Systematic Review and Meta-analysis of Cannabis Treatment for Chronic Pain

[Justin]

Pain Med. 2009 Sep 1. [Epub ahead of print]

Systematic Review and Meta-analysis of Cannabis Treatment for Chronic Pain.

Martín-Sánchez E, Furukawa TA, Taylor J, Martin JL.
Department of Clinical Research, Castile-La Mancha Health Research Foundation (FISCAM), Toledo, Spain.

ABSTRACT

Setting. Cannabis preparations have been used as a remedy for thousands of years in traditional medicine. Clinical use of cannabinoid substances is restricted, due to legal and ethical reasons, as well as limited evidence showing benefits.

Objective. To assess the efficacy and harms of cannabis preparations in the treatment of chronic pain.

Design. Systematic review and meta-analysis of double-blind randomized controlled trials that compared any cannabis preparation to placebo among subjects with chronic pain. An electronic search was made in Medline/Pubmed, Embase, and The Cochrane Controlled Trials Register (TRIALS CENTRAL) of all literature published until February 2008, as well as specific web pages devoted to cannabis. Studies were cross-checked, selected, and assessed.

Results. Eighteen trials were included. The efficacy analysis (visual analog scales) displayed a difference in standardized means in favor of the cannabis arm of -0.61 (-0.84 to -0.37), with statistical homogeneity (I(2) = 0.0%; P = 0.50). For the analysis of harms, the following Odds Ratios (OR) and number needed to harm (NNH) were obtained: for events linked to alterations to perception, OR: 4.51 (3.05-6.66), NNH: 7 (6-9); for events affecting motor function, 3.93 (2.83-5.47), NNH: 5 (4-6); for events that altered cognitive function, 4.46 (2.37-8.37), NNH: 8 (6-12).

Conclusions. Currently available evidence suggests that cannabis treatment is moderately efficacious for treatment of chronic pain, but beneficial effects may be partially (or completely) offset by potentially serious harms. More evidence from larger, well-designed trials is needed to clarify the true balance of benefits to harms.

PMID: 19732371 [PubMed - as supplied by publisher]

[Cindylou]

Well, I will respond to this study. Surprisingly, probably to many of you, I have used cannabis for pain relief. When my pain becomes quite intolerable, I personally receive excellent relief from it. Obviously, this is a very touchy subject for legal and ethical reasons. I use it exclusively at home, typically in the evening, NEVER drive under the influence. This is the only thing that has given me the best pain relief of all the remedies I have tried. Of course, I never use it during the day for obvious reasons. This probably surprises many as I said earlier. I was such a goody-too-shoes growing up. Extremely obedient to my folks (my Dad was very strict), an excellent student, captain of cheerleading squad, voted most fun person to be with in high school, homecoming queen, etc. You get the picture. I drank once in high school, got caught by my oldest brother of all things, and he ragged me out more than my Dad would have.....never touched another drink in high school. College, pretty much the same. I never even went into a bar in college. Never experimented w/ drugs ever. Never touched a cigarette. My friends now laugh about that. So when my pain became so intolerable this summer, someone suggested I give this a try as a last resort. At middle age now, my world is not so black and white anymore. I have experienced enough grey in life that I gave this suggestion considerable thought. Ultimately, I decided to take the risk. I could not believe the benefits that I received. Just unbelievable. It is so unfortunate that cannabis is still illegal. Obviously, many of you will disagree with me, and I have no problem with that. I would have never had these words come out of my mouth myself when I was young. Hard to believe I am saying them now. But that's my story.

[Dave]

I grew up as a military "brat". That's what we were called. My father was extremely strict when we were growing up. My mother on the other hand was very liberal. I had been know to partake in a little myself, usually for recreational use. When my mother would find our stash, she would tell us to hide it better so "Dad" would not find out. When I got married that changed everything. My wife is an ultra Conservative Catholic. For 21 years I never touched the stuff again. 2 years ago, when I really started to have a ton of pain, I tried it again. I must say it did help. Occasionally, and I stress that, I will hit it a little to relieve heavy pain.

Michigan passed the Medical Marijuana law last year, but I'm not sure on how to apply to that program. It's something I'm looking into.

[Justin]

Thank you CL and Dave for your replies. This is a very interesting topic. I believe cannabis will have an expanded role in the treatment of chronic pain and other diseases in the future.

[Cindylou]

Thank you CL and Dave for your replies. This is a very interesting topic. I believe cannabis will have an expanded role in the treatment of chronic pain and other diseases in the future.

Very interesting Justin. I hope this is true. Unfortunately, Minnesota has not passed the medical marijuana bill. Hopefully, next time it comes up it will go through.

[ajj1001]

Use is illegal in the UK. Professionally I have worked with cannabis users and observed mental health issues with even occasional users and severe problems with heavy users. Both these things mean that I would not consider using it.

[davemmevad]

I'll chime in here as well. I'm 46, and many of my generation smoked and still smoke pot, but I also never got into it aside from the occasional party experience. That was until 1 year ago, when the spine issues got worse, and my GP sent me to an alternative care clinic, which here in California is where you get a recommendation for Medical Marijuana. Since that time I've used a tiny bit in the morning and a tiny bit at night and it works. Funny thing is, if I use too much and get 'stoney' it stops working so well and I once again notice the nerve pain. But a tiny bit seems to do a lovely job at making my arm feel just a little numb, instead of feeling like it is shoved in a hornets nest. And unlike Vicoden (which he initially perscribed) or Oxycontin, it leaves me mentally clear and able to function throughout the day, hold down my job and continue to help support my family. Also, I should be clear that for me it manages the pain, but does not stop it. I'm fine with that, but I've always figured pain wasn't something to be avoided, but listened to. Vicoden and Oxy just seem to block it, and I dont' believe in avoiding sensation. My body is messed up, and if I don't listen to it I'll mess it up more. But gritting my teeth and wincing makes it hard to function. It may not be for every one, but for me it works, though frankly I'll be glad when I don't need it any more. The only thing I want to be dependant on is gravity, and that's only because skiing stinks without it ;-).

So, I feel like one of those poster people, and it is awkward, but even my parents were open to it, but then they raised me, and knew it wasn't something I had pursued in the past.

Oh, this 'tiny bit' is something I picked up on from a UC Davis study, but I can't seem to find it at the moment. There is a copy somewhere on my hard drive, but ... Oh well. It was reinforced by the Dr at the clinic, that less is more also.

[Jack-of-all-trades]

Interesting topic. I have always been fascinated how us humans can have such varied responses to the chemicals we put in our bodies. MJ makes me so stupid, even being in the room with someone else doing it, I don't think I could even remember my name. Opioids have minimal effect on my cognitive ability, much less than say 25 mg of benadryl. Back when I could afford it and just before I quit flying (not as an airline pilot), I would only fly my plane if I had an instructor who was legally the pilot in command. I could do takeoffs, landings even in cross winds, do complicated instrument approaches in IFR conditions (in clouds where you can't see) to published minimums both with and without the autopilot. My instructor was very surprised to know I was taking Percocet. To me, flying was a passion. Flying my airplane was as good as sex (my wife reads this occasionally and I'd hate to jepardize 20 years of marriage to make a point on which is best. One of my token sacrifice as a result of chronic pain.