Medical Cannabis Review Articles and Reports on Non-Cancer Pain
The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research
A report published by the U.S. National Academies of Sciences, Engineering, and Medicine. 2017.
A rigorous review of relevant scientific research published since 1999, summarizing the current state of evidence regarding what is known about the health impacts of cannabis and cannabis-derived products, including effects related to therapeutic uses of cannabis and potential health risks related to certain cancers, diseases, mental health disorders, and injuries. Sections on evidence of therapeutic effects include: chronic pain, cancer treatment, chemotherapy-induced nausea and vomiting, anorexia and weight loss associated with HIV/AIDS, cancer-associated anorexia-cachexia syndrome, anorexia nervosa, irritable bowel syndrome, epilepsy, spasticity associated with multiple sclerosis or spinal cord injury, Tourette syndrome, amyotrophic lateral sclerosis, Huntington’s disease, Parkinson’s disease, dystonia, dementia, glaucoma, traumatic brain injury/intracerebral hemorrhage, substance addiction, anxiety, depression, sleep disorders, posttraumatic stress disorder, and schizophrenia and other psychoses. Chapters summarizing evidence of harms include: cancer, cardiometabolic risk, respiratory disease, immunity, injury and death, prenatal/perinatal/neonatal exposure, psychosocial, mental health, cannabis use problems, and abuse of other substances.
A Review of Medical Cannabis Studies relating to Chemical Compositions and Dosages for Qualifying Medical Conditions (PDF)
Office of Medical Cannabis.
Summary of clinical trials and prospective observational studies in humans, published in peer-reviewed journals, which focus on medical cannabis formulations consistent with Minnesota’s medical cannabis program.
Information for Health Care Professionals: Cannabis and the cannabinoids (PDF)
Health Canada. February, 2013.
Endocannabinoid system, clinical pharmacology, dosing, potential therapeutic uses (by condition), precautions, warnings, adverse effects, and overdose/toxicity.
Cannabinoids for Medical Use: A Systematic Review and Meta-analysis
Whiting PF, Wolff RF, Deshpande S, Di Nisio M, et al JAMA 2015;313(24):2456-2473.
Systematic review of the benefits and adverse effects of therapeutic use of cannabinoids. The study included randomized clinical trials of cannabinoids for the following indications: nausea and vomiting due to chemotherapy, appetite stimulation in HIV/AIDS, chronic pain, spasticity due to multiple sclerosis or paraplegia, depression, anxiety disorder, sleep disorder, psychosis, glaucoma, or Tourette syndrome.
Here is JAMA’s summary of the Whiting article, “In a systematic review, Whiting and colleagues identified 79 randomized trials, involving 6462 participants, that compared cannabinoid use with active comparators or placebo for the treatment of several medical conditions. The authors found moderate-quality evidence supporting cannabinoid treatment of chronic pain and spasticity due to multiple sclerosis or paraplegia. Low-quality evidence suggests cannabinoids may lessen nausea and vomiting due to chemotherapy, foster weight gain in patients with HIV infection, and improve symptoms of sleep disorders or Tourette syndrome. In an Editorial, D’Souza and Ranganathan discuss the need for high-quality evidence to guide decisions about medical marijuana use.”
Medical Marijuana for Treatment of Chronic Pain and Other Medical and Psychiatric Problems: A Clinical Review
Hill KP. JAMA 2015;313:2474-2483.
A literature review and case presentation based on a Grand Rounds conference at Beth Israel Deaconess Medical Center, Boston, in May, 2014. The patient discussed is a 60 year old with back pain since a fall 19 years ago and extensive surgical and medical treatment for pain since then. From the FINDINGS section of the abstract, “Use of marijuana for chronic pain, neuropathic pain, and spasticity due to multiple sclerosis is supported by high-quality evidence. Six trials that included 325 patients examined chronic pain, 6 trials that included 396 patients investigated neuropathic pain, and 12 trials that included 1600 patients focused on multiple sclerosis. Several of these triials had positive results, suggesting that marijuana or cannabinoids may be efficacious for these indications.” Of particular note is the clinical approach to evaluation of a patient for medical cannabis certification, beginning on page 2478 and summarized in a box on page 2480.
Cannabis: The Evidence for Medical Use
Barnes MP, Barnes JC. Report published by Northumberland, Tyne & Wear NHS Foundation Trust, May 2016.
Literature review and discussion of strength of evidence of effectiveness for a wide variety of medical conditions. This report was commissioned by the All Party Parliamentary Group for Drug Policy Reform (UK). The authors note they received no renumeration other than a small grand from the APPG for Drug Policy Reform for their work and that they have no commercial interests in cannabis or cannabis products. The report includes good discussions of the evidence – or lack thereof – for long-term negative effects often ascribed to marijuana use: psychotic disorders, dependence, respiratory system cancer, cognition, amotivational syndrome, and decreased brain volume.
