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'Weak recommendation' for medical cannabis for chronic pain

Thursday September 9th 2021

Trials of cannabis products should only be set up for people living with chronic pain, experts say today.

Writing in the latest edition of The BMJ, they say it should be offered to adults and children living with all types of moderate to severe chronic pain if standard care is not sufficient.

However, their advice, produced as part of a BMJ Rapid Recommendations initiative, does not extend it to smoked or vaporised forms of cannabis, recreational cannabis, or patients receiving end-of-life care.

The recommendation is based on systematic reviews of 32 randomised trials that examined the benefits and harms of medical cannabis or cannabinoids for chronic pain; 39 observational studies exploring long-term harms; 17 studies of cannabis substitution for opioids; and 15 studies of patient values and preferences.

The panel was confident that non-inhaled medical cannabis or cannabinoids result in small to very small improvements in self reported pain intensity, physical functioning, and sleep quality, and no improvement in emotional, role, or social functioning.

They found no evidence linking psychosis to the use of medical cannabis or cannabinoids but say these carry a small-to-modest risk of mostly self limited and transient harms, such as loss of concentration, vomiting, drowsiness, and dizziness.

However, the experts were less confident about whether or not medical cannabis or cannabinoids use resulted in reduced use of opioids, and they found potential serious harms included cannabis dependence and falls. Suicidal ideation or suicide were also found to be uncommon, but this evidence was only very low certainty.

The panel said their recommendation is weak because of the close balance between benefits and harms of medical cannabis for chronic pain.

However, the experts issued strong support for shared decision making to ensure patients make choices that reflect their values and personal context.

Busse JW, Vankrunkelsven P, Zeng L et al. Rapid Recommendation: Medical cannabis or cannabinoids for chronic pain: a clinical practice guideline. BMJ 9 September 2021

[abstract]

Tags: Alternative Therapy | Pain Relief | UK News

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