Use of medical cannabis to relieve chronic pain gets ‘weak’ endorsement

Some forms of medical cannabis may relieve pain and improve quality of life for people with chronic pain, a panel of international experts has said.

The panel has made a “weak” recommendation for a trial of non-inhaled medical cannabis for people living with chronic pain, if standard care is not sufficient.

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

Writing in The British Medical Journal, the panel says its guidance aims to address confusion around the role of medical cannabis in the treatment of chronic pain.

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The recommendation applies to adults and children living with all types of moderate to severe chronic pain. It does not apply to smoked or vaporised forms of cannabis, recreational cannabis, or patients receiving end-of-life care.

In Ireland, medical cannabis is indicated for treating three conditions, but not chronic pain, although the access scheme is not yet operational.

After reviewing almost 100 studies and trials, the panel found no evidence linking psychosis to the use of medical cannabis or cannabinoids, but said they do carry a small to modest risk of mostly self limited and transient harms, such as loss of concentration, vomiting, drowsiness, and dizziness.

“The panel was less confident about whether use of medical cannabis or cannabinoids resulted in reduced use of opioids, and found that potential serious harms including cannabis dependence, falls, suicidal ideation or suicide were uncommon, but this evidence was only very low certainty.”

“The recommendation is weak because of the close balance between benefits and harms of medical cannabis for chronic pain.”