Medical Cannabis: A Review from the American Society of Pain and Neuroscience

Abstract

Cannabinoids have recently gained a renewed interest due to their potential applicability to various medical conditions, specifically the management of chronic pain conditions. Unlike many other medications, medical cannabis is not associated with serious adverse events, and no overdose deaths have been reported. However, both safety and efficacy data for medical cannabis treatment of chronic, nonmalignant pain conditions are lacking. Therefore, representatives from the American Society of Pain and Neuroscience summarize the evidence, according to level and grade, for medical cannabis treatment of several different pain conditions. Treatment of cancer-related pain has prospective evidentiary support for the use of medical cannabis. Although 3 large and well-designed randomized controlled trials investigated cannabis treatment of cancer-related pain, the evidence yielded only a grade D recommendation. Neuropathic pain has been investigated in prospective studies, but a lack of high-quality evidence renders cannabis treatment for this indication a grade C recommendation. Both safety and efficacy data are lacking for use of medical cannabis to treat chronic nonmalignant pain conditions.

Keywords:

• analgesia
• chronic pain
• marijuana treatment
• neuralgia
• postoperative pain

Abbreviations

CBD, cannabidiol; CBP, cannabis-based product; CSA, Controlled Substances Act; FDA, US Food and Drug Administration; PPSP, persistent postsurgical pain; THC, tetrahydrocannabinol.

Data Sharing Statement

All relevant data supporting the findings of this study are reported in the article.

Acknowledgment

Nisha Badders, PhD, ELS, Mayo Clinic, substantively edited the manuscript. The Scientific Publications staff at Mayo Clinic provided proofreading and administrative and clerical support.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

Dr Jackie Weisbein reports consulting, advisory board, and/or research for Abbott, Saluda, Biotronik, SI Bone, Vertos, and Medtronic, outside the submitted work. Dr Jason E Pope reports research, consultant for, and/or stock from Abbott, Saluda, Biotronik, SPR Therapeutics, Thermaquil, Spark, Painteq, Vertos, Aurora, WISE, and Boston Scientific, outside the submitted work; In addition, Dr Jason E Pope has a patent DRG Neuromonitoring licensed to NIS. Dr Dawood Sayed reports personal fees from Nevro, Saluda, and Vertos; stocks from Painteq, outside the submitted work. The authors report no other conflicts of interest in this work.

Additional information

Funding

There is no funding to report.