Effects of cannabis ingestion on endometriosis-associated pelvic pain and related symptoms.

Abstract

Background The use of cannabis for symptoms of endometriosis was investigated utilising retrospective archival data from Strainprint Technologies Ltd., a Canadian data technology company with a mobile phone application that tracks a range of data including dose, mode of administration, chemovar and their effect on various self-reported outcomes, including pelvic pain. Methods A retrospective, electronic record-based cohort study of Strainprint™ users with self-reported endometriosis was conducted. Self-rated cannabis efficacy, defined as a function of initial and final symptom ratings, was investigated across the included symptom clusters of cramps, pelvic pain, gastrointestinal pain, nausea, depression, and low libido. Cannabis dosage form, dose and cannabinoid ratio information was also recorded. Results A total number of 252 participants identifying as suffering endometriosis recorded 16193 sessions using cannabis between April 2017 and February 2020. The most common method of ingestion was inhalation (n = 10914, 67.4%) with pain as the most common reported symptom being treated by cannabis (n = 9281, 57.3%). Gastrointestinal symptoms, though a less common reason for cannabis usage (15.2%), had the greatest self-reported improvement after use. Inhaled forms had higher efficacy for pain, while oral forms were superior for mood and gastrointestinal symptoms. Dosage varied across ingestion methods, with a median dose of 9 inhalations (IQR 5 to 11) for inhaled dosage forms and 1 mg/mL (IQR 0.5 to 2) for other ingested dosage forms. The ratio of THC to CBD had a statistically significant, yet clinically small, differential effect on efficacy, depending on method of ingestion. Conclusions Cannabis appears to be effective for pelvic pain, gastrointestinal issues and mood, with effectiveness differing based on method of ingestion. The greater propensity for use of an inhaled dosage delivery may be due to the rapid onset of pain-relieving effects versus the slower onset of oral products. Oral forms appeared to be superior compared to inhaled forms in the less commonly reported mood or gastrointestinal categories. Clinical trials investigating the tolerability and effectiveness of cannabis for endometriosis pain and associated symptoms are urgently required.

Cannabis for endometriosis‐related pain and symptoms: It's high time that we see this as a legitimate treatment

“…Similarly people with endometriosis in Australia and New Zealand reported substantial substitution effects (>50% reduction in dose) in non‐opioid analgesia (63.1%), opioid analgesia (66.1%), hormonal therapies (27.5%), anti‐neuropathics (61.7%), antidepressants (28.2%) and anxiolytic medications (47.9%) 18 . A retrospective cohort study 19 on data collected using the Strainprint app among North American legal therapeutic cannabis users found that pelvic pain (42.4% of all participants) was the primary clinical indication for use of cannabis. Medicinal cannabis had a significant reduction on pelvic pain severity, with an efficacy rating of 31.98 (95% CI 31.26–32.71, P < 0.0001), 19 roughly equivalent to 20 mm on a 100 mm visual analogue scale, exceeding the minimum clinically important difference for endometriosis and consistent with other cohort studies 13 .…”

“…A retrospective cohort study 19 on data collected using the Strainprint app among North American legal therapeutic cannabis users found that pelvic pain (42.4% of all participants) was the primary clinical indication for use of cannabis. Medicinal cannabis had a significant reduction on pelvic pain severity, with an efficacy rating of 31.98 (95% CI 31.26–32.71, P < 0.0001), 19 roughly equivalent to 20 mm on a 100 mm visual analogue scale, exceeding the minimum clinically important difference for endometriosis and consistent with other cohort studies 13 . Adverse events with medicinal cannabis, apart from cannabis hyperemesis syndrome, tend to be mild and self‐limiting, and include euphoria, orthorexia, sedation, dry mouth and lethargy 11,14 …”