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Patient-reported outcomes in those consuming medical cannabis: a prospective longitudinal observational study in chronic pain patients

Résultats rapportés par les patients consommant du cannabis médical : une étude observationnelle longitudinale prospective chez des patients souffrant de douleur chronique

Abstract

Purpose

We investigated patients with chronic pain seeking medical cannabis. We assessed their demographics, patterns of cannabis use, and the long-term effectiveness of cannabis on their pain and functional domains.

Methods

This observational study enrolled patients between 8 September 2015 and 31 July 2018 from community-based cannabis clinics in Ontario, Canada. In addition to collecting demographic information, the primary outcomes studied were pain intensity and pain-related interference scores assessed at baseline, three, six, and 12 months. Using validated questionnaires, we also assessed anxiety, depression, quality of life (QoL), general health symptoms, neuropathic pain, self-reported opioid consumption, and adverse events.

Results

Of the 1,000 patients consented, 757 (76%) participated at one or more of the study time points. At six and 12 months, 230 (30.4%) and 104 (13.7%) of participants were followed up, respectively. Most participants were female (62%), Caucasian (91%), and sought cannabis for pain relief (88%). Time was a significant factor associated with improvement in pain intensity (P < 0.001), pain-related interference scores (P < 0.001), QoL (P < 0.001), and general health symptoms (P < 0.001). Female sex was significantly associated with worse outcomes than male sex including pain intensity (P < 0.001) and pain-related interference (P < 0.001). The proportion of individuals who reported using opioids decreased by half, from 40.8% at baseline to 23.9% at 12 months.

Conclusion

Despite significant challenges to collecting long-term observational data on patients who attempted a trial of cannabis products, approximately one-third of patients in the cohort remained on medical cannabis for six months. In this cohort, pain intensity and pain-related interference scores were reduced and QoL and general health symptoms scores were improved compared with baseline.

Résumé

Objectif

Nous avons étudié des patients souffrant de douleur chronique et cherchant à obtenir du cannabis médical. Nous avons évalué leurs données démographiques, leurs habitudes de consommation de cannabis et l’efficacité à long terme du cannabis sur leur douleur et leurs domaines fonctionnels.

Méthode

Cette étude observationnelle a recruté des patients entre le 8 septembre 2015 et le 31 juillet 2018 dans des cliniques communautaires de cannabis en Ontario, au Canada. En plus de recueillir des renseignements démographiques, les critères d’évaluation principaux étudiés étaient l’intensité de la douleur et les scores d’interférence liés à la douleur évalués au début de l’étude et à trois, six et 12 mois. À l’aide de questionnaires validés, nous avons également évalué l’anxiété, la dépression, la qualité de vie (QdV), les symptômes généraux de santé, la douleur neuropathique, la consommation d’opioïdes rapportée et les effets indésirables.

Résultats

Sur les 1000 patients consentants, 757 (76 %) ont participé à un ou plusieurs des points d’analyse de l’étude. À six et douze mois, 230 (30,4 %) et 104 (13,7 %) patients ont participé, respectivement. La plupart des participants étaient des femmes (62 %) d’origine caucasienne (91 %) et cherchaient à soulager leur douleur avec du cannabis (88 %). Le temps était un facteur important associé à l’amélioration de l’intensité de la douleur (P < 0,001), aux scores d’interférence liés à la douleur (P < 0,001), à la QdV (P < 0,001), et aux symptômes de santé généraux (P < 0,001). Le sexe féminin a été significativement associé à des pronostics moins bons que le sexe masculin, y compris en matière d’intensité de la douleur (P < 0,001) et d’interférences liées à la douleur (P < 0,001). La proportion de personnes qui ont déclaré utiliser des opioïdes a diminué de moitié, passant de 40,8 % au début de l’étude à 23,9 % à 12 mois.

Conclusion

Malgré des défis importants dans la collecte de données observationnelles à long terme concernant les patients qui participent à une étude sur les produits du cannabis, environ un tiers des patients de la cohorte ont continué à prendre du cannabis médical pendant six mois. Dans cette cohorte, l’intensité de la douleur et les scores d’interférence liés à la douleur ont été réduits, et les scores de QdV et de symptômes généraux de santé se sont améliorés par rapport au début de la période à l’étude.

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References

  1. 1.

    Schopflocher D, Taenzer P, Jovey R. The prevalence of chronic pain in Canada. Pain Res Manag 2011; 16: 445-50.

    Article  Google Scholar 

  2. 2.

    Lynch ME. The need for a Canadian pain strategy. Pain Res Manag 2011; 16: 77-80.

    Article  Google Scholar 

  3. 3.

    Aronoff GM. Chronic pain and the disability epidemic. Clin J Pain 1991; 7: 330-8.

    CAS  Article  Google Scholar 

  4. 4.

    Garcia Pereira F, Franca MH, Alochio de Paiva MC, Andrade LH, Viana MC. Prevalence and clinical profile of chronic pain and its association with mental disorders. Rev Saude Publica 2017; DOI: https://doi.org/10.11606/S1518-8787.2017051007025.

  5. 5.

