European Pain Federation (<scp>EFIC</scp>) position paper on appropriate use of cannabis‐based medicines and medical cannabis for chronic pain management

Haüser, Winfried; Finn, David P.; Kalso, Eija; Krcevski–Škvarc, Nevenka; Kress, Hans G.; Morlion, Bart; Perrot, Serge; Schäfer, Michael; Wells, Chris; Brill, Silviu

doi:10.1002/ejp.1297

Cited by 171 publications

(134 citation statements)

References 101 publications

(123 reference statements)

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“…71 The European Pain Federation has published a position paper about the appropriate use of cannabis-based medicines and medical cannabis for chronic pain management. Key points are that: 1) current evidence is insufficient to state whether cannabis-based medicines and medical cannabis differ in their efficacy, tolerability and safety; 2) cannabis-based medicines can be considered as third-line therapy for chronic neuropathic pain; 3) THC:CBD oromucosal spray (nabiximols) can be considered as part of an add-on individual therapeutic trial for individuals with cancer pain who have inadequate pain relief from opioids or other established analgesics, 72 although evidence for this latter recommendation is limited.…”

Section: Cannabinoids For Pain Managementmentioning

confidence: 99%

<p>A Review of Scientific Evidence for THC:CBD Oromucosal Spray (Nabiximols) in the Management of Chronic Pain</p>

Überall¹

2020

JPR

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The 20% prevalence of chronic pain in the general population is a major health concern given the often profound associated impairment of daily activities, employment status, and health-related quality of life in sufferers. Resource utilization associated with chronic pain represents an enormous burden for healthcare systems. Although analgesia based on the World Health Organization's pain ladder continues to be the mainstay of chronic pain management, aside from chronic cancer pain or end-of-life care, prolonged use of non-steroidal anti-inflammatory drugs or opioids to manage chronic pain is rarely sustainable. As the endocannabinoid system is known to control pain at peripheral, spinal, and supraspinal levels, interest in medical use of cannabis is growing. A proprietary blend of cannabis plant extracts containing delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) as the principal cannabinoids is formulated as an oromucosal spray (USAN name: nabiximols) and standardized to ensure quality, consistency and stability. This review examines evidence for THC:CBD oromucosal spray (nabiximols) in the management of chronic pain conditions. Cumulative evidence from clinical trials and an exploratory analysis of the German Pain e-Registry suggests that add-on THC:CBD oromucosal spray (nabiximols) may have a role in managing chronic neuropathic pain, although further precise clinical trials are required to draw definitive conclusions.

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Section: Cannabinoids For Pain Managementmentioning

confidence: 99%

<p>A Review of Scientific Evidence for THC:CBD Oromucosal Spray (Nabiximols) in the Management of Chronic Pain</p>

Überall¹

2020

JPR

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“…Initially, we expected marijuana use to be associated with pain as chronic pain is one of the leading reasons for starting medical marijuana. 37 Similarly, we thought alcohol may be associated with pain as a recently published qualitative study, Cook et al concluded that PLWH may engage in risky drinking, in order to manage physical pain. 38 A similar study by Merlin et al also noted marijuana use was not statistically associated with reductions in pain among PLWH.…”

Section: Substance Usementioning

confidence: 83%

Factors Associated with Current and Severe Pain among People Living with HIV: Results from a Statewide Sample

Joseph

Jones

Canidate

et al. 2020

Preprint

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Background People living with HIV (PLWH) are more likely to suffer from pain compared to the general public. Pain often clusters with mental health symptoms and substance use. This study sought to evaluate mental health and substance use factors associated with and pain and severe pain intensities among PLWH. Methods Data were derived from HIV+ adults (N=733) recruited from community health centers across Florida who completed questionnaires regarding demographics, chronic pain, HIV clinical outcomes, mental health symptoms, and substance use information. Pain was assessed using the Brief Pain Inventory (BPI) short form. Multivariate logistic regression analysis was utilized to assess the relationship between selected covariates and pain. Results Approximately half (45.0%) of participants reported having current pain. After controlling for covariates, PLWH reporting current symptoms of anxiety or PTSD were 2.49 (CI=1.48, 4.18) and 1.69 (CI= 1.11, 2.57) times as likely to report pain compared to PLWH without those factors respectively. PLWH reporting current symptoms of anxiety and male participants were 2.03 (CI= 1.03, 4.01) and 2.02 (CI= 1.26, 3.24) times as likely to report severe pain compared to PLWH without those factors respectively. Conclusion The relationship between pain and mental health is complex, thus future research is needed to determine if pain treatments may reduce mental health symptoms or if treatments can be targeted to address both issues simultaneously

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“…registries is the prevalent use of cannabinoid medicines to treat chronic pain, 17,18,20 despite the limited RCT evidence for use in this indication. 24 Harmonisation of standard data collected is necessary to pool data from various registries internationally. 10 However, RWD obtained from registries does not provide conclusive evidence of efficacy or effectiveness for the same reasons as observational studies of harms arising from recreational use, namely, the challenges in ruling out residual confounding.…”

Section: United Kingdom 19mentioning

confidence: 99%

Translational hurdles with cannabis medicines

Graham

Lucas

Schneider

et al. 2020

Pharmacoepidemiology and Drug

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Purpose: Internationally, there has been widespread medical use of cannabis medicines before rigorous evaluations in randomised controlled trials (RCTs). Some advocates of medicinal use of cannabis argue that real-world evidence (RWE) can be a substitute for or at least supplement evidence from RCTs. We explore the utility, limitations and impact of RWE in the translation of cannabis medicines research into clinical practice using the established literature. Methods: A literature search was performed via Embase and Medline using a diverse range of cannabinoid and RWE search terms. The review provides a snapshot of cannabis medicine RWE initiatives from around the world. Results: Diverse and novel sources of real-world data and RWE include international cannabis registries, surveys, post-marketing data collection and use of electronic or digital health records. The strengths and limitations of using RWE in translational research are highlighted, along with the identification of barriers to RCTs involving cannabis medicines. Conclusions: RWE promises to play a significant role in the evaluation of cannabis medicines around the world. When used appropriately RWE may complement RCT data by providing valuable insights into cannabis medicine safety and effectiveness.

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European Pain Federation (EFIC) position paper on appropriate use of cannabis‐based medicines and medical cannabis for chronic pain management

Cited by 171 publications

References 101 publications

<p>A Review of Scientific Evidence for THC:CBD Oromucosal Spray (Nabiximols) in the Management of Chronic Pain</p>

<p>A Review of Scientific Evidence for THC:CBD Oromucosal Spray (Nabiximols) in the Management of Chronic Pain</p>

Factors Associated with Current and Severe Pain among People Living with HIV: Results from a Statewide Sample

Translational hurdles with cannabis medicines

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