Skip to main content

Advertisement

SpringerLink
Log in

Analgesic Effects of Cannabinoids for Chronic Non-cancer Pain: a Systematic Review and Meta-Analysis with Meta-Regression

  • Review
  • Published:
Journal of Neuroimmune Pharmacology Aims and scope Submit manuscript

Abstract

There is growing interest in using cannabinoids for chronic pain. We performed a systematic review and meta-analysis of randomized controlled trials to evaluate the analgesic efficacy and adverse effects of cannabinoids for chronic non-cancer pain. PubMed, EMBASE, Web of Science, Cochrane CENTRAL and clinicaltrials.gov were searched up to December 2018. Information on the type, dosage, route of administration, pain conditions, pain scores, and adverse events were extracted for qualitative analysis. Meta-analysis of analgesic efficacy was performed. Meta-regression was performed to compare the analgesic efficacy for different pain conditions (neuropathic versus non-neuropathic pain). Risk of bias was assessed by The Cochrane Risk of Bias tool, and the strength of the evidence was assessed using the Grade of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Forty-three randomized controlled trials were included. Meta-analysis was performed for 33 studies that compared cannabinoids to placebo, and showed a mean pain score (scale 0–10) reduction of −0.70 (p < 0.001, random effect). Meta-regression showed that analgesic efficacy was similar for neuropathic and non-neuropathic pain (Difference = −0.14, p = 0.262). Inhaled, oral, and oromucosal administration all provided statistically significant, but small reduction in mean pain score (−0.97, −0.85, −0.45, all p < 0.001). Incidence of serious adverse events was rare, and non-serious adverse events were usually mild to moderate. Heterogeneity was moderate. The GRADE level of evidence was low to moderate. Pain intensity of chronic non-cancer patients was reduced by cannabinoids consumption, but effect sizes were small. Efficacy for neuropathic and non-neuropathic pain was similar.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11

Similar content being viewed by others

References

  • Abrams DI, Vizoso HP, Shade SB, Jay C, Kelly ME, Benowitz NL (2007) Vaporization as a smokeless cannabis delivery system: a pilot study. Clin Pharmacol Ther 82:572–578

    Article  CAS  PubMed  Google Scholar 

  • Agurell S, Halldin M, Lindgren JE, Ohlsson A, Widman M, Gillespie H, Hollister L (1986) Pharmacokinetics and metabolism of delta 1-tetrahydrocannabinol and other cannabinoids with emphasis on man. Pharmacol Rev 38:21–43

    CAS  PubMed  Google Scholar 

  • Andre CM, Hausman J, Guerriero G (2016) Cannabis sativa: the Plant of the Thousand and one Molecules. Front Plant Sci 7:19

  • Andreae MH, Carter GM, Shaparin N, Suslov K, Ellis RJ, Ware MA, Abrams DI, Prasad H, Wilsey B, Indyk D, Johnson M, Sacks HS (2015) Inhaled Cannabis for chronic neuropathic pain: a meta-analysis of individual patient data. J Pain : Off J Am Pain Soc 16:1221–1232

    Article  Google Scholar 

  • Atakan Z (2012) Cannabis, a complex plant: different compounds and different effects on individuals. Therapeutic Adv Psychopharmacol 2:241–254

    Article  CAS  Google Scholar 

  • Aviram J, Samuelly-Leichtag G (2017) Efficacy of Cannabis-based medicines for pain management: a systematic review and meta-analysis of randomized controlled trials. Pain Physician 20:E755–e796

    Article  CAS  PubMed  Google Scholar 

  • Berman JS, Symonds C, Birch R (2004) Efficacy of two cannabis based medicinal extracts for relief of central neuropathic pain from brachial plexus avulsion: results of a randomised controlled trial. Pain 112:299–306

    Article  PubMed  Google Scholar 

  • Blake DR, Robson P, Ho M, Jubb RW, McCabe CS (2006) Preliminary assessment of the efficacy, tolerability and safety of a cannabis-based medicine (Sativex) in the treatment of pain caused by rheumatoid arthritis. Rheumatology 45:50–52

