Clinical Practice Guidelines for Cannabis and Cannabinoid-Based Medicines in the Management of Chronic Pain and Co-Occurring Conditions

Abstract

Background: One in five individuals live with chronic pain globally, which often co-occurs with sleep problems, anxiety, depression, and substance use disorders. Although these conditions are commonly managed with cannabinoid-based medicines (CBM), health care providers report lack of information on the risks, benefits, and appropriate use of CBM for therapeutic purposes. Aims: We present these clinical practice guidelines to help clinicians and patients navigate appropriate CBM use in the management of chronic pain and co-occurring conditions. Materials and Methods: We conducted a systematic review of studies investigating the use of CBM for the treatment of chronic pain. Articles were dually reviewed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Clinical recommendations were developed based on available evidence from the review. Values and preferences and practical tips have also been provided to support clinical application. The GRADE system was used to rate the strength of recommendations and quality of evidence. Results: From our literature search, 70 articles met inclusion criteria and were utilized in guideline development, including 19 systematic reviews and 51 original research studies. Research typically demonstrates moderate benefit of CBM in chronic pain management. There is also evidence for efficacy of CBM in the management of comorbidities, including sleep problems, anxiety, appetite suppression, and for managing symptoms in some chronic conditions associated with pain including HIV, multiple sclerosis, fibromyalgia, and arthritis. Conclusions: All patients considering CBM should be educated on risks and adverse events. Patients and clinicians should work collaboratively to identify appropriate dosing, titration, and administration routes for each individual. Systematic Review Registration: PROSPERO no. 135886.

The Interaction of Opiate Misuse and Marijuana Use on Behavioral Health Outcomes Using the Traumatic Brain Injury Model Systems Pain Collaborative Dataset

“…There has been conflicting evidence regarding the efficacy of marijuana to treat depression, PTSD, anxiety, and sleep deprivation 44–46. Recently published clinical practice guidelines reviewed literature investigating the use of cannabinoid-based medicines (CBM) for treatment of chronic pain in co-occurring conditions 47. These guidelines strongly recommended CBM adjunct therapy for sleep deprivation and anxiety among people who experience chronic pain, and weakly recommended CBM adjunct therapy for PTSD and depression 47.…”

“…[44][45][46] Recently published clinical practice guidelines reviewed literature investigating the use of cannabinoid-based medicines (CBM) for treatment of chronic pain in co-occurring conditions. 47 These guidelines strongly recommended CBM adjunct therapy for sleep deprivation and anxiety among people who experience chronic pain, and weakly recommended CBM adjunct therapy for PTSD and depression. 47 Furthermore, a strong recommendation for CBM adjunct therapy was endorsed for opioid sparing for people who use opioids for chronic pain.…”

“…47 These guidelines strongly recommended CBM adjunct therapy for sleep deprivation and anxiety among people who experience chronic pain, and weakly recommended CBM adjunct therapy for PTSD and depression. 47 Furthermore, a strong recommendation for CBM adjunct therapy was endorsed for opioid sparing for people who use opioids for chronic pain. 47 These recommendations were not specific to individuals with TBI.…”

Influence of Cannabinoid Treatment on Trajectories of Patient-Related Outcomes in Chronic Pain: Pain Intensity, Emotional Distress, Tolerability and Physical Disability

“…Based on our initial scientific findings and clinical experience, medication was selected depending on the patient’s chronic pain disorder, accompanying symptoms and side effects. Recent reviews differ in their potential cannabinoid indications and dosing regimens, and there remains significant uncertainty regarding the choice of optimal compounds [ 7 , 8 ]. Therefore, the selection of cannabinoids prescribed by the pain department was made through team consensus.…”

Cannabis-Based Medicines Effective for Management of Pain

“…Recent data have demonstrated that cannabinoid-based medicines (CBMs) provide a “moderate benefit” in the management of chronic pain. Based on these findings, a team of researchers from several medical schools in Canada have formulated and published clinical practice guidelines for CBMs 1…”