Patients Living with Chronic Pain Get Help with Cannabis

Research suggests that switching from opioid pills to cannabis can lessen the burden of living with chronic pain. 

Right now, more than 100 million Americans live with chronic pain. This adds an estimated 695 billion dollars to healthcare costs per year ^[1]Simon, L. S. (2012)Relieving pain in America: A blueprint for transforming prevention, care, education, and research. Journal of Pain & Palliative Care Pharmacotherapy, 26(2), 197-198.. Unfortunately, ineffective treatments and unfavorable side effects reveal why living with chronic pain is a challenge for society.

Unfortunately, this is all magnified by the opioid crisis, which heavily contributed to 67,000 overdose deaths in 2018. Effective and safer treatment options are desperately needed. Cannabis has emerged as a possible alternative to traditional pharmaceuticals for many health conditions, yet still with little evidence to back it up. Cannabis for the treatment of chronic pain, however, enjoys some positive research. Growing evidence, endorsed by some of the largest medical associations in the world, suggests that cannabis is an effective treatment for chronic pain. And the word is getting out to chronic pain patients.

Cannabis May Be Effective for Those Living With Chronic Pain

In a meta-analysis, published in the Journal of the American Medical Association (2015), authors investigated the effect of cannabis on various disease-specific outcomes, including chronic pain ^[2]Whiting, P. F., Wolff, R. F., Deshpande, S., Di Nisio, M., Duffy, S., Hernandez, A. V., … & Schmidlkofer, S. (2015). Cannabinoids for medical use: a systematic review and … Continue reading. The analysis included twenty-eight studies consisting of almost 2500 participants and cannabis consumption methods ranging from smoked THC, oromucosal spray, synthetic cannabinoids, vaporized cannabis, and oral THC. All but one of the studies were placebo-controlled.

The data demonstrated that in eight of the studies, the average number of patients who reported a reduction in pain (of at least thirty percent), was greater with cannabis compared to the placebo. This outcome, combined with the rest of the analysis, led the authors to conclude that there was moderate-quality evidence to suggest that cannabinoids may be effective for the treatment of chronic neuropathic or cancer-related pain. However, the outcomes were not statistically significant and the researchers flagged seventeen of the twenty-eight studies as having a high risk of bias. Additional large, well-designed randomized controlled trials will provide further clarity on the benefit of cannabis for chronic pain, but patients are not waiting.

Living With Chronic Pain is the Top Reason for Trying Cannabis 

When chronic pain becomes too much, patients are turning to cannabis. In fact, it’s the number one reason people seek a medical cannabis prescription. So, in a study published in Health Affairs (2019), the researchers analyzed state registry data to obtain country-wide estimates characterising the qualifying conditions for patient cannabis prescriptions ^[3]Boehnke, K. F., Gangopadhyay, S., Clauw, D. J., & Haffajee, R. L. (2019). Qualifying conditions of medical cannabis license holders in the United States. Health Affairs, 38(2), 295-302.. Additionally, they provided a report on cannabis’s efficacy in treating each qualifying condition from the National Academies of Sciences, Engineering, and Medicine (NASEM).

The findings showed that chronic pain is currently, and has been, the most common qualifying condition for cannabis. Accordingly, medical patient referrals for chronic pain sit at almost sixty-five percent. Furthermore, the 2017 NASEM report classified cannabis for chronic pain treatment as having a substantial level of evidence. Increasing awareness and evidence of efficacy and safety in the context of the current opioid crisis is making patients switch from pills to medical cannabis.

Many Patients Are Making the Switch to Cannabis

In a study published in the Journal of Pain (2019), the researchers recruited chronic pain patients to participate in an on-going, online survey about how cannabis affects their pain management, health, and pain medication use ^[4]Boehnke, K. F., Scott, J. R., Litinas, E., Sisley, S., Williams, D. A., & Clauw, D. J. (2019). Pills to pot: observational analyses of cannabis substitution among medical cannabis users with … Continue reading. Of the almost 1500 respondents, approximately eighty percent reported substituting cannabis for pain medications, such as opioids and benzodiazepines. Interestingly, experienced cannabis consumers (more than one year experience) were less likely to take additional pain medications and more likely to report improved health compared to novice consumers (less than one year experience). This suggests that experience and comfortability with the drug is associated with substitution.

Research Suggests that Patients Experience Better Outcomes with Cannabis

When moving from traditional pain medications to cannabis, the chronic pain patients reported that fewer side effects and better symptom management motivated the switch. Accordingly, this aligns with previous research from the same authors that demonstrated that cannabis is associated with better health outcomes^[5]Boehnke, K. F., Litinas, E., & Clauw, D. J. (2016). Medical cannabis use is associated with decreased opiate medication use in a retrospective cross-sectional survey of patients with chronic … Continue reading. Again, utilizing an online questionnaire, the researchers found that medical cannabis consumption changed individual patterns of opioid use leading to a sixty-four percent decrease.

Furthermore, the patients reported:

• a decrease in their number of medications,
• fewer side effects,
• and most importantly, improved quality of life.

What’s Next for Chronic Pain Patients? 

More chronic pain patients will make the switch to cannabis. So what will drive this? Most likely patient to patient awareness or media attention. With increasing evidence, more physicians may further recommend it as well. But as mentioned earlier, the evidence is not what many physicians would consider strong. Larger and more robust RCTs are needed to move the needle.

Currently, the Canadian Pain Society Consensus Statement recommends prescribing opioid analgesics before cannabis for certain chronic pain conditions ^[6]Moulin, D. E., Boulanger, A., Clark, A. J., Clarke, H., Dao, T., Finley, G. A., … & Sessle, B. J. (2014). Pharmacological management of chronic neuropathic pain: revised consensus statement … Continue reading. This is particularly based on the evidence of benefit and harm for both substances. Future trials of head-to-head comparisons between opioids and cannabinoids could be very revealing. As yet, it is unclear when such trials will take place – however, if the momentum cannabis is gaining in research is any guide, it will be soon.