Digging Deeper

 

the bmj | BMJ 2021;374:n2040 | doi: 10.1136/bmj.n2040

http://dx.doi.org/10.1136/bmj.n2040

Chronic pain is common and distressing and associated with considerable socioeconomic burden globally.

The increasing legalisation of medical cannabis globally, escalating use by patients, lack of training in the use of medical cannabis or cannabinoids during formal medical education, and inconsistent guidance from professional associations and federal agencies have led to confusion regarding the role of medical cannabis in the management of chronic pain

What is the role of medical cannabis or cannabinoids for people living with chronic pain due to cancer or non-cancer causes?

To date guidance has been conflicting. The most significant guidance in the UK has come from the National Institute of Clinical Excellence

NICE 2019- do not offer THC or CBD for chronic pain unless it is part of a clinical trial

This review makes the following recommendation

“If standard care is not sufficient, then we suggest offering a trial of non- inhaled medical cannabis or cannabinoids.”

They make a weak recommendation for offering such a trial and say,

“The weak recommendation reflects a high value placed on small to very small improvement in self-reported pain intensity, physical functioning, and sleep quality, and willingness to accept a small to modest risk of mostly self-limited and transient harms.”

It is significant because it is the first to make any such positive recommendation for medicinal cannabis use in chronic pain in the UK and significant too as it is published in such a widely respected medical journal, i.e., The British Medical Journal (BMJ)

 

Comment

At ActforPain, we think this is unlikely to change NHS prescribing policy and certainly NICE which has cost-effectiveness as primary driver for recommendation in a guidance are unlikely to change their views.

 

The panel of experts making this recommendation recognise that small reductions in pain intensity means an enormous amount to people living with chronic pain

 

For people taking medicinal cannabis they unfortunately only can expect- small or very small reductions in pain. We therefore we believe there is also a place for  combining it with a program such as ours which  addresses the ongoing emotional and psychological sequelae to living with chronic pain, even with a positive response to medicinal cannabis, significant ongoing pain, based on the evidence, seems inevitable.

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