    Article  CAS  PubMed  Google Scholar 

  • Chan BK, Tam LK, Wat CY, Chung YF, Tsui SL, Cheung CW (2011) Opioids in chronic non-cancer pain. Expert Opin Pharmacother 12:705–720

    Article  PubMed  Google Scholar 

  • Cheung CW, Qiu Q, Choi SW, Moore B, Goucke R, Irwin M (2014) Chronic opioid therapy for chronic non-cancer pain: a review and comparison of treatment guidelines. Pain Physician 17:401–414

    Article  PubMed  Google Scholar 

  • Corey-Bloom J, Wolfson T, Gamst A, Jin S, Marcotte TD, Bentley H, Gouaux B (2012) Smoked cannabis for spasticity in multiple sclerosis: a randomized, placebo-controlled trial. Can Med Assoc J 184:1143–1150

    Article  Google Scholar 

  • D'Souza DC, Ranganathan M (2015) Medical marijuana: is the cart before the horse? Jama 313:2431–2432

    Article  CAS  PubMed  Google Scholar 

  • de Vries M, van Rijckevorsel DCM, Vissers KCP, Wilder-Smith OHG, van Goor H (2016) Single dose delta-9-tetrahydrocannabinol in chronic pancreatitis patients: analgesic efficacy, pharmacokinetics and tolerability. Br J Clin Pharmacol 81:525–537

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • de Vries M, van Rijckevorsel DCM, Vissers KCP, Wilder-Smith OHG, van Goor H (2017) Tetrahydrocannabinol does not reduce pain in patients with chronic abdominal pain in a phase 2 placebo-controlled study. Clin. Gastroenterol. Hepatol. 15:1079–1086.e1074

    Article  PubMed  CAS  Google Scholar 

  • Ellis RJ, Toperoff W, Vaida F, van den Brande G, Gonzales J, Gouaux B, Bentley H, Atkinson JH (2009) Smoked medicinal cannabis for neuropathic pain in HIV: a randomized, crossover clinical trial. Neuropsychopharmacol : Off Public Am College Neuropsychopharmacol 34:672–680

    Article  CAS  Google Scholar 

  • Els C, Jackson TD, Kunyk D, Lappi VG, Sonnenberg B, Hagtvedt R, Sharma S, Kolahdooz F, Straube S (2017) Adverse events associated with medium- and long-term use of opioids for chronic non-cancer pain: an overview of Cochrane reviews. Cochrane Database Syst Rev 10:Cd012509

    PubMed  Google Scholar 

  • Farrar JT, Portenoy RK, Berlin JA, Kinman JL, Strom BL (2000) Defining the clinically important difference in pain outcome measures. Pain 88:287–294

    Article  CAS  PubMed  Google Scholar 

  • Fitzcharles MA, Eisenberg E (2018) Medical cannabis: a forward vision for the clinician. Eur J Pain (London, England) 22:485–491

    Article  CAS  Google Scholar 

  • Frank B, Serpell MG, Hughes J, Matthews JNS, Kapur D (2008) Comparison of analgesic effects and patient tolerability of nabilone and dihydrocodeine for chronic neuropathic pain: randomised, crossover, double blind study. Br Med J 336:199–201

    Article  CAS  Google Scholar 

  • Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J, Norris S, Falck-Ytter Y, Glasziou P, Debeer H, Jaeschke R, Rind D, Meerpohl J, Dahm P, Schünemann HJ (2011) GRADE guidelines: 1. Introduction—GRADE evidence profiles and summary of findings tables. J Clin Epidemiol 64:383–394

    Article  PubMed  Google Scholar 

  • Hall W, Degenhardt L (2009) Adverse health effects of non-medical cannabis use. Lancet 374:1383–1391

    Article  CAS  PubMed  Google Scholar 

  • Hauser W, Petzke F, Fitzcharles MA (2018) Efficacy, tolerability and safety of cannabis-based medicines for chronic pain management - an overview of systematic reviews. Eur J Pain (London, England) 22:455–470

