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The Role of Cannabis, Cannabidiol and Other Cannabinoids in Chronic Pain. The Perspective of Physicians

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Abstract

Currently, there is a renewed interest in treatments with medical cannabis and cannabinoids. Based on an increasing number of publications over the last decades that permitted new insights into mechanisms, efficacy and safety of cannabinoids, the use of cannabinergic medications is authorised in an increasing number of European and non-European countries. The alleviation of chronic, painful conditions is, since thousands of years, one of the primary reasons for the use of cannabis. Depending on the country, a wide range of medicinal cannabis preparations are available:ranging from defined cultivars of medical cannabis, mainly varying in their THC:CBD ratio, that are inhaled or taken as whole plant extracts,to highly purified single cannabinoids, such as delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD),or mixtures of two enriched extracts, standardised to a 1:1 ratio of THC:CBD (nabiximols). Although conflicting opinions continue to exist, the majority of reviews in the past concluded that medical cannabis and cannabinoids play a significant role in the management of pain. Surprisingly, systematic studies to date do not support an “entourage effect” of the other plant constituents of cannabis (mainly terpenoids) in treatment of chronic pain. An emerging cannabinoid is CBD which is the only cannabinergic medication available at present that does not cause the typical “cannabis high”; it is not a “controlled substance”. However, despite years of research, there is either no study or no well-conducted, head-to-head, comparison available between different cannabis cultivars, between pure cannabinoids, and between pure cannabinoids and extracts. It remains unanswered which is the optimal treatment approach.

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Abbreviations

CND:

Commission on Narcotic Drugs (the UN’s central drug policy-making body)

ECDD:

Expert Committee on Drug Dependence (WHO)

EMA:

European Medicines Agency

EO:

Essential oil

FDA:

Food and Drug Administration (US)

MS:

Multiple sclerosis

NRS:

Numerical rating scale

VAS:

Visual analogue scale

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Authors and Affiliations

  1. Klinikum Klagenfurt Am Wörthersee, Department of Anaesthesiology, Critical Care, Emergency, Palliative and Pain Medicine, Klagenfurt am Wörthersee, Austria

    Markus Köstenberger, Stefan Neuwersch & Rudolf Likar

  2. Medical University Graz, Graz, Austria

    Markus Köstenberger & Stefan Neuwersch

  3. CIS Clinical Investigation Support GmbH, Vienna, Austria

    Gerhard Nahler

  4. King´S College London, London, UK

    Trevor M. Jones

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  1. Markus Köstenberger
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  2. Gerhard Nahler
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  4. Stefan Neuwersch
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  5. Rudolf Likar
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All authors have made substantial contributions to the conception and design of the review, or acquisition of data, or analysis and interpretation of data, to drafting the article or revising it critically for important intellectual content and made a final approval of the version which is submitted.

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Köstenberger, M., Nahler, G., Jones, T.M. et al. The Role of Cannabis, Cannabidiol and Other Cannabinoids in Chronic Pain. The Perspective of Physicians. J Neuroimmune Pharmacol 17, 318–333 (2022). https://doi.org/10.1007/s11481-021-10010-x

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