The Role of Cannabidiol (CBD) in Chronic Pain Management: An Assessment of Current Evidence

Boyaji, Shafik; Merkow, Justin; Elman, R Noel M; Kaye, Alan D.; Yong, R. Jason; Urman, Richard D.

doi:10.1007/s11916-020-0835-4

Cited by 85 publications

(56 citation statements)

References 24 publications

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“…RCTs on CBM and pain symptoms provide inconclusive results; however, several report that treatments of THC and CBD have some benefit for pain management (Häuser et al 2018 ; Russo 2008 ; Prosk et al 2020 ). Our results are largely novel as research on the effect of CBD on pain control is very limited (Boyaji et al 2020 ). The reduction in reported anxiety may also contribute to the improvement in pain perception.…”

Section: Discussionmentioning

confidence: 89%

Cannabidiol use and effectiveness: real-world evidence from a Canadian medical cannabis clinic

et al. 2021

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Background Cannabidiol (CBD) is a primary component in the cannabis plant; however, in recent years, interest in CBD treatments has outpaced scientific research and regulatory advancement resulting in a confusing landscape of misinformation and unsubstantiated health claims. Within the limited results from randomized controlled trials, and lack of trust in product quality and known clinical guidelines and dosages, real-world evidence (RWE) from countries with robust regulatory frameworks may fill a critical need for patients and healthcare professionals. Despite growing evidence and interest, no real-world data (RWD) studies have yet investigated patients’ reports of CBD impact on symptom control in the common expression of pain, anxiety, depression, and poor wellbeing. The objective of this study is to assess the impact of CBD-rich treatment on symptom burden, as measured with a specific symptom assessment scale (ESAS-r). Methods This retrospective observational study examined pain, anxiety, depression symptoms, and wellbeing in 279 participants over 18 years old, prescribed with CBD-rich treatment at a network of clinics dedicated to medical cannabis in Quebec, Canada. Data were collected at baseline, 3 (FUP1), and 6 (FUP2) month after treatment initiation. Groups were formed based on symptom severity (mild vs moderate/severe) and based on changes to treatment plan at FUP1 (CBD vs THC:CBD). Two-way mixed ANOVAs were used to assess ESAS-r scores differences between groups and between visits. Results All average ESAS-r scores decreased between baseline and FUP1 (all ps < 0.003). The addition of delta-9-tetrahydrocannabinol (THC) during the first follow-up had no effect on symptom changes. Patients with moderate/severe symptoms experienced important improvement at FUP1 (all ps < 0.001), whereas scores on pain, anxiety, and wellbeing of those with mild symptoms actually increased. Differences in ESAS-r scores between FUP1 and FUP2 were not statistically different. Conclusion This retrospective observational study suggests CBD-rich treatment has a beneficial impact on pain, anxiety, and depression symptoms as well as overall wellbeing only for patients with moderate to severe symptoms; however, no observed effect on mild symptoms. The results of this study contribute to address the myths and misinformation about CBD treatment and demand further investigation.

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Section: Discussionmentioning

confidence: 89%

Cannabidiol use and effectiveness: real-world evidence from a Canadian medical cannabis clinic

et al. 2021

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“…Although none of the four phytocannabinoids quantified in the current study are known to behave as CB 2 agonists individually, phytocannabinoid synergy at the CB 2 receptor may result in CB 2 agonism and, in turn, the subsequent anti-nociceptive effects observed clinically. This may explain the anti-nociceptive effects observed in cannabis plant extracts [ 31 , 32 , 33 ], as well as CBD-containing cannabinoid mixtures, such as nabiximols, unlike CBD alone [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

Bioactive Chemical Composition of Cannabis Extracts and Cannabinoid Receptors

et al. 2020

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Cannabis is widely used as a therapeutic drug, especially by patients suffering from psychiatric and neurodegenerative diseases. However, the complex interplay between phytocannabinoids and their targets in the human receptome remains largely a mystery, and there have been few investigations into the relationship between the chemical composition of medical cannabis and the corresponding biological activity. In this study, we investigated 59 cannabis samples used by patients for medical reasons. The samples were subjected to extraction (microwave and supercritical carbon dioxide) and chemical analyses, and the resulting extracts were assayed in vitro using the CB1 and CB2 receptors. Using a partial least squares regression analysis, the chemical compositions of the extracts were then correlated to their corresponding cannabinoid receptor activities, thus generating predictive models that describe the receptor potency as a function of major phytocannabinoid content. Using the current dataset, meaningful models for CB1 and CB2 receptor agonism were obtained, and these reveal the insignificant relationships between the major phytocannabinoid content and receptor affinity for CB1 but good correlations between the two at CB2 receptors. These results also explain the anomalies between the receptor activities of pure phytocannabinoids and cannabis extracts. Furthermore, the models for CB1 and CB2 agonism in cannabis extracts predict the cannabinoid receptor activities of individual phytocannabinoids with reasonable accuracy. Here for the first time, we disclose a method to predict the relationship between the chemical composition, including phytocannabinoids, of cannabis extracts and cannabinoid receptor responses.

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“…The recent evolution of the opioid epidemic coupled with the increasing challenge of chronic pain management, and the increasing public use of CBD products have prompted further research of CBD utility in pain management. A recent review of current evidence by Boyaji et al 20 concluded that it was difficult to provide a solid recommendation for the use of CBD in pain management because most available products are not approved, and the only approved pharmaceuticals do not contain CBD alone; they contain CBD always in combination with THC. Even though the current evidence of CBD's therapeutic potential does not mount to clinical significance, this will change soon.…”

Section: Aphaeaprsmentioning

confidence: 99%

Role of the pharmacist in the care of patients using cannabis

El‐Alfy¹

2020

Journal of the American Pharmacists Association

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The Role of Cannabidiol (CBD) in Chronic Pain Management: An Assessment of Current Evidence

Cited by 85 publications

References 24 publications

Cannabidiol use and effectiveness: real-world evidence from a Canadian medical cannabis clinic

Cannabidiol use and effectiveness: real-world evidence from a Canadian medical cannabis clinic

Bioactive Chemical Composition of Cannabis Extracts and Cannabinoid Receptors

Role of the pharmacist in the care of patients using cannabis

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