Medical Cannabis May Be Helpful For Pain Relief in a Minority of People with Chronic Pain, But Will Not Be Effective For Most

PainRelief.com Interview with:
JASON BUSSE DC, PhD
Associate Professor
Associate Director
Michael G. DeGroote Centre for Medicinal Cannabis Research
McMaster University Medical Centre
Ontario, Canada

PainRelief.com:  What is the background for this study?  What are the main findings?

Response: Our focused clinical practice guideline was informed by 4 systematic reviews exploring benefits and harms of medical cannabis for chronic pain, the potential for cannabis to help people who live with pain to reduce their use of opioids, and patients values & preferences regarding medical cannabis for chronic pain. We found that non-inhaled medical cannabis provided small to very small improvements in pain relief, physical functioning and sleep quality compared to placebo, but did not improve mental functioning, role functioning or social functioning. Use of medical cannabis, versus placebo, also caused small increases in the risk of several transient, moderate, side effects, such as impaired attention, nausea, and drowsiness, and a larger increase in the risk of dizziness.

There was insufficient evidence to inform the risk of serious adverse events, such as motor vehicle accidents, cannabis use disorder (addiction), or suicide. We also found that patients’ attitudes towards medical cannabis show considerable variation, meaning that when presented with the same evidence different patients are likely to make different decisions about embarking on a trial of medical cannabis. Due to the close balance between modest benefits and harms, and high variability among patients’ attitudes, we made a weak recommendation to consider a trial of medical cannabis for people living with chronic pain who had not achieved sufficient relief with standard care.

A weak recommendation means that clinicians should provide chronic pain patients with the evidence for benefits and harms and help them to make a decision consistent with their patient’s values and preferences.

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Study Identifies Three Patterns of Medical Cannabis Use for Pain

Dr. Deepika Slawek,

PainRelief.com Interview with:
Deepika Slawek, MD, MS, MPH 
(she/hers)
Assistant Professor of Medicine, Division of General Internal Medicine
Montefiore Medical Center
Albert Einstein College of Medicine
Bronx, NY 10467

PainRelief.com:  What is the background for this study?

Response: Medical cannabis has become increasingly available in the United States over the past 25 years and is commonly used for the management of pain. Little is known about the patterns of medical cannabis use by patients with chronic pain. This information could help providers anticipate patients’ needs and identify potential disparities in access.

We followed 99 adults in New York State who were newly certified for medical cannabis use and who were prescribed opioids over the course of 1 year. Using a latent class trajectory analysis, we identified clusters of participants based on 14-day frequency of medical cannabis use. We used logistic regression to determine factors associated with cluster membership including sociodemographic characteristics, pain, substance use, and mental health symptoms.

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Does Medical Marijuana Prevents Opioid Overdoses?

PainRelief.com Interview with:

Daniel Kaufman, MS Geisinger Commonwealth School of Medicine
Daniel Kaufman

Daniel Kaufman, MS
Geisinger Commonwealth School of Medicine

Brian J. Piper, PhD, MS
Department of Medical Education
Geisinger Commonwealth School of Medicine
Scranton, PA 18510

Dr. Piper










PainRelief.com:  What is the background for this study?

Response: The opioid epidemic has stricken the United States and caused thousands of deaths nationally. Researchers continue to search for a solution to the ongoing escalation in opioid related deaths, with some states turning to medical cannabis as a potential alternative treatment for chronic pain. The objectives of this study were to:

  1. To determine if medical cannabis program implementation had any effect on opioid overdoses at a state-wide level
  2. To contribute to the discussion of researchers searching for a solution to the opioid epidemic facing the United States
  3. Begin the discussion on the standardization of autopsy procedures, including death/overdose determination
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Withdrawal Symptoms Common in People Using Cannabis for Pain Relief

PainRelief.com Interview with:
Lara Coughlin, Ph.D.
Assistant Professor | Addiction Center
Department of Psychiatry
University of Michigan

PainRelief.com:  What is the background for this study?  What are the main findings?

Response: In this study we followed people that were seeking certification for medical cannabis use for chronic pain over the course of two years. We assessed the prevalence and progression of cannabis withdrawal.

We found that most people experienced multiple withdrawal symptoms, such as craving cannabis, anxiety, and irritability, when they went without cannabis. People that used cannabis more frequently, used larger amounts, and reported smoking cannabis had more withdrawal symptoms. Over time, people that were younger were more likely to experience increasing withdrawal symptoms and people that vaped cannabis tended not to experience improvement in their withdrawal symptoms.  

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A Systematic Review of Cannabis-Based Medications for Pain Relief

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

Dr. Aviram

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.

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Can CBD and Cannabis Provide Pain Relief in Fibromyalgia?

PainRelief.com Interview with:
Amnon A. Berger, MD, PhD
MD/PhD Program 2006-2017
The Hebrew University Hadassah Medical School
Jerusalem, Israel
Resident Physician (CA-1/PGY-2) and Loring Scholar
Department of Anesthesiology, Critical Care and Pain Medicine
Beth Israel Deaconess Medical Center, Boston, MA

Dr. Berger

PainRelief.com:  What is the background for this study?  What are the main findings?

Response: Fibromyalgia is a common disorder of chronic widespread pain. It has been estimated to affect 2-4% of the general population, though that number is likely an underestimate of the actual incidence. Outside of chronic pain, it also contributes to morbidity and disability because it affects sleep, causes cognitive impairment and psychiatric perturbations. Fibromyalgia is difficult to diagnose and even more difficult to treat.