    Article  CAS  Google Scholar 

  • Hazekamp A, Ware MA, Muller-Vahl KR, Abrams D, Grotenhermen F (2013) The medicinal use of cannabis and cannabinoids--an international cross-sectional survey on administration forms. J Psychoactive Drugs 45:199–210

    Article  PubMed  Google Scholar 

  • Higgins J, Green S (eds) (2011) Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated march 2011]. In: The Cochrane Collaboration. Available from https://www.handbook.cochrane.org

  • Hill KP, Palastro MD, Johnson B, Ditre JW (2017) Cannabis and pain: a clinical review. Cannabis Cannabinoid Res 2:96–104

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Huestis MA (2007) Human cannabinoid pharmacokinetics. Chem Biodivers 4:1770–1804

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Huggins JP, Smart TS, Langman S, Taylor L, Young T (2012) An efficient randomised, placebo-controlled clinical trial with the irreversible fatty acid amide hydrolase-1 inhibitor PF-04457845, which modulates endocannabinoids but fails to induce effective analgesia in patients with pain due to osteoarthritis of the knee. Pain 153:1837–1846

    Article  CAS  PubMed  Google Scholar 

  • Iskedjian M, Bereza B, Gordon A, Piwko C, Einarson TR (2007) Meta-analysis of cannabis based treatments for neuropathic and multiple sclerosis-related pain. Curr Med Res Opin 23:17–24

    Article  CAS  PubMed  Google Scholar 

  • Issa MA, Narang S, Jamison RN, Michna E, Edwards RR, Penetar DM, Wasan AD (2014) The subjective psychoactive effects of oral dronabinol studied in a randomized, controlled crossover clinical trial for pain. Clin J Pain 30:472–478

    Article  PubMed  PubMed Central  Google Scholar 

  • Krcevski-Skvarc N, Wells C, Hauser W (2018) Availability and approval of cannabis-based medicines for chronic pain management and palliative/supportive care in Europe: a survey of the status in the chapters of the European pain federation. Eur J Pain (London, England) 22:440–454

    Article  CAS  Google Scholar 

  • Krebs EE, Gravely A, Nugent S, Jensen AC, DeRonne B, Goldsmith ES, Kroenke K, Bair MJ, Noorbaloochi S (2018) Effect of opioid vs nonopioid medications on pain-related function in patients with chronic Back pain or hip or knee osteoarthritis pain: the SPACE randomized clinical trial. Jama 319:872–882

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Langford RM, Mares J, Novotna A, Vachova M, Novakova I, Notcutt W, Ratcliffe S (2013) A double-blind, randomized, placebo-controlled, parallel-group study of THC/CBD oromucosal spray in combination with the existing treatment regimen, in the relief of central neuropathic pain in patients with multiple sclerosis. J Neurol 260:984–997

    Article  CAS  PubMed  Google Scholar 

  • Leocani L, Nuara A, Houdayer E, Schiavetti I, Del Carro U, Amadio S, Straffi L, Rossi P, Martinelli V, Vila C, Sormani M, Comi G (2015) Sativex ® and clinical–neurophysiological measures of spasticity in progressive multiple sclerosis. Off J Eur Neurol Soc 262:2520–2527

    CAS  Google Scholar 

  • Levy B, Paulozzi L, Mack KA, Jones CM (2015) Trends in opioid analgesic-prescribing rates by specialty, U.S., 2007-2012. Am J Prev Med 49:409–413

    Article  PubMed  PubMed Central  Google Scholar 

  • Lopez-Quintero C, Perez de los Cobos J, Hasin DS, Okuda M, Wang S, Grant BF, Blanco C (2011) Probability and predictors of transition from first use to dependence on nicotine, alcohol, cannabis, and cocaine: results of the National Epidemiologic Survey on alcohol and related conditions (NESARC). Drug Alcohol Depend 115:120–130

