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Understanding the evidence for medical cannabis and cannabis-based medicines for the treatment of chronic non-cancer pain

Abstract

The use of medical cannabis and cannabis-based medicines has received increasing interest in recent years; with a corresponding surge in the number of studies and reviews conducted in the field. Despite this growth in evidence, the findings and conclusions of these studies have been inconsistent. In this paper, we outline the current evidence for medical cannabis and cannabis-based medicines in the treatment and management of chronic non-cancer pain. We discuss limitations of the current evidence, including limitations of randomised control trials in the field, limits on generalisability of previous findings and common issues such as problems with measurements of dose and type of cannabinoids. We discuss future directions for medicinal cannabinoid research, including addressing limitations in trial design; developing frameworks to monitor for use disorder and other unintended outcomes; and considering endpoints other than 30% or 50% reductions in pain severity.

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Funding

No direct funding was received to write this article. SN, ES and GC are supported by NHMRC research fellowships (#1132433, #1104600 and #1119992). The National Drug and Alcohol Research Centre at the University of New South Wales is supported by funding from the Australian Government under the Substance Misuse Prevention and Service Improvements Grant Fund.

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Correspondence to Gabrielle Campbell.

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SN has been an investigator on untied investigator-driven educational grants funded by Indivior and Reckitt-Benckiser and has had travel costs covered and honoraria paid to her institution to provide training on identification and management of codeine dependence by Indivior. GC has been an investigator on untied investigator driven educational grants from Reckitt-Benckiser. ES declares no conflicts of interest.

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Campbell, G., Stockings, E. & Nielsen, S. Understanding the evidence for medical cannabis and cannabis-based medicines for the treatment of chronic non-cancer pain. Eur Arch Psychiatry Clin Neurosci 269, 135–144 (2019). https://doi.org/10.1007/s00406-018-0960-9

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Keywords

  • Cannabis
  • Chronic pain
  • Medical cannabis
  • Cannabis-based medicines