    Manchikanti L, Fellows B, Ailinani H, Pampati V. Therapeutic use, abuse, and nonmedical use of opioids: a ten-year perspective. Pain Physician 2010; 13: 401-35.

    Article  Google Scholar 

  6. 6.

    Patented Medicine Prices Review Board The market for prescription oral solid opioids, 2010 to 2017 - Canada and the United States. Chartbook National Prescription Drug Utilization Information System. Available from URL: http://www.pmprb-cepmb.gc.ca/CMFiles/NPDUIS/chartbook_tramadol_e.pdf (accessed October 2020).

  7. 7.

    Ballantyne JC, LaForge KS. Opioid dependence and addiction during opioid treatment of chronic pain. Pain 2007; 129: 235-55.

    CAS  Article  Google Scholar 

  8. 8.

    Benyamin R, Trescot AM, Datta S, et al. Opioid complications and side effects. Pain Physician 2008; 11(2 Suppl): S105-20.

    Article  Google Scholar 

  9. 9.

    Busse JW, Craigie S, Juurlink DN, et al. Guideline for opioid therapy and chronic noncancer pain. CMAJ 2017; 189: E659-66.

    Article  Google Scholar 

  10. 10.

    Meng H, Dai T, Hanlon JG, Downar J, Alibhai SM, Clarke H. Cannabis and cannabinoids in cancer pain management. Curr Opin Support Palliat Care 2020; 14: 87-93.

    Article  Google Scholar 

  11. 11.

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

    Article  Google Scholar 

  12. 12.

    Troutt WD, DiDonato MD. Medical cannabis in Arizona: patient characteristics, perceptions, and impressions of medical cannabis legalization. J Psychoactive Drugs 2015; 47: 259-66.

    Article  Google Scholar 

  13. 13.

    Walsh Z, Callaway R, Belle-Isle L, et al. Cannabis for therapeutic purposes: patient characteristics, access, and reasons for use. Int J Drug Policy 2013; 24: 511-6.

    Article  Google Scholar 

  14. 14.

    Kelly S, Jhaveri MD, Sagar DR, Kendall DA, Chapman V. Activation of peripheral cannabinoid CB1 receptors inhibits mechanically evoked responses of spinal neurons in noninflamed rats and rats with hindpaw inflammation. Eur J Neurosci 2003; 18: 2239-43.

    Article  Google Scholar 

  15. 15.

    Ibrahim MM, Rude ML, Stagg NJ, et al. CB2 cannabinoid receptor mediation of antinociception. Pain 2006; 122: 36-42.

    CAS  Article  Google Scholar 

  16. 16.

    Aviram J, Samuelly-Leichtag G. Efficacy of cannabis-based medicines for pain management: a systematic review and meta-analysis of randomized controlled trials. Pain Physician 2017; 20: E755-96.

    CAS  Article  Google Scholar 

  17. 17.

    Meng H, Johnston B, Englesakis M, Moulin DE, Bhatia A. Selective cannabinoids for chronic neuropathic pain: a systematic review and meta-analysis. Anesth Analg 2017; 125: 1638-52.

    CAS  Article  Google Scholar 

  18. 18.

    Stockings E, Campbell G, Hall WD, et al. 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 2018; 159: 1932-54.

    CAS  Article  Google Scholar 

  19. 19.

    Hill KP. Medical marijuana for treatment of chronic pain and other medical and psychiatric problems: a clinical review. JAMA 2015; 313: 2474-83.

    CAS  Article  Google Scholar 

  20. 20.

    Kuhathasan N, Dufort A, MacKillop J, Gottschalk R, Minuzzi L, Frey BN. The use of cannabinoids for sleep: a critical review on clinical trials. Exp Clin Psychopharmacol 2019; 27: 383-401.

    Article  Google Scholar 

  21. 21.

    Rod K. A pilot study of a medical cannabis - opioid reduction program. Am J Psychiatry Neurosci 2019; 7: 74-7.

    Article  Google Scholar 

  22. 22.

    Whiting PF, Wolff RF, Deshpande S, et al. Cannabinoids for medical use: a systematic review and meta-analysis. JAMA 2015; 313: 2456-73.

    CAS  Article  Google Scholar 

  23. 23.

    Gates PJ, Albertella L, Copeland J. The effects of cannabinoid administration on sleep: a systematic review of human studies. Sleep Med Rev 2014; 18: 477-87.

    Article  Google Scholar 

  24. 24.

    Lucas P. Rationale for cannabis-based interventions in the opioid overdose crisis. Harm Reduct J 2017; DOI: https://doi.org/10.1186/s12954-017-0183-9

    Article  PubMed  PubMed Central  Google Scholar 

  25. 25.

    Tan G, Jensen MP, Thornby JI, Shanti BF. Validation of the brief pain inventory for chronic nonmalignant pain. J Pain 2004; 5: 133-7.

    Article  Google Scholar 

  26. 26.

    Turk DC, Fillingim RB, Ohrbach R, Patel KV. Assessment of psychosocial and functional impact of chronic pain. J Pain 2016; 17(9 Suppl): T21-49.

    Article  Google Scholar 

  27. 27.

