PainRelief.com Interview with:
Joshua (Shuki) Aviram PhD, R.N
Prof. Meiri’s Laboratory of Cancer Biology and Cannabinoid Research
Post doc Fellow Faculty of Biology
Technion Institute of Technology – Haifa, Israel
PainRelief.com: What is the background for this study?
Response: I am a RN by profession, and treating patients with opioids as the main solution to alleviate their pain, with many adverse effects, such as severe constipation made me looking for another solution.
In the course of my PhD thesis, from which I recently published results in the European Journal of Pain (link:https://www.researchgate.net/publication/344739061_Medical_Cannabis_Treatment_for_Chronic_Pain_Outcomes_and_Prediction_of_Response),
I reviewed the literature and I noticed that there were few reviews that used the same clinical trials as their basis, reaching somewhat different conclusions. Therefore, I decided to conduct a systematic review and meta-analysis of all available randomized controlled trials (RCTs) at that time.
PainRelief.com: What are the main findings?
Response: The main findings were that although most patients in the “real world” consume whole-plant cannabis products, the majority of RCTs evaluated the effects of cannabis based medicines (CBMs; synthetic oral THC tablets or THC:CBD oromucosal spray).
We demonstrated that although CBMs were superior in their pain reduction effects, this difference was mostly statistical, rather than clinical (>2 NPS points reduction). The pain reduction effects of the few studies that investigated the effects of inhaled whole-plant cannabis were more impressive than those of the CBMs. Nonetheless, these studies were very short-termed (one session to few days), with very small sample sizes, and they reported only on the THC concentrations in the cultivar.
PainRelief.com: What should readers take away from your report?
Response: Readers should evaluate carefully the generalization that is widely used in the clinical field from these studies to “real life” treatment. Regulations that base their clinical decisions of whole-plant cannabis treatment only on THC and CBD concentrations are probably making a grave mistake. Such simplification ignores more than 100 other phytocannabinoids, terpenes and flavonoids with distinct biological effects.
PainRelief.com: What recommendations do you have for future research as a result of this work?
Response: My recommendations are for future RCTs, that will comprise future meta-analyses. Future RCTs should focus on whole-plant cannabis treatment (taking in mind that eventually this is what most “real world” chronic pain patients consume), they should report the concentrations of all biological active components in the cultivars they investigate, they should follow-up patients for at least 12 weeks, their placebo should not contain any biologically active components of the cannabis plant (studies by now utilized 0% THC as placebo), and they should evaluate whether patients think they received the treatment or the placebo.
PainRelief.com: Is there anything else you would like to add?
Response: Working on this meta-analysis made me believe that cannabis could be an additional tool in the pain physician box. Unfortunately, most of the caregivers’ recommendations these days are based mostly on personal experience and not on founded evidence-base. I hope that future RCTs will take in mind all the recommendations I gave.
I have no conflict of interests. I would note that this paper was criticized for not including non-peer reviewed grey literature in a letter to the editor of Pain Physician, for which we replied in the same issue.
Efficacy of Cannabis-Based Medicines for Pain Management: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Pain Physician 2017; 20:E755-E796 • ISSN 2150-1149
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