Effect of Medicinal Cannabis Therapy (MCT) on Severity of Chronic Low Back Pain, Sciatica and Lumbar Range of Motion

Abstract

Background: Anecdotal evidence indicates the possible efficacy of cannabis use as an adjunctive treatment in chronic low back pain. The purpose of the current study was to assess the results of treatment of patients suffering from chronic low back pain by medicinal cannabis (MCT). Methods: A cohort of 46 patients was followed for a minimum of twelve months. They were evaluated at baseline prior to MCT, 3 months later when MCT was begun and up to 12 months of MCT by patient reported outcome questionnaire (SF-12), visual analogue scale (VAS) and the Brief Pain Inventory (BPI), back specific function was assessed using the Oswestry score, range of motion was measured using the Saunders digital inclinometer. Opiate use was assessed using pharmacy dispensation records at baseline and after 12 months of MCT. Inclusion criteria included: Age over 25 years, sciatica with documented treatment for at least 12 months, evidence on CT or MRI scan of disc herniation or spinal stenosis, failure of at least two narcotic drugs, and consent to use medicinal cannabis. Exclusion criteria included evidence of bone cancer, evidence of diabetic neuropathy, and evidence of prior psychotic reactions. Treatment protocol: Cannabis usage was at a fixed dosage of 20 grams per month, dose increase was considered at least after 6 months of treatment. The cannabis was smoked at a recommended rate of 4 dosages per day. Results: After 12 months of MCT BPI VAS decreased from 8.4 ± 1.4 to 2.0 ± 2.0; SF12-PCS improved from 47 ± 14 to 55 ± 12; SF12-MCS improved from 44 ± 6 to 50 ± 10; and sagittal plane active range of motion improved from 34º ± 8º degrees to 48º ± 8º, Conclusion: Short term usage of smoked medicinal cannabis appear to improve both physical and mental function while decreasing pain levels of chronic low back pain sufferers.

Medical cannabis treatment for chronic pain: Outcomes and prediction of response

“…Of interest is our findings regarding the reduction in consuming all types of analgesic medications, which further supports earlier reports of analgesics sparing effect of MC treatment (Bradford et al., 2018; Haroutounian et al., 2016; McCarty, 2018; Stith et al., 2017; Yassin et al., 2016). In light of the ‘opioid epidemic’ (Fitzcharles & Eisenberg, 2018), reduction in opioids consumption and even cessation of their use is an important goal.…”

“…Third, the fact that only 50% of the patients who completed the baseline questionnaires were included in the long‐term analyses may affect generalization of findings and the determination of responder profile. However, a high unaccounted dropout rate is an inherent shortcoming of all such cohort studies (Abuhasira et al., 2018; Haroutounian et al., 2016; Yassin et al., 2016; Zaki et al., 2017). Forth, higher baseline pain intensities than typically seen in other studies (Portenoy et al., 2007) were reported by our patients (i.e.…”

“…Typically, RCTs are not aimed at answering these questions, whereas well‐conducted, large‐scale cohort studies may be helpful. Indeed, several cohort studies on MC for chronic pain have been published in recent years (Abuhasira et al., 2018; Haroutounian et al., 2016; Hoggart et al., 2015; Ware et al., 2015; Yassin et al., 2016; Zaki et al., 2017) and point towards its potential effectiveness. However, none of these studies provided data on the relative effectiveness of MC for different chronic pain conditions nor identified measures, which can predict good treatment response.…”

Migraine Frequency Decrease Following Prolonged Medical Cannabis Treatment: A Cross-Sectional Study

“…There is increasing evidence that MC treatment has opioid-sparing effects [36][37][38][39][40]. Here, we found that responders to MC treatment also reported lower rates of consumption of opioids and triptans compared to non-responders.…”

Magnesium Efficacy to Improve Analgesic Effects of Transversus Abdominis Plane Blocks

“…However, the study cited by Häuser and Fitzcharles was published after the predefined date for trials inclusion (July 2015). Furthermore, we would like to note that long term benefits have recently been published, and although not from randomized controlled trials (RCT), for long term follow-up of 6 months to one year, showing significant improvement of chronic pain and associated symptoms by medical cannabis inhalation (16)(17)(18) and similarly in 9 months follow-up of tetrahydrocannabinol/cannabidiol (THC/CBD) spray treatment (19). We agree that future meta-analyses should include analyses for very short/short/intermediate/ long trials duration.…”