  • Lynch ME, Campbell F (2011) Cannabinoids for treatment of chronic non-cancer pain; a systematic review of randomized trials. Br J Clin Pharmacol 72:735–744

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Lynch ME, Ware MA (2015) Cannabinoids for the treatment of chronic non-Cancer pain: an updated systematic review of randomized controlled trials. J Neuroimmune Pharmacol : Off J Soc NeuroImmune Pharmacol 10:293–301

    Article  CAS  Google Scholar 

  • Lynch ME, Cesar-Rittenberg P, Hohmann AG (2014) A double-blind, placebo-controlled, crossover pilot trial with extension using an Oral mucosal cannabinoid extract for treatment of chemotherapy-induced neuropathic pain. J Pain Symptom Manag 47:166–173

    Article  Google Scholar 

  • Malik Z, Bayman L, Valestin J, Rizvi-Toner A, Hashmi S, Schey R (2017) Dronabinol increases pain threshold in patients with functional chest pain: a pilot double-blind placebo-controlled trial. Dis Esophagus 30(2):1–8

  • Markovà J, Essner U, Akmaz B, Marinelli M, Trompke C, Lentschat A, Vila Silván C (2018) Sativex® as Add-on therapy Vs. further optimized first-line ANTispastics (SAVANT) in resistant multiple sclerosis spasticity: a double-blind, placebo-controlled randomised clinical trial. Int J Neurosci:1–28

  • Martin-Sanchez E, Furukawa TA, Taylor J, Martin JL (2009) Systematic review and meta-analysis of cannabis treatment for chronic pain. Pain Med (Malden, mass) 10:1353–1368

    Article  Google Scholar 

  • Meng H, Johnston B, Englesakis M, Moulin DE, Bhatia A (2017) Selective cannabinoids for chronic neuropathic pain: a systematic review and meta-analysis. Anesth Analg 125:1638–1652

    Article  CAS  PubMed  Google Scholar 

  • Moulin D, Boulanger A, Clark AJ, Clarke H, Dao T, Finley GA, Furlan A, Gilron I, Gordon A, Morley-Forster PK, Sessle BJ, Squire P, Stinson J, Taenzer P, Velly A, Ware MA, Weinberg EL, Williamson OD (2014) Pharmacological management of chronic neuropathic pain: revised consensus statement from the Canadian Pain Society. Pain Res Manag 19:328–335

    Article  PubMed  PubMed Central  Google Scholar 

  • Mucke M, Phillips T, Radbruch L, Petzke F, Hauser W (2018) Cannabis-based medicines for chronic neuropathic pain in adults. Cochrane Database Systematic Rev 3:Cd012182

    Google Scholar 

  • Murphy KL, Bethea JR, Fischer R (2017) Neuropathic pain in multiple sclerosis-current therapeutic intervention and future treatment perspectives. In: Zagon IS, McLaughlin PJ (eds) Multiple sclerosis: perspectives in treatment and pathogenesis. Codon Publications, Brisbane (AU)

    Google Scholar 

  • Narang S, Gibson D, Wasan AD, Ross EL, Michna E, Nedelikovic SS, Jamison RN (2008) Efficacy of dronabinol as an adjuvant treatment for chronic pain patients on opioid therapy. J Pain 9:254–264

    Article  CAS  PubMed  Google Scholar 

  • NCT00710424 (2006) A study of Sativex® for pain relief due to diabetic neuropathy

  • NCT01606176 (2002) A Study to Evaluate the Effects of Cannabis Based Medicine in Patients With Pain of Neurological Origin

  • NCT01606202 (2005) A study of cannabis based medicine extracts and placebo in patients with pain due to spinal cord injury

  • Nicol AL, Hurley RW, Benzon HT (2017) Alternatives to opioids in the pharmacologic Management of Chronic Pain Syndromes: a narrative review of randomized, controlled, and blinded clinical trials. Anesth Analg 125:1682–1703

