Perceptions and Preoccupations of Patients and Physicians Regarding Use of Medical Cannabis as an Intervention Against Chronic Musculoskeletal Pain: Results from a Qualitative Study

Abstract

Objective

Explore perceptions and preoccupations regarding use of medical cannabis against chronic musculoskeletal pain, among patients and physicians.

Design

Qualitative study using interviews with patients and physicians, based on the Theory of Planned Behavior (TPB).

Setting

The study was conducted in Quebec, Canada, in spring 2020.

Subjects

We included 27 adult patients and 11 physicians (GPs, anesthesiologists, psychiatrists, and a rheumatologist); the mean age of patients was 48.2 years; 59.3% of patients and 36.4% of physicians were women; 59.3% of patients used no medical cannabis at the time of study; 45.5% of physicians had never authorized it.

Methods

Semi-structured interviews were conducted, transcribed and for the qualitative analysis codes were developed in a hybrid, inductive and deductive approach. Guided by the TPB, facilitators and barriers, perceived benefits and harms, and perceived norms that may influence cannabis use or authorization were documented.

Results

Although medical cannabis is an interesting avenue for the relief of chronic musculoskeletal pain, doctors and patients agreed that it remained a last line option, due to the lack of scientific evidence regarding its safety and efficacy. The norms surrounding medical cannabis also play an important role in the social and professional acceptance of this therapeutic option.

Conclusion

Medical cannabis is seen as a last line option among interventions in the management of chronic pain, and attitudes and prior experiences play a role in the decision to use it. Study results may contribute to improved shared decision making between patients and physicians regarding this option.

Plain Language Summary

Little is known about the motivations, perceptions, and preoccupations of patients with chronic pain and their physicians regarding the use of medical cannabis against chronic pain. A qualitative study was done on the attitudes and perceptions of these patients and their physicians. We performed semi-structured interviews, guided by the Theory of Planned Behavior, with chronic pain patients and with physicians treating such patients. Results indicate that both patients and physicians consider medical cannabis as a last line therapeutic option against chronic pain. Also, both groups expressed a need for stronger evidence on the effectiveness and safety of medical cannabis, as well as for more and clearer guidance on when and how to use this additional option in the treatment of chronic pain.

Keywords:

• medical cannabis
• theory of planned behavior
• chronic musculoskeletal pain
• qualitative study
• lack of knowledge
• stigma

Acknowledgments

The authors wish to thank all patients and physicians who agreed to be interviewed as well as several research professionals (Steve Paquet, Justine Langlois) and the members of the study’s advisory committee (Drs Anne-Marie Pinard and Aline Boulanger).

Disclosure

All authors declare that they have no conflicts of interest to report in this work.

Additional information

Funding

The study received financial support from the Canadian Institutes of Health Research and the Quebec Network for Research in Aging of the Fonds de Recherche du Quebec – Santé (Quebec Health Research Funds), as well as logistical support from the Centre d’excellence sur le vieillissement de Québec (Quebec Centre for Excellence in Aging) du CIUSSSCN).