The use of cannabis for management of chronic pain
Bostwick JM. Gen Hosp Psychiatry. 2014;36:2-3.
Short, lively opinion piece that covers many of the observations regarding medical cannabis and pain that appear in “PRO” opinion pieces on the subject. Bostwick is a Mayo psychiatrist.
Medical Marijuana: Is the Cart Before the Horse?
D’Souza DC and Ranganathan M. JAMA. 2015;313:2431-2432.
This editorial covers many of the observations regarding medical cannabis and pain that appear in “CON” opinion pieces on the subject. Both authors are Yale psychiatrists.
The pharmacologic and clinical effects of medical cannabis
Borgelt LM, Franson KL, Nussbaum AM, Wang GS.Pharmacotherapy 2013;33(2):195-209.
Pharmacodynamics and pharmacokinetics (smoked and orally ingested) of cannabis, clinical effects (focusing on pain and muscle spasm), adverse effects and drug interactions, psychiatric implications, and pediatric implications.
The Medicinal Cannabis Treatment Agreement: Providing Information to Chronic Pain Patients Through a Written Document
Wilsey B, Atkinson JH, Marcotte TD, Grant I. Clin J Pain 2015;31:1087-1096.
Suggestion of content for a written agreement to describe and minimize risks of medical cannabis therapy. It draws on concepts developed for prescribing opioids to create 12 tenets incorporated into a model agreement.
Cannabis in Pain Treatment: Clinical and Research Considerations
Savage SR, Romero-Sandoval A, Schatman M, Wallace M, Fanciullo G, McCarberg B, Ware M. J Pain 2016;17:654-668.
Though there is some focus on pain, most of this article is relevant to all therapeutic use of cannabis products. It includes sections on risks, regulatory and professional considerations, research constraints, and responsible incorporation of medical cannabis into clinical practice.
Cannabis and Pain: A Clinical Review
Hill KP, Palastro MD, Johnson B, Ditre JW. Cannabis and pain: A clinical review. Cannabis and Cannabinoid Research 2017;2:1,96-104, DOI: 10.1098/can.2017.0017
A brief review of pre-clinical studies suggesting a potential therapeutic role and recent meta-analyses and reviews of clinical studies. Includes sections on potential for pain patients to develop cannabis use disorder and population studies suggesting cannabis therapy for pain leads to reduced opioid use and fewer opioid complications.
The Use of Cannabis for Headache Disorders
Lochte BC, Beletsky A, Samuel NK, Grant I. The use of cannabis for headache disorders. Cannabis and Cannabinoid Research 2017;2:1, 61-67, DOI: 10.1098/can.2016.0033
Review article on evidence for cannabis and cannabinoids as treatment of headache. It focuses on four types of headache: migraine, tension-type headache, trigeminal autonomic cephalalgias (especially cluster headache), and medication-overuse headache.
The effects of cannabis among adults with chronic pain and an overview of general harms: A systematic review
Nugent SM, Morasco BJ, O’Neil ME, Freeman M, Low A, et al. The effects of cannabis among adults with chronic pain and an overview of general harms: A systematic review. Ann Intern Med 2017;167:319-331.
This review was limited to studies assessing the effect of plant-based cannabis preparations or whole-plant extracts. The authors state, “We did not include synthesized pharmaceutically prepared cannabinoids, such as dronabinol or nabilone, because they are not available in dispensaries, and the efficacy of synthetic cannabinoid preparations for chronic pain was examined in 2 recent reviews.” The Conclusion section of the abstract reads: “Limited evidence suggests that cannabis may alleviate neuropathic pain in some patients, but insufficient evidence exists for other types of chronic pain. Among general populations, limited evidence suggests that cannabis is associated with an increased risk of adverse mental health effects.”
Cannabis and cannabinoids for the treatment of people with chronic noncancer pain conditions: a systematic review and meta-analysis of controlled and observational studies
Stockings E, Campbell G, Hall WD, Nielsen S, Zagic D, et al. Cannabis and cannabinoids for the treatment of people with chronic noncancer pain conditions: a systematic review and meta-analysis of controlled and observational studies. Pain 2018;159:1932-1954.
This review includes a wide variety of agents and study types. Included agents: cannabis preparations, plant-based cannabinoids, synthetic THC, and nabilone. Included study types: randomized, controlled trials (n=47); nonrandomized controlled trials; quasi-experimental before and after studies; prospective and retrospective cohort studies; case-control studies; analytical cross-sectional studies; observational studies; self-report; and N-of-1 studies. Data were analyzed separately for the randomized controlled trials and observational study designs. From the Abstract: “Evidence for effectiveness of cannabinoids in chronic non-cancer pain is limited. Effects suggest that number needed to treat to benefit is high, and number needed to treat to harm is low, with limited impact on other domains. It seems unlikely that cannabinoids are highly effective medicines for chronic non-cancer pain.”