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Notcutt W, Price M, Miller R, Newport S, Phillips C, Simmons S, Sansom C (2004) Initial experiences with medicinal extracts of cannabis for chronic pain: results from 34′N of 1′ studies. Anaesthesia 59:440–452

    Article  PubMed  Google Scholar 

  • Nurmikko TJ, Serpell MG, Hoggart B, Toomey PJ, Morlion BJ, Haines D (2007) Sativex successfully treats neuropathic pain characterised by allodynia: a randomised, double-blind, placebo-controlled clinical trial. Pain 133:210–220

    Article  CAS  PubMed  Google Scholar 

  • Pini LA, Guerzoni S, Cainazzo MM, Ferrari A, Sarchielli P, Tiraferri I, Ciccarese M, Zappaterra M (2012) Nabilone for the treatment of medication overuse headache: results of a preliminary double-blind, active-controlled, randomized trial. J Headache Pain 13:677–684

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Rintala DH, Fiess RN, Tan G, Holmes SA, Bruel BM (2010) Effect of Dronabinol on central neuropathic pain after spinal cord injury. Am J Phys Med Rehabil 89:840–848

    Article  PubMed  Google Scholar 

  • Rog DJ, Nurmikko TJ, Friede T, Young CA (2005) Randomized, controlled trial of cannabis-based medicine in central pain in multiple sclerosis. Neurology 65:812–819

    Article  PubMed  Google Scholar 

  • Romero-Sandoval EA, Kolano AL, Alvarado-Vazquez PA (2017) Cannabis and cannabinoids for chronic pain. Curr Rheumatol Rep 19:67

    Article  PubMed  CAS  Google Scholar 

  • Russell C, Rueda S, Room R, Tyndall M, Fischer B (2018) Routes of administration for cannabis use - basic prevalence and related health outcomes: a scoping review and synthesis. Int J Drug Policy 52:87–96

    Article  PubMed  Google Scholar 

  • Salim K, Schneider U, Burstein S, Hoy L, Karst M (2005) Pain measurements and side effect profile of the novel cannabinoid ajulemic acid. Neuropharmacology 48:1164–1171

    Article  CAS  PubMed  Google Scholar 

  • Selvarajah D, Gandhi R, Emery CJ, Tesfaye S (2010) Randomized placebo-controlled double-blind clinical trial of Cannabis-based medicinal product (Sativex) in painful diabetic neuropathy depression is a major confounding factor. Diabetes Care 33:128–130

    Article  PubMed  Google Scholar 

  • Serpell M, Ratcliffe S, Hovorka J, Schofield M, Taylor L, Lauder H, Ehler E (2014) A double-blind, randomized, placebo-controlled, parallel group study of THC/CBD spray in peripheral neuropathic pain treatment. Eur J Pain 18:999–1012

    Article  CAS  PubMed  Google Scholar 

  • Skrabek RQ, Gallmova L, Ethans K, Perry D (2008) Nabilone for the treatment of pain in fibromyalgia. J Pain 9:164–173

    Article  CAS  PubMed  Google Scholar 

  • Stockings E, Campbell G, Hall WD, Nielsen S, Zagic D, Rahman R, Murnion B, Farrell M, Weier M, Degenhardt L (2018) 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 159:1932–1954

    Article  CAS  PubMed  Google Scholar 

  • Stubbs B, Vancampfort D, Veronese N, Thompson T, Fornaro M, Schofield P, Solmi M, Mugisha J, Carvalho AF, Koyanagi A (2017) Depression and pain: primary data and meta-analysis among 237 952 people across 47 low- and middle-income countries. Psychol Med 47:2906–2917

    Article  CAS  PubMed  Google Scholar 

  • Svendsen KB, Jensen TS, Bach FW (2004) Does the cannabinoid dronabinol reduce central pain in multiple sclerosis? Randomised double blind placebo controlled crossover trial. Br Med J 329:253–257

