Cannabinoids for Pain Control During Medical Abortion

Colwill, Alyssa Covelli; Alton, Katie; Bednarek, Paula H.; Bayer, Lisa L.; Jensen, Jeffrey T.; Garg, Bharti; Beardsworth, Kathleen Marie; Edelman, Alison

doi:10.1097/aog.0000000000003850

Cited by 8 publications

(3 citation statements)

References 21 publications

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“…Our review also has several limitations. All trials except five [ 60 , 80 , 90 , 111 ] were at high risk of bias. Therefore, there is a high risk that our results overestimate the beneficial effects and underestimate the harmful effects of cannabinoids [ 122 – 128 ].…”

Section: Discussionmentioning

confidence: 99%

Cannabinoids versus placebo for pain: A systematic review with meta-analysis and Trial Sequential Analysis

et al. 2023

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Objectives To assess the benefits and harms of cannabinoids in participants with pain. Design Systematic review of randomised clinical trials with meta-analysis, Trial Sequential Analysis, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Data sources The Cochrane Library, MEDLINE, Embase, Science Citation Index, and BIOSIS. Eligibility criteria for selecting studies Published and unpublished randomised clinical trials comparing cannabinoids versus placebo in participants with any type of pain. Main outcome measures All-cause mortality, pain, adverse events, quality of life, cannabinoid dependence, psychosis, and quality of sleep. Results We included 65 randomised placebo-controlled clinical trials enrolling 7017 participants. Fifty-nine of the trials and all outcome results were at high risk of bias. Meta-analysis and Trial Sequential Analysis showed no evidence of a difference between cannabinoids versus placebo on all-cause mortality (RR 1.20; 98% CI 0.85 to 1.67; P = 0.22). Meta-analyses and Trial Sequential Analysis showed that cannabinoids neither reduced acute pain (mean difference numerical rating scale (NRS) 0.52; 98% CI -0.40 to 1.43; P = 0.19) or cancer pain (mean difference NRS -0.13; 98% CI -0.33 to 0.06; P = 0.1) nor improved quality of life (mean difference -1.38; 98% CI -11.81 to 9.04; P = 0.33). Meta-analyses and Trial Sequential Analysis showed that cannabinoids reduced chronic pain (mean difference NRS -0.43; 98% CI -0.72 to -0.15; P = 0.0004) and improved quality of sleep (mean difference -0.42; 95% CI -0.65 to -0.20; P = 0.0003). However, both effect sizes were below our predefined minimal important differences. Meta-analysis and Trial Sequential Analysis indicated that cannabinoids increased the risk of non-serious adverse events (RR 1.20; 95% CI 1.15 to 1.25; P < 0.001) but not serious adverse events (RR 1.18; 98% CI 0.95 to 1.45; P = 0.07). None of the included trials reported on cannabinoid dependence or psychosis. Conclusions Cannabinoids reduced chronic pain and improved quality of sleep, but the effect sizes are of questionable importance. Cannabinoids had no effects on acute pain or cancer pain and increased the risks of non-serious adverse events. The harmful effects of cannabinoids for pain seem to outweigh the potential benefits.

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Section: Discussionmentioning

confidence: 99%

Cannabinoids versus placebo for pain: A systematic review with meta-analysis and Trial Sequential Analysis

et al. 2023

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“…We included the single additional RCT with 70 patients published up to April 2021. 11 Thirty-four RCT abstracts were therefore available for testing.…”

Section: Methodsmentioning

confidence: 99%

“…As both reviews had concluded searches up to April 2019, we extended searches using simple PubMed searches for additional RCTs and systematic reviews published to April 2021. We found one additional RCT, 11 and 10 additional systematic reviews. 1,15,18,19,21,29,34,37,45,68…”

Section: Studies Used To Test the Narrative Bias Toolmentioning

confidence: 99%

Narrative bias (“spin”) is common in randomised trials and systematic reviews of cannabinoids for pain

Moore,

Karadag,

Fisher

et al. 2024

Pain

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We define narrative bias as a tendency to interpret information as part of a larger story or pattern, regardless of whether the facts support the full narrative. Narrative bias in title and abstract means that results reported in the title and abstract of an article are done so in a way that could distort their interpretation and mislead readers who had not read the whole article. Narrative bias is often referred to as “spin.” It is prevalent in abstracts of scientific papers and is impactful because abstracts are often the only part of an article read. We found no extant narrative bias instrument suitable for exploring both efficacy and safety statements in randomized trials and systematic reviews of pain. We constructed a 6-point instrument with clear instructions and tested it on randomised trials and systematic reviews of cannabinoids and cannabis-based medicines for pain, with updated searches to April 2021. The instrument detected moderate or severe narrative bias in the title and abstract of 24% (8 of 34) of randomised controlled trials and 17% (11 of 64) of systematic reviews; narrative bias for efficacy and safety occurred equally. There was no significant or meaningful association between narrative bias and study characteristics in correlation or cluster analyses. Bias was always in favour of the experimental cannabinoid or cannabis-based medicine. Put simply, reading title and abstract only could give an incorrect impression of efficacy or safety in about 1 in 5 papers reporting on these products.

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