Medical Cannabis Research Australia
CHRONIC PAIN
Effects of Cannabinoid Administration for Pain:
A Meta-Analysis and Meta-Regression
FINDINGS:
Our meta-analysis outcomes show that cannabinoid administration was associated with reductions in subjective pain across included studies, making them viable candidates for pain management and treatment. Moreover, meta-regression results suggested that drug administration condition and sample size predicted pain reduction effects. Finally, we observed that sample sex composition was associated (although, not statistically significant) with observed pain reduction, suggesting that this may be an important biological variable when considering cannabis-induced pain reduction. As social, societal, and political attitudes towards cannabis evolve, it is becoming increasingly important to provide enhanced scientific understanding regarding risks and potential therapeutic applications. Such understanding should lead to more informed decision-making regarding cannabis among patients, care providers, and law makers.
Exp Clin Psychopharmacol. 2019 Aug; 27(4): 370–382.
Personal experience and attitudes of pain medicine specialists in Israel regarding:
Medical use of cannabis for Chronic Pain.
FINDINGS:
In this survey, pain clinicians experienced in prescribing cannabis over prolonged periods view it as an effective and relatively safe treatment for chronic pain, based on their own experience. Their responses suggest a possible change of paradigm from using cannabis as the last resort.
PubMed.gov – J Am Pharm Assoc (2003). 2019 Sep 5. pii: S1544-3191(19)30353-X. doi: 10.1016/j.japh.2019.07.015.
The effects of cannabis, cannabinoids, and their administration routes on pain control efficacy and safety:
A systematic review and network meta-analysis.
FINDINGS:
The use of cannabis and cannabinoids via certain administration routes could reduce different types of pain. Product developers could consider our findings as part of their product design so that the effective route of cannabis and cannabinoids for pain control can be achieved.
PubMed.gov – J Am Pharm Assoc (2003). 2019 Sep 5. pii: S1544-3191(19)30353-X. doi: 10.1016/j.japh.2019.07.015.
Cannabis and joints:
Scientific evidence for the alleviation of Osteoarthritis Pain by Cannabinoids
FINDINGS:
Recent pre-clinical evidence supporting a role for the ECS to control OA pain is described as well as current clinical evidence of the efficacy of cannabinoids for treating OA pain in mixed patient populations.
Recent pre-clinical evidence supporting a role for the ECS to control OA pain is described as well as current clinical evidence of the efficacy of cannabinoids for treating OA pain in mixed patient populations.
April 2018 Current Opinion in Pharmacology 40:104-109
Cannabinoids and Pain:
New Insights From Old Molecules
FINDINGS:
The key findings are summarized below:
The key findings are summarized below:
- Cannabinoids and cannabis are old drugs but now they are a promising new therapeutic strategy for pain treatment.
- Cannabinoids (plant-derived, synthetic) themselves or endocannabinoid-directed therapeutic strategies have been shown to be effective in different animal models of pain (acute nociceptive, neuropathic, inflammatory). However, medical cannabis is not equally effective against all types of pain in humans.
- A recent meta-analysis of clinical trials of medical cannabis for chronic pain found substantial evidence encouraging its use in pharmacotherapy of chronic pain. Also, it was shown that medical cannabis may only moderately reduce chronic pain, similar all other currently available analgesic drugs. However, controlled comparative studies on the efficacy and safety of cannabis/cannabinoids and other analgesics, including opioids, are missing.
- Inhaled (smoked or vaporized) cannabis is constantly effective in reducing neuropathic pain and this effect is dose-related and can be achieved with a concentration of cannabis THC lower than 10%. Compared to oral cannabinoids, the effect of inhaled cannabis is more rapid, predictable and can be titrated. Compared to inhaled cannabis, the effectiveness of oral cannabinoids in reducing the sensory component of neuropathic pain seems to be less convincing and oral cannabinoids in general may be less tolerable. However, data suggest that they may improve secondary measures such as sleep, quality of life and patient satisfaction.
- There are no controlled clinical trials on the use of inhaled cannabis for the treatment of cancer or rheumatic (osteoarthritis, rheumatoid arthritis, and fibromyalgia) pain.
- Whether oral cannabinoids reduce the intensity of chronic cancer pain is not completely clear. Recent long-term studies of nabiximols are not encouraging.
- Sparse literature data show that oral cannabinoids have inadequate efficacy in rheumatological pain conditions. Also, oral cannabinoids do not reduce acute postoperative or chronic abdominal pain.