    Article  CAS  Google Scholar 

  • Toth C, Mawani S, Brady S, Chan C, Liu CX, Mehina E, Garven A, Bestard J, Korngut L (2012) An enriched-enrolment, randomized withdrawal, flexible-dose, double-blind, placebo-controlled, parallel assignment efficacy study of nabilone as adjuvant in the treatment of diabetic peripheral neuropathic pain. Pain 153:2073–2082

    Article  CAS  PubMed  Google Scholar 

  • Treede R, Rief W, Barke A, Aziz Q, Bennett MI, Benoliel R, Cohen M, Evers S, Finnerup NB, First MB, Giamberardino MA, Kaasa S, Kosek E, Lavandʼhomme P, Nicholas M, Perrot S, Scholz J, Schug S, Smith BH, Svensson P, Vlaeyen JW, Wang SJ (2015) A classification of chronic pain for ICD-11. Pain 156:1003–1007

  • Turcotte D, Doupe M, Torabi M, Gomori A, Ethans K, Esfahani F, Galloway K, Namaka M (2015) Nabilone as an adjunctive to gabapentin for multiple sclerosis-induced neuropathic pain: a randomized controlled trial. Pain Med 16:149–159

    Article  PubMed  Google Scholar 

  • van Amerongen G, Kanhai K, Baakman AC, Heuberger J, Klaassen E, Beumer TL, Strijers RL, Killestein J, van Gerven J, Cohen A, Groeneveld GJ (2017) Effects on spasticity and neuropathic pain of an Oral formulation of Delta9-Tetrahydrocannabinol in patients with progressive multiple sclerosis. Clin Ther 40:1467–1482

  • Wade DT, Robson P, House H, Makela P, Aram J (2003) A preliminary controlled study to determine whether whole-plant cannabis extracts can improve intractable neurogenic symptoms. Clin Rehabil 17:21–29

    Article  PubMed  Google Scholar 

  • Wade DT, Makela P, Robson P, House H, Bateman C (2004) Do cannabis-based medicinal extracts have general or specific effects on symptoms in multiple sclerosis? A double-blind, randomized, placebo-controlled study on 160 patients. Mult Scler 10:434–441

    Article  CAS  PubMed  Google Scholar 

  • Wallace MS, Marcotte TD, Umlauf A, Gouaux B, Atkinson JH (2015) Efficacy of inhaled Cannabis on painful diabetic neuropathy. J Pain 16:616–627

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Ware M, Desroches J (2014) Medical cannabis and pain. Pain Clinical Updates, International Association for the Study of Pain

  • Ware MA, Fitzcharles MA, Joseph L, Shir Y (2010a) The effects of nabilone on sleep in fibromyalgia: results of a randomized controlled trial. Anesth Analg 110:604–610

    Article  CAS  PubMed  Google Scholar 

  • Ware MA, Wang TT, Shapiro S, Robinson A, Ducruet T, Huynh T, Gamsa A, Bennett GJ, Collet JP (2010b) Smoked cannabis for chronic neuropathic pain: a randomized controlled trial. Can Med Assoc J 182:E694–E701

    Article  Google Scholar 

  • Whiting PF, Wolff RF, Deshpande S, Di Nisio M, Duffy S, Hernandez AV, Keurentjes JC, Lang S, Misso K, Ryder S, Schmidlkofer S, Westwood M, Kleijnen J (2015) Cannabinoids for medical use: a systematic review and meta-analysis. Jama 313:2456–2473

    Article  CAS  PubMed  Google Scholar 

  • Wilsey B, Marcotte T, Deutsch R, Gouaux B, Sakai S, Donaghe H (2013) Low-dose vaporized Cannabis significantly improves neuropathic pain. J Pain 14:136–148

    Article  CAS  PubMed  Google Scholar 

  • Wilsey B, Marcotte TD, Deutsch R, Zhao H, Prasad H, Phan A (2016) An exploratory human laboratory experiment evaluating vaporized Cannabis in the treatment of neuropathic pain from spinal cord injury and disease. J Pain 17:982–1000

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Wilsey B, Marcotte T, Tsodikov A, Millman J, Bentley H, Gouaux B, Fishman S (2008) A randomized, placebo-controlled, crossover trial of cannabis cigarettes in neuropathic pain. J Pain 9:506–521

