State of the evidence

Abstract

Background and purpose Cannabinoids are widely used to alleviate intractable symptoms such as pain, nausea, and muscle spasticity. The purpose of this review was to ascertain the current state of the science regarding use of cannabinoids for cancer pain. Methods Four electronic databases were searched for randomized control trials of cannabinoids and cancer pain. Studies included examined the analgesic effects of cannabinoids for cancer pain. Methodological quality was assessed using the Jadad scale. Conclusions Eight randomized control trials met the inclusion criteria for review. Most trials found analgesic effects from cannabinoids when compared to placebo, although not all associations reached statistical significance. The analgesic effects of cannabinoids were also limited by dose‐dependent side effects. Side effects most commonly reported were changes in cognition, sedation, and dizziness. Implications for practice There is evidence that cannabinoids are effective adjuvants for cancer pain not completely relieved by opioid therapy, but there is a dearth of high‐quality studies to support a stronger conclusion. Cannabinoids appear to be safe in low and medium doses. Methodological limitations of the trials limited the ability to make sound conclusions. Further research is warranted before efficacy, safety, and utility of cannabinoids for cancer pain can be determined.

Molecular Basis of Cancer Pain Management: An Updated Review

“…The combination of THC and cannabidiol as a treatment has shown to provide significant pain relief among patients [81]. In a recent systematic review by Tateo [83], from eight low or moderate quality randomized clinical trials, cannabinoids were reported to effectively manage cancer pain when administered in combination with opioid. Nonetheless, further investigations must be carried out on the effectiveness of cannabinoids as adjuvant analgesics.…”

“…Nonetheless, further investigations must be carried out on the effectiveness of cannabinoids as adjuvant analgesics. There is no clear evidence that cannabinoids are beneficial for the treatment of cancer pain [80,83,84,85].…”

Prospects for the Use of Cannabinoids in Oncology and Palliative Care Practice: A Review of the Evidence

“…Even when the analgesic effects from NIB were apparent, the frequency and severity of side effects made the medicine useless. Pain intensity worsened in patients administered BPP [61].…”

“…The analgesic effect of THC is, at least in part, mediated through delta and kappa opioid receptors, indicating an intimate connection between cannabinoid and opioid signaling pathways in the modulation of pain perception [62]. In conclusion of the review above, there was low evidence that cannabinoids were effective adjuvants for cancer pain not completely relieved by opioid therapy, and they appeared to be safe in low and medium doses [61].…”

Potential of Endocannabinoids to Control Bladder Pain

“…Recent developments in legalization of cannabis or cannabinoid products has increased interest in these compounds as an alternative therapy for pain. Systemic administration of exogenous cannabinoids to control pain appears to be most efficacious in patients with cancer-related pain (Tateo, 2017 ). The capacity of cannabinoids to decrease nausea and pain in cancer patients has been described by multiple authors, albeit often in the presence of side effects relating to altered mentation (Johnson et al, 2010 ; Abrams and Guzman, 2015 ; Davis, 2016 ).…”