Because the underlying causes – the etiology and pathophysiology at the base of this condition – are still largely unknown, it is harder to tailor specific treatments. There is evidence to support several modes of treatment, but truly high-level evidence exists only for physical exercise. Effective treatment depends on long term commitment and a multimodal approach by a multidisciplinary team.

Recently, with the rise of use in cannabis and CBD, both for medical and recreational use, evidence has emerged to support its use in fibromyalgia. While most of the evidence is not clear cut and not high enough evidence to support cannabis use, the evidence is overall positive and cannabis derivatives may be an effective choice as part of a multimodal treatment plan.

Study Evaluates Inhaled Cannabis for Pain Relief from Headache and Migraine

PainRelief.com Interview with:
Carrie Cuttler, Ph.D.
Assistant ProfessorWashington State University
Department of Psychology
Pullman, WA, 99164-4820

PainRelief.com:  What is the background for this study?

Response: Many people report using cannabis for headache and migraine and claim that it is effective in reducing their symptoms. However, to date there has only been one clinical trial examining the effectiveness of a cannabinoid drug called Nabilone (synthetic THC that is orally administered) on headache. The results of that trial indicated that Nabilone was more effective than ibuprofen in reducing pain and increasing quality of life. There have also been a couple of preclinical (animal) studies suggesting that cannabinoids like THC may be beneficial in the treatment of migraine. But there are surprisingly few studies examining the effectiveness of cannabis, particularly whole plant cannabis rather than synthetic cannabinoids on headache and migraine.

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Study Evaluates Effects of Inhaled Cannabis for Pain Relief in Adults With Sickle Cell Disease

PainRelief.com Interview with:

Donald I. Abrams, MD
Division of Hematology-Oncology
Department of Medicine,
Zuckerberg San Francisco General Hospital
University of California, San Francisco

PainRelief.com:  What is the background for this study?  What are the main findings?

Response: A number of years ago, Kalpna Gupta, PhD, an investigator then at the University of Minnesota, came and told me about her mice with Hemoglobin SS who experienced pain that responded to laboratory cannabinoids. She was going to apply for a grant from the National Heart, Lung and Blood Institute to continue her studies and sought us out because of our prior clinical trials with cannabis and pain. Dr. Gupta wanted to include a pilot proof of principle human study in her application and asked if we could design one. As cannabidiol (CBD) was just becoming known at that time, we suggested to do a study in patients with sickle cell disease and pain looking at a delta-9-tetrahydrocannabinol (THC)-dominant strain of inhaled cannabis, a CBD-dominant strain, a balanced 1:1 strain and placebo. She said that we would only have funds to do a two-arm study, one of which needed to be placebo. As we had already shown that there was a trend for vaporized cannabis that was predominantly THC to add to the analgesic effect of sustained-release opioids in patients with chronic pain, we chose to investigate a 4.4% THC:4.9% CBD product obtained from the National Institute on Drug Abuse.

We designed a crossover trial so that each participant would spend two 5-day inpatient stays separated by at least a month in our Clinical Research Center at Zuckerberg San Francisco General Hospital. During one stay they would add vaporized cannabis to their stable ongoing analgesic regimen and during the other stay they would inhale placebo cannabis three times a day. We use the Volcano vaporizer device that heats the plant material and not an oil as has become popular in the recent “vaping” craze. Our target was to enroll 35 patients with sickle cell disease and chronic ongoing pain on an opioid-containing regimen. Our primary endpoint was change in pain as measured by way of a visual analog scale and the Brief Pain Inventory as well as safety.

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Which Older Adults Use Cannabis for Chronic Pain Relief?

PainRelief.com Interview with:
Julie Bobitt, PhD

Director, Interdisciplinary Health Sciences
University of Illinois at Urbana Champaign
Champaign, IL. 61820

Dr. Julie Bobitt
Dr. Julie Bobitt

PainRelief.com:  What is the background for this study?

Response: Our previous research found that older adults, who we interviewed, used cannabis primarily for pain related reasons and that they were reporting using cannabis to reduce or altogether stop their use of opioids.  We wanted to further study this and we wanted to see if there were any differences between self-reported pain in non-cannabis users vs. cannabis users and then if there were differences between groups who used cannabis alone versus those who used opioids alone, versus cannabis in combination with opioids. 

Short and Long-Term Effects of Cannabis For Headache and Migraine Pain Relief

PainRelief.com Interview with:
Carrie Cuttler, Ph.D.
Assistant Professor
Washington State University
Department of Psychology
Pullman, WA, 99164-4820

PainRelief.com:  What is the background for this study?  What are the main findings?

Response: Use of cannabis for headache and migraine is relatively common yet there have been few studies examining the effectiveness of medical cannabis for these purposes.

PainRelief.com: What should readers take away from your report?

Response: We analyzed data from nearly 20,000 cannabis use sessions tracked using the medical cannabis app Strainprint. The results show that headache and migraine severity ratings were reduced by nearly 50% from before to immediately after cannabis use. The results further revealed that men report larger reductions in headache severity following cannabis use than do women and that use of cannabis concentrates was associated with larger reductions in headache severity ratings than use of more traditional cannabis flower.

We also demonstrate that dose of cannabis used to manage these conditions increases across time and that efficacy of cannabis in reducing headache decreases across time. This indicates that there is some evidence of tolerance to the acute effects of cannabis on ameliorating headache across time. More encouragingly we found that baseline ratings of headache and migraine remained stable across time/cannabis use sessions which indicates that cannabis is not associated with the medication overuse headaches (i.e., increases in baseline headache and migraine severity across time as a function of the use of medications to treat these conditions) that more conventional treatments tend to produce.