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Wissel J, Haydn T, Muller J, Schelosky LD, Brenneis C, Berger T, Poewe W (2006) Low dose treatment with the synthetic cannabinoid Nabilone significantly reduces spasticity-related pain - a double-blind placebo-controlled cross-over trial. J Neurol 253:1337–1341

    Article  CAS  PubMed  Google Scholar 

  • Workman EA, Hubbard JR, Felker BL (2002) Comorbid psychiatric disorders and predictors of pain management program success in patients with chronic pain. Primary Care Companion J Clin Psychiatry 4:137–140

    Article  PubMed  PubMed Central  Google Scholar 

  • Yadav V, Bever C Jr, Bowen J, Bowling A, Weinstock-Guttman B, Cameron M, Bourdette D, Gronseth GS, Narayanaswami P (2014) Summary of evidence-based guideline: complementary and alternative medicine in multiple sclerosis: report of the guideline development subcommittee of the American Academy of Neurology. Neurology 82:1083–1092

    Article  PubMed  PubMed Central  Google Scholar 

  • Yanes JA, McKinnell ZE, Reid MA, Busler JN, Michel JS, Pangelinan MM, Sutherland MT, Younger JW, Gonzalez R, Robinson JL (2019) Effects of cannabinoid administration for pain: a meta-analysis and meta-regression. Exp Clin Psychopharmacol 27(4):370–382

  • Yayan J, Rasche K (2016) Damaging effects of Cannabis use on the lungs. Adv Exp Med Biol 952:31–34

    Article  PubMed  Google Scholar 

  • Zajicek J, Fox P, Sanders H, Wright D, Vickery J, Nunn A, Thompson A, Grp UMR (2003) Cannabinoids for treatment of spasticity and other symptoms related to multiple sclerosis (CAMS study): multicentre randomised placebo-controlled trial. Lancet (London, England) 362:1517–1526

    Article  CAS  Google Scholar 

  • Zajicek JP, Hobart JC, Slade A, Barnes D, Mattison PG, Grp MR (2012) Multiple sclerosis and extract of Cannabis: results of the MUSEC trial. J Neurol Neurosurg Psychiatry 83:1125–1132

Download references

Acknowledgements

This study was supported by the Department of Anaesthesiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong.

Funding

This study was funded by the Department of Anaesthesiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong.

Author information

Authors and Affiliations

  1. Laboratory and Clinical Research Institute for Pain, Department of Anaesthesiology, The University of Hong Kong, Hong Kong, HKSAR, People’s Republic of China

    Stanley Sau Ching Wong & Chi Wai Cheung

  2. Department of Anaesthesiology, The University of Hong Kong, Room 424, Block K, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, HKSAR, People’s Republic of China

    Stanley Sau Ching Wong, Wing Shing Chan & Chi Wai Cheung

Authors
  1. Stanley Sau Ching Wong
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wing Shing Chan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chi Wai Cheung
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Stanley Sau Ching Wong, Wing Shing Chan and Chi Wai Cheung contributed to the design, analysis, interpretation of data, and critical revision. Chi Wai Cheung conceived the study. Stanley Sau Ching Wong and Wing Shing Chan contributed to acquisition of data and drafting of the manuscript. All authors had discussed the results and commented on the manuscript with final approval of the version to be published. Chi Wai Cheung had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Corresponding author

Correspondence to Chi Wai Cheung.

Ethics declarations

Conflict of Interests

None declared, including any commercial or non-commercial affiliations or other associations.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wong, S.S.C., Chan, W.S. & Cheung, C.W. Analgesic Effects of Cannabinoids for Chronic Non-cancer Pain: a Systematic Review and Meta-Analysis with Meta-Regression. J Neuroimmune Pharmacol 15, 801–829 (2020). https://doi.org/10.1007/s11481-020-09905-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11481-020-09905-y

Keywords

Search

Navigation