New Guidelines Offer Recommendations for Cannabis Use in Chronic Pain Management

To help clinicians and patients needing better information on using cannabis to manage chronic pain, a group of Canadian researchers conducted a systematic review (an analysis of available evidence) and used it to create clinical practice guidelines for using cannabis to manage chronic pain. Their review and guidelines were published in the journal Cannabis and Cannabinoid Research.

This development comes as interest in medical cannabis for pain relief grows. A 2019 CreakyJoints survey found that 57 percent of 1,059 rheumatic disease patients had tried cannabis for medicinal purposes at least once. In addition, a review article by CreakyJoints and published in Current Rheumatology confirmed interest in medical cannabis among such patients is primarily due to the drug’s potential pain-relieving properties.

The growing interest in medical cannabis corresponds with the legalization or decriminalization of the substance in more states. However, there is a lack of solid research on cannabis’s health benefits, making it hard for doctors to give advice to their patients.

This is slowly changing. Studies on cannabis can be tough to do because of legal limits, but more research on using cannabis for chronic pain has been done in recent years. Patients and doctors are eager for actionable advice.

Developing the Guidelines

The researchers started by searching scientific databases for peer-reviewed articles on cannabis and pain that were published between 2001 and 2019 in English. Their final, in-depth reviewed ultimately covered 70 studies, 19 of which were systematic reviews. (The other 51 were original studies.)

The authors graded the 70 studies based on evidence quality and used their analyses — along with input from chronic pain patients and those currently using cannabis-based treatments — to develop specific guidelines.

Several recommendations were based on moderate-quality evidence, while others were based on low-quality evidence. The guidelines provide suggestions for using cannabis and cannabis-based natural medicines for various types of chronic pain, sleep problems, anxiety, and appetite loss.

CreakyJoints advises arthritis patients to continue using standard-of-care treatments recommended by major medical groups such as the American College of Rheumatology (ACR) and the European Alliance of Associations for Rheumatism (EULAR).

They strongly recommended using cannabis (and cannabis-based natural medicines) in the following instances, based on moderate-quality evidence:

• As a primary or adjunct treatment for chronic pain, including central and/or peripheral pain
• To manage muscular or neuropathic pain in people with HIV who aren’t getting adequate relief or having adverse effects from other treatments
• As an adjunct treatment for pain related to multiple sclerosis, in patients not responding well enough to other remedies
• As a primary or adjunct treatment for sleep problems in chronic pain patients who haven’t responded to other sleep treatment options
• As an adjunct therapy for anxiety in chronic pain patients who haven’t responded to non-pharmacologic treatment for anxiety
• As an adjunct treatment for people with chronic pain who don’t get enough relief from opioids alone
• As an adjunct treatment for people with chronic pain who are taking high doses of opioids and either aren’t getting enough relief or want to be less reliant on opioids

The group also strongly recommended using cannabis for the following purposes, despite having to rely on low-quality evidence:

• As an adjunct treatment for chronic pain in arthritis patients who aren’t getting enough relief from other treatments
• As an adjunct treatment for back pain, fibromyalgia pain, or other chronic pain related to fibromyalgia in people who don’t respond enough to other pain relievers
• For combatting “problematic loss of appetite” in people with chronic pain (THC-dominant cannabis)

What This Means for You

In the past, discussing medical marijuana for pain management related to your condition might have felt off-limits, but nowadays, patients often seek advice from rheumatologists on this topic.

Keep in mind that medical cannabis shouldn’t replace standard-of-care and guideline-based treatments. It’s important to remember that cannabis may interact with some medications, such as blood thinners, so discussing it with your doctor before trying is crucial. Additionally, cannabis isn’t regulated as strictly as FDA-approved drugs in the U.S., which means the strength and purity could vary.