ongoing opioid crisis, there is an absolute need for effective and safer treatment alternatives for chronic pain syndrome including FM. With a high margin of safety and proposed regulatory effects of tetrahydrocannabinol (THC) and cannabidiol (CBD) on major endogenous pain circuitry systems, cannabis is emerging as a promising alternative treatment option for the management of chronic pain [ 14 ].…”

“…Nevertheless, results concluded over patients were promising with improved pain scores over 12 months. Moreover, the medical cannabis (MC) treatment course in this study was not associated with increases in the frequency of undesired adverse events, but rather decreased the frequency of headaches, fatigue, feelings of anxiety, and nausea [ 14 ].…”