Cannabis and intractable chronic pain: an explorative retrospective analysis of Italian cohort of 614 patients

Abstract

BackgroundDespite growing interest in the therapeutic use of cannabis to manage chronic pain, only limited data that address these issues are available. In recent years, a number of nations have introduced specific laws to allow patients to use cannabis preparations to treat a variety of medical conditions. In 2015, the Italian government authorized the use of cannabis to treat several diseases, including chronic pain generally, spasticity in multiple sclerosis, cachexia and anorexia among AIDS and cancer patients, glaucoma, Tourette syndrome, and certain types of epilepsy. We present the first snapshot of the Italian experience with cannabis use for chronic pain over the initial year of its use.MethodsThis is a retrospective case series analysis of all chronic pain patients treated with oral or vaporized cannabis in six hubs during the initial year following the approval of the new Italian law (December 2015 to November 2016). We evaluated routes of administration, types of cannabis products utilized, dosing, and effectiveness and safety of the treatment.ResultsAs only one of the six centers has extensively used cannabinoids for intractable chronic pain (614 patients of 659), only the population from Azienda Ospedaliero Universitaria Pisana (Pisa) was considered. Cannabis tea was the primary mode of delivery, and in almost all cases, it was used in association with all the other pain treatments. Initial and follow-up cannabinoid concentrations were found to vary considerably. At initial follow-up, 76.2% of patients continued the treatment, and <15% stopped the treatment due to side effects (none of which were severe).ConclusionWe present the first analysis of Italian clinical practice of the use of cannabinoids for a large variety of chronic pain syndromes. From this initial snapshot, we determined that the treatment seems to be effective and safe, although more data and subsequent trials are needed to better investigate its ideal clinical indication.

Cannabis against chronic musculoskeletal pain: A scoping review on users and their perceptions

“…Participants' characteristics are described in Table 1. Mean age of participants ranged from 28 to 61 years; the youngest participants were 14 years old [89] and the oldest 93 years old [51,89]. Most studies were not balanced regarding women and men, and proportions of included women varied between 12% and 82%.…”

Cannabis against chronic muskuloskeletal pain: A scoping review on users and their perceptions

“…These studies were published between 1999 and June 2019, with 27 (55%) of them published in the last four years. Twentyone studies were conducted in the US [18,36,, nine in Canada [73][74][75][76][77][78][79][80][81][82], ten in Europe [83][84][85][86][87][88][89][90][91][92], three in Australia [34, 93,94], three in Israel , and three included data from several countries (up to 43) in Europe and North America [51, 98,99].…”

“…Thirty-four studies used quantitative methods. Among these studies, 29 primarily used questionnaires [18, 34, 52-55, 57, 59, 60, 62, 66, 67, 70, 72, 73, 75, 76, 78, 80-83, 85, 87, 88, 92, 94, 95, 97, 99], ve collected data through retrospective chart review [36,79,86,89,90], and two combined questionnaires with retrospective chart review [64,69]. Only one study used mixed methods [61].…”

“…Participants had been recruited at different locations, with MC or cannabis dispensaries, MC associations or MC advocacy groups as the most frequent recruitment sites (reported in 20 out of the 49 included studies) [18, 54-58, 60-62, 65, 66, 70, 73, 75, 78, 81, 87, 88, 92, 97-99]. Other reported recruitment sites were MC clinics [52,53,59,71], pain or health-care clinics [36,63,64,68,69,72,76,79,80,82,86,95,96], pharmacies specialized in MC distribution [83,89], other pharmacies [85,93], newspapers, university websites, mass media, restaurants or bookstores [34,77,84,99], social media or social networks [84,91,98,99], online forum or websites of MC association [51, 74,94], a Public Health Agency [89,90] and industry-based consumers directed organizations or consumers/patients' organizations [67,91].…”

“…The reported prevalence of ingested MC varied from 0.5% [99] to 70% [85] and the prevalence of topical administration varied from 0.6% [99] to 11% [59]. A combined mode of cannabis consumption (e.g., smoked MC and edible MC products) was also reported [78,79,88,95] [86] to 28 grams per day [62]. It was not possible to further classify study participants according to daily cannabis consumption from the information provided in the articles.…”