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Cannabis as Medicine? Overview

It is utterly mind-blowing that people have no idea that Cannabis has been part of the medical prescription landscape for over 20 years. That’s right T. G. A (Therapeutic Goods Administration) trialled and approved cannabis based medicines have been available as an option to alleviate, if only in small ways, some of the symptoms of a couple of diseases or help with recovery from treatment. However, the claims of this plant being a ‘miracle cure’ for just about everything, have existed for of 100 years… yet in no credible and advanced research has any of the properties of the Cannabis plant ‘cured’ anything, ever!

There is no argument that some components of this incredibly complex plant can have some therapeutic benefit, be it ever so small, but deriving such from the plant with out co-opting some of the more detrimental components has proven incredibly difficult. On top of that, the evidence emerging from latest science, sees that some of these therapies, do more harm than good, with the temporary alleviating of a symptom on one hand, and incurring along term genetic harm on the other!

Again if facts and evidence matter to your best-practice health care, then this is the space for you. Make informed decisions based on science, and not quackery!

PAIN: October 2018 - Volume 159 - Issue 10 - p 1932–1954                                                                   

doi: 10.1097/j.pain.0000000000001293

This review examines evidence for the effectiveness of cannabinoids in chronic noncancer pain (CNCP) and addresses gaps in the literature by: considering differences in outcomes based on cannabinoid type and specific CNCP condition; including all study designs; and following IMMPACT guidelines. MEDLINE, Embase, PsycINFO, CENTRAL, and clinicaltrials.gov were searched in July 2017. 

Analyses were conducted using Revman 5.3 and Stata 15.0. A total of 91 publications containing 104 studies were eligible (n = 9958 participants), including 47 randomised controlled trials (RCTs) and 57 observational studies. Forty-eight studies examined neuropathic pain, 7 studies examined fibromyalgia, 1 rheumatoid arthritis, and 48 other CNCP (13 multiple sclerosis–related pain, 6 visceral pain, and 29 samples with mixed or undefined CNCP). 

Across RCTs, pooled event rates (PERs) for 30% reduction in pain were 29.0% (cannabinoids) vs 25.9% (placebo); significant effect for cannabinoids was found; number needed to treat to benefit was 24 (95% confidence interval [CI] 15-61); for 50% reduction in pain, PERs were 18.2% vs 14.4%; no significant difference was observed. Pooled change in pain intensity (standardised mean difference: −0.14, 95% CI −0.20 to −0.08) was equivalent to a 3 mm reduction on a 100 mm visual analogue scale greater than placebo groups. In RCTs, PERs for all-cause adverse events were 81.2% vs 66.2%; number needed to treat to harm: 6 (95% CI 5-8). 

There were no significant impacts on physical or emotional functioning, and low-quality evidence of improved sleep and patient global impression of change. Evidence for effectiveness of cannabinoids in CNCP is limited. Effects suggest that number needed to treat to benefit is high, and number needed to treat to harm is low, with limited impact on other domains. It seems unlikely that cannabinoids are highly effective medicines for CNCP.

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