cbd oil usage for chronic pain

Chronic Pain Most Common Reason for Medical Cannabis Use

Slowly but surely, the stigma surrounding marijuana use is losing its grip in the U.S. Since the 1990s, advocates have pushed for a re-evaluation of cannabis (the plant species name often used interchangeably with marijuana) as a viable treatment for a host of ailments. As of 2018, 33 states and the District of Columbia have approved the medical use of cannabis, while 10 states have legalized marijuana for recreational use. Despite this fact, at the federal level, marijuana remains a Schedule 1 drug under the Controlled Substances Act, defined as a drug with no currently accepted medical use and a high potential for abuse.

New research from the University of Michigan, published in the February issue of Health Affairs, takes a deeper dive into state medical marijuana registry data to provide more insight into its use.

“We did this study because we wanted to understand the reasons why people are using cannabis medically, and whether those reasons for use are evidence based,” says lead author Kevin Boehnke, Ph.D., research investigator in the department of anesthesiology and the Chronic Pain and Fatigue Research Center.

He and his U-M colleagues Daniel J. Clauw, M.D., a professor of anesthesiology, medicine, and psychiatry and Rebecca L. Haffajee, Ph.D., assistant professor of health management and policy, as well as U-M alum Saurav Gangopadhyay, M.P.H., a consultant at Deloitte, sought out data from states with legalized medical use of marijuana.

To examine patterns of use, the researchers grouped patient-reported qualifying conditions (i.e. the illnesses/medical conditions that allowed a patient to obtain a license) into evidence categories pulled from a recent National Academies of Sciences, Engineering and Medicine report on cannabis and cannabinoids. The report, published in 2017, is a comprehensive review of 10,000 scientific abstracts on the health effects of medical and recreational cannabis use. According to the report, there was conclusive or substantial evidence that chronic pain, nausea and vomiting due to chemotherapy, and multiple sclerosis (MS) spasticity symptoms were improved as a result of cannabis treatment.

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Evidence-based relief

One major finding of the Health Affairs paper was the variability of available data. Less than half of the states had data on patient-reported qualifying conditions and only 20 reported data on the number of registered patients. The authors also noted that the number of licensed medical users, with 641,176 registered medical cannabis patients in 2016 and 813,917 in 2017, was likely far lower than the actual number of users.

However, with the available data, they found that the number of medical cannabis patients rose dramatically over time and that the vast majority — 85.5 percent — of medical cannabis license holders indicated that they were seeking treatment for an evidence-based condition, with chronic pain accounting for 62.2 percent of all patient-reported qualifying conditions.

“This finding is consistent with the prevalence of chronic pain, which affects an estimated 100 million Americans,” the authors state.

This research provides support for legitimate evidence-based use of cannabis that is at direct odds with its current drug schedule status, notes Boehnke. This is especially important as more people look for safer pain management alternatives in light of the current opioid epidemic.

Recommendations for Medical Cannabis and Cannabinoid Use in Chronic Pain

The BMJ has published a clinical practice guideline summarizing the evidence for the use of medical cannabis and cannabinoids in chronic pain. These recommendations, provided by an expert panel, encourage clinicians to offer a trial of non-inhaled medical cannabis or cannabinoids to patients with chronic pain in addition to standard of care.

There has been a recent push in the United States for certain jurisdictions to allow medical use of cannabis or cannabinoids, particularly in jurisdictions where policies exist to reduce opioid use for pain management. However, as the authors emphasize, current guidelines from professional associations and federal agencies in the United States and Europe are inconsistent regarding whether or not patients should be advised to use these products.

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Cannabis and cannabinoids have multifaceted analgesic and anti-inflammatory effects — such as promoting the release of dopamine, enhancing adenosine receptor signaling, and decreasing reactive oxygen species, all of which may provide relief for patients experiencing chronic pain.

The authors’ recommendation was informed by a linked series of 4 systematic reviews that summarized the current body of evidence for benefits and harms, as well as patient preferences and values, associated with the use of medical cannabis or cannabinoids for chronic pain. In their evaluation, they used the GRADE approach and standards for guideline creation.

The resulting systematic review reports on the effects of medical non-inhaled cannabis or cannabinoids, added to standard care, in people with chronic pain due to cancer or non-cancer-related causes. Importantly, 3 people with lived and living experience of chronic pain were members of the guideline panel, and fully participated in development of the guidelines.

The authors concluded that, for individuals for whom standard care is insufficient at alleviating their pain symptoms, non-inhaled medical cannabis or cannabinoids may be recommended for a trial period.

They noted that currently published trials have found that at 1-4 months post initiation of therapy, cannabis reduced pain and improved physical function and sleep quality. There is no current evidence that cannabis use had a significant effect on emotional function, role function, or social function, they said.

This therapeutic option may not be viable for all patients, given that cannabis has been associated with cognitive impairment, drowsiness, and impaired attention at 1.3-3.5 months.

Clinicians who choose to advocate for cannabis use should advise their patients to begin their trial period using low dose, non-inhaled products, increasing their intake slowly depending on clinical response and tolerability, the authors wrote. Patients should be instructed to avoid operating machinery or driving until they are familiar with clinical effects.

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Younger patients should be given cannabidiol-predominant preparations, since the effect of tetrahydrocannabinol on neurocognitive development remains unclear. Women who are pregnant, may become pregnant, or are breastfeeding should be advised to avoid cannabis.

This recommendation is subject to change as additional research is conducted on the benefits and harms of using medical cannabis and cannabinoids for the treatment of both cancer-related and non-cancer-related chronic pain.