Cannabis-Based Medicines and Medical Cannabis in Rheumatic Diseases: A Treasure Chest or Pandora’s box

  • Mary-Ann FitzcharlesEmail author
  • Winfried Hauser
Pain in Rheumatology (W Nielson, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Pain in Rheumatology



Interest in cannabinoids as a therapy in rheumatic diseases has grown exponentially. With legalization of medical and recreational cannabis in many jurisdictions worldwide, patients have easier access and opportunity to explore medicinal use. We report on the evidence for effect of cannabinoids in rheumatic diseases and critically address the current challenges surrounding use.

Recent findings

Preclinical study of cannabinoids points to an effect on pain and inflammation, fundamental features of rheumatic diseases. The findings of the few randomized controlled trials (RCTSs) of cannabis-based medicines in rheumatic diseases are limited by short study duration, small study samples, and methodology flaws. There are no RCTs of medical cannabis in rheumatic diseases. Therefore, current guidelines mostly recommend against use of any cannabinoid product for rheumatology patients.


Even with limited clinical evidence, patients are increasingly showing interest in cannabis. Rheumatologists must be diligent in exploring other established treatment options prior to a trial of cannabinoids in any form. Cannabis holds potential as a treasure chest for rheumatic disease treatment, but with true effect and risks largely unknown and requiring study. Governments’ move to legalize medical cannabis has bypassed the established procedures of drug approval and opened Pandora’s box.


Cannabinoids Rheumatic disease Medicinal herbal cannabis 


Compliance with Ethical Standards

Conflict of Interest

Dr. Fitzcharles declares that she has no conflicts of interest.

Dr. Häuser received travel and hotel reimbursement from Bioevents. Dr. Häuser is the head of the task force of a position paper of the European Pain Federation on cannabis-based medicines and medical cannabis for chronic pain, and a member of the task force of the German Pain Society of a position paper on cannabis-based medicines and medical cannabis for chronic pain.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Alan Edwards Pain Management UnitMcGill University Health CentreMontrealCanada
  2. 2.Division of RheumatologyMcGill University Health CentreQuebecCanada
  3. 3.Health Care Center for Pain Medicine and Mental Health Saarbrücken-St. JohannSaarbrückenGermany
  4. 4.Department of Psychosomatic Medicine and PsychotherapyTechnische Universität MünchenMunichGermany

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