Medical Cannabis for the Treatment of Chronic Pain: A Review of Clinical Effectiveness and Guidelines

Key Message

Based on four overviews (with overlapping systematic reviews), and one systematic review of guidelines,8 there is some suggestion of benefit with cannabis-based medicines for neuropathic pain. However, benefits need to be weighed against harms. Findings are inconsistent for effect of cannabis-based medicines in patients with fibromyalgia, musculoskeletal pain, Crohn’s disease, and multiple sclerosis.Six evidence-based guidelines were identified. The majority of the guidelines present recommendations for chronic neuropathic pain. The guidelines report that cannabis-based medicines may be considered as a treatment option for patients with neuropathic pain, with chronic non-cancer pain, and with chronic non-cancer, non-neuropathic pain, but with some caveats. Recommendations are against the use of cannabis-based medicines for pain associated with fibromyalgia and back pain in two guidelines and for pain associated with headache, rheumatoid arthritis and osteoarthritis in one guideline. For pain management in multiple sclerosis patients, one guideline mentions that cannabis-based medicines may or may not be offered, depending on the type cannabis-based medicine and patient condition.Findings need to be interpreted considering the limitations (such studies of variable quality [low to moderate], and studies of short duration)