- In general, the efficacy of medical cannabis in pain treatment is not completely clear due to several limitations. Clinical trials are scarce and most were of short duration, with relatively small sample sizes, heterogeneous patient populations, different types of cannabinoids, a range of dosages, variability in the assessment of domains of pain (sensory, affective) and modest effect sizes. Therefore, further larger studies examining specific cannabinoids and strains of cannabis, using improved and objective pain measurements, appropriate dosages and duration of treatment in homogeneous patient populations need to be carried out.
- The current review of evidence from clinical trials of medicinal cannabis suggests that the adverse effects of its short-term use are modest, most of them are not serious and are self-limiting.
- Long-term safety assessment of medicinal cannabis is based on scant clinical trials, so the evidence is limited, and the safety interpretation should be taken cautiously. More research is needed to evaluate the adverse effects of long-term use of medical cannabis.
- In view of the limited effect size and the low but not unimportant risk of serious, adverse events, a more precise determination of the risk-to-benefit ratio for medicinal cannabis in pain treatment is needed to help establishing evidence-based policy implementation.
- Current evidence supports the use of medical cannabis in the treatment of chronic pain in adults. Monitoring and follow-up of patients is obligatory.
Front. Pharmacol., 13 November 2018
The Therapeutic Goods Administration (TGA)
Guidance for the use of Medicinal Cannabis in the treatment of Chronic Non-Cancer Pain in Australia
INTRODUCTION:
A set of guidance documents has been made available to assist doctors and their patients who choose to prescribe medicinal cannabis in Australia under current access schemes. These have been developed based on reviews of available evidence for the use of medicinal cannabis in five different settings. Included is an overview addressing the evidence base for medicinal cannabis therapy generally as well as specific documents relating to medicinal cannabis in the treatment of palliative care, epilepsy, chemotherapy-induced nausea and vomiting (CINV), multiple sclerosis (MS) and chronic pain.
This document reflects the evidence supporting the use of medicinal cannabis in treating chronic pain and the recommendations of the Chronic Pain Working Group.
Note: These guidance documents are based on evidence available at the time of publication and will be updated as new evidence emerges. Each document should be read in conjunction with the ‘Guidance to the use of medicinal cannabis in Australia – Overview‘.
In September 2017 a workshop was held in Sydney to discuss the review of the available evidence for the use of medicinal cannabis (medicinal cannabis) in patients with chronic non-cancer pain (CNCP). Workshop participants included representatives from consumer groups, medical colleges, special societies and states and territories.
For more information, please follow the link for TGA Guidance.
Effectiveness and tolerability of THC:CBD oromucosal spray as add-on measure in patients with severe chronic pain:
Analysis of 12-week open-label real-world data provided by the German Pain e-Registry.
FINDINGS:
In this exploratory analysis of real-world data on 800 patients with elsewhere refractory SCP provided by the GPR, THC:CBD oromucosal spray, a cannabinoid-based fixed dose low THC high CBD medication (originally developed and approved for the symptomatic treatment of adult patients with moderate to severe spasticity due to MS), proved to be an efficacious add-on treatment for the relief of pain, especially if it was neuropathic in nature. The legalized treatment with THC:CBD was well tolerated – especially in comparison with other cannabis products and usually recommended analgesics – and showed a good safety profile without any evidence of abuse, persistent patterns of deliberate overdose, misuse, psychiatric complications or tolerance development. Beneficial effects found for CP patients in this analysis clearly outweighed the potential risks of treatment and confirmed that THC:CBD oromucosal spray provides an effective add-on measure for patients suffering either from elsewhere refractory neuropathic pain conditions as well as those presenting with a pain phenotype suggestive for underlying neuropathic mechanisms.
In this exploratory analysis of real-world data on 800 patients with elsewhere refractory SCP provided by the GPR, THC:CBD oromucosal spray, a cannabinoid-based fixed dose low THC high CBD medication (originally developed and approved for the symptomatic treatment of adult patients with moderate to severe spasticity due to MS), proved to be an efficacious add-on treatment for the relief of pain, especially if it was neuropathic in nature. The legalized treatment with THC:CBD was well tolerated – especially in comparison with other cannabis products and usually recommended analgesics – and showed a good safety profile without any evidence of abuse, persistent patterns of deliberate overdose, misuse, psychiatric complications or tolerance development. Beneficial effects found for CP patients in this analysis clearly outweighed the potential risks of treatment and confirmed that THC:CBD oromucosal spray provides an effective add-on measure for patients suffering either from elsewhere refractory neuropathic pain conditions as well as those presenting with a pain phenotype suggestive for underlying neuropathic mechanisms.
J Pain Res. 2019 May 20;12:1577-1604. doi: 10.2147/JPR.S192174. eCollection 2019.