    Agborsangaya CB, Lahtinen M, Cooke T, Johnson JA. Comparing the EQ-5D 3L and 5L: measurement properties and association with chronic conditions and multimorbidity in the general population. Health Qual Life Outcomes 2014; DOI: https://doi.org/10.1186/1477-7525-12-74

    Article  PubMed  PubMed Central  Google Scholar 

  28. 28.

    David H, Bruera E. The Edmonton symptom assessment system 25 years later: past, present and future developments. J Pain Symptom Manage 2018; 53: 630-43.

    Google Scholar 

  29. 29.

    Yawn BP, Wollan PC, Weingarten TN, Watson JC, Hooten WM, Melton LJ 3rd. The prevalence of neuropathic pain: clinical evaluation compared with screening tools in a community population. Pain Med 2009; 10: 586-93.

    Article  Google Scholar 

  30. 30.

    Government of Canada. Market data under the access to cannabis for medical purposes regulations - 2019. Available from URL: https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/research-data/medical-purpose.html (accessed October 2020).

  31. 31.

    Government of Canada. Cannabis extracts market data: Government of Canada; 2019. Available from URL: https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/research-data/market/extracts.html (accessed October 2020).

  32. 32.

    .Barrus DG, Capogrossi KL, Cates SC, et al. Tasty THC: promises and challenges of cannabis edibles. Methods Rep RTI Press 2016; DOI: https://doi.org/10.3768/rtipress.2016.op.0035.1611.

  33. 33.

    Ware MA, Wang T, Shapiro S, Collet JP; COMPASS Study Team. Cannabis for the Management of Pain: Assessment of Safety Study (COMPASS). J Pain 2015; 16: 1233-42.

  34. 34.

    Cuttler C, Spradlin A, McLaughlin RJ. A naturalistic examination of the perceived effects of cannabis on negative affect. J Affect Disord 2018; 235: 198-205.

    Article  Google Scholar 

  35. 35.

    Salio C, Fischer J, Franzoni MF, Mackie K, Kaneko T, Conrath M. CB1-cannabinoid and mu-opioid receptor co-localization on postsynaptic target in the rat dorsal horn. Neuroreport 2001; 12: 3689-92.

    CAS  Article  Google Scholar 

  36. 36.

    Rios C, Gomes I, Devi LA. mu opioid and CB1 cannabinoid receptor interactions: reciprocal inhibition of receptor signaling and neuritogenesis. Br J Pharmacol 2006; 148: 387-95.

    CAS  Article  Google Scholar 

  37. 37.

    Cuttler C, Mischley LK, Sexton M. Sex differences in cannabis use and effects: a cross-sectional survey of cannabis users. Cannabis Cannabinoid Res 2016; 1: 166-75.

    Article  Google Scholar 

  38. 38.

    Cooper ZD, Craft RM. Sex-dependent effects of cannabis and cannabinoids: a translational perspective. Neuropsychopharmacology 2018; 43: 34-51.

    CAS  Article  Google Scholar 

  39. 39.

    Redmond WJ, Goffaux P, Potvin S, Marchand S. Analgesic and antihyperalgesic effects of nabilone on experimental heat pain. Curr Med Res Opin 2008; 24: 1017-24.

    CAS  Article  Google Scholar 

  40. 40.

    Cooper ZD, Haney M. Sex-dependent effects of cannabis-induced analgesia. Drug Alcohol Depend 2016; 167: 112-20.

    Article  Google Scholar 

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Author contributions

Howard Meng, Hance Clarke, and Amol Deshpande contributed to the design of the study and writing of the manuscript. Gabrielle Page contributed to the data analysis and writing of the manuscript. Prabjit Ajrawat, Karim Ladha, Joseph Fiorellino, Alexander Huang, Yuvaraj Kotteeswaran, Alex McClaren-Blades, and Lakshmi P. Kotra contributed to the writing of the manuscript. Bana Samman and Mary Dominicis contributed to the data analysis.

Acknowledgements

We would like to acknowledge funding of this project provided by Canvas Rx. Canvas Rx provided funding for a research coordinator tasked with managing data collection. Canvas Rx did not have any role in data analysis or access to the manuscript before submission.

Disclosures

None.

Funding statement

Canvas Rx Clinics Canvas Rx was a private Cannabis Clinic operating the province of Ontario at the time of this study. They have since been acquired by Aurora Cannabis Inc. a Canadian licensed cannabis producer, Edmonton, Alberta, Canada. Canvas Rx provided funding for a research coordinator tasked with managing data collection. Canvas Rx did not have any role in data analysis or access to the manuscript before submission.

Editorial responsibility

This submission was handled by Dr. Hilary P. Grocott, Editor-in-Chief, Canadian Journal of Anesthesia.

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Correspondence to Hance Clarke MD, PhD, FRCPC.

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Meng, H., Page, M.G., Ajrawat, P. et al. Patient-reported outcomes in those consuming medical cannabis: a prospective longitudinal observational study in chronic pain patients. Can J Anesth/J Can Anesth 68, 633–644 (2021). https://doi.org/10.1007/s12630-020-01903-1

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