{"id":2981,"date":"2021-09-02T09:26:08","date_gmt":"2021-09-01T23:26:08","guid":{"rendered":"https:\/\/www.dalgarnoinstitute.org.au\/wp_site\/cannabis-and-pain-helpful-what-is-the-evidence\/"},"modified":"2025-11-10T12:45:28","modified_gmt":"2025-11-10T01:45:28","slug":"cannabis-and-pain-helpful-what-is-the-evidence","status":"publish","type":"post","link":"https:\/\/www.dalgarnoinstitute.org.au\/wp_site\/cannabis-and-pain-helpful-what-is-the-evidence\/","title":{"rendered":"Cannabis and Pain \u2013 Helpful \u2013 What is the Evidence?"},"content":{"rendered":"

\u201cDo not prescribe currently available \u2018medicinal cannabis\u2019 products to treat chronic non-cancer pain (CNCP) unless part of a registered clinical trial\u201d<\/em><\/strong>   <\/span><\/p>\n

So was just one of the unambiguous and evidence-based recommendations outlined in recent literature.<\/span><\/p>\n

The \u2018red flags\u2019 on current therapeutic claims around cannabis and pain (and other pain\/distress inducing ailments i.e., certain rare epilepsies) continue to grow.<\/span><\/p>\n

As the Dalgarno Institute has intimated repeatedly, the decades long declaration on the promised \u2018panacea of pot\u2019 have not been actualized, even after repeated proclamations of potential, that it was \u2018merely a matter of time and new science\u2019.<\/em> <\/span><\/p>\n

Whilst the scientific process is not at an end, one would have thought that nearly 20 years of pursuit would have actualized just some of those remarkable claims. Yet, still promises failed, or any potentials for good, undermined or diminished by unintended consequences, side-effects, and harms.<\/span><\/p>\n

Ah, but one thing that seems to emerge in the \u2018benefits\u2019 column of this purported plant panacea<\/em> is the placebo effect. As we\u2019ve stated previously, and here again, this emergence should be harnessed to give people Pot-placebos<\/em> and allow those for who it works to be managed accordingly, without the toxicity of this now utterly engineered plant.<\/span><\/p>\n

The Literature Speaks and Anecdotes Challenged?<\/strong><\/span><\/p>\n

The following is just some of the latest recommendations emerging in the latest literature<\/span><\/p>\n

Cannabis-derived products are now available for use with therapeutic intentions in Australia and New Zealand. By far the most common reason for their use is chronic pain however there is a critical lack of evidence that it provides a consistent benefit for any type of chronic non-cancer pain. More than 90% of Special Access Scheme \u2013 Category B (SAS-B) approvals have been for chronic pain of various types.<\/em><\/span><\/p>\n

The evidence available is either unsupportive of using cannabinoid products in chronic non-cancer pain (CNCP) or is of such low quality that no valid scientific conclusion can be drawn. Cannabidiol-only formulations have not been the subject of a published randomised controlled trial (RCT) for pain indications, yet they are the most commonly prescribed type of product.<\/em><\/span><\/p>\n

In addition, evidence of harms does exist, particularly in relation to sedative effects, interactions with other medications and neuropsychiatric effects (for products which contain tetrahydrocannabinol (THC)).<\/em><\/span><\/p>\n

Given the above, the clinical use of cannabinoid products cannot be ethically recommended outside a properly established and registered clinical trial environment until high-quality evidence for specific indications is published.<\/em><\/span><\/p>\n

Recommendation 6:<\/em><\/strong>  Draft guidance says patients with chronic pain should not be offered tetrahydrocannabinol (THC) or mixtures of cannabidiol and THC unless the treatment is part of a clinical trial.<\/em><\/span><\/p>\n

Choosing Wisely Australia<\/em><\/strong><\/a> 19 March 2021 Faculty of Pain Medicine, ANZCA<\/strong><\/span><\/p>\n

International Association for the Study of Pain Presidential Task Force on Cannabis and Cannabinoid Analgesia position statement<\/em><\/strong><\/span><\/p>\n

Conclusion: <\/em><\/strong>Reviews of preclinical research and clinical safety and efficacy of cannabis and cannabinoids for pain relief have identified important research gaps. Due to the lack of high-quality clinical evidence IASP does not currently endorse general use of cannabis and cannabinoids for pain relief. International Association for the Study of Pain recognizes the pressing need for preclinical and clinical studies to fill the research gap, and for education on this topic.<\/em><\/span><\/p>\n

Basic science advances are promising, but these are yet to be fully translated to efficacious and safe medicines. There is a need to increase our understanding of the biology of the endocannabinoid system. High-quality research is required to elucidate the types of pain, and characteristics of individuals, where there is benefit or harm from particular cannabinoid compounds (personalised medicine). Improved understanding of the clinical pharmacology of cannabis and cannabinoids in a pain relief setting is needed. Expansion in the range of chemical entities tested, elucidation of dose effects, and the optimisation of drug delivery is required.<\/em><\/span><\/p>\n

As a global multidisciplinary organization of health and science professionals, IASP has a duty to protect public health, although IASP recognises that some jurisdictions already permit the use of cannabis and cannabinoids for pain relief, other medical indications, or recreational use. More research is required to elucidate the benefits and harms of therapeutic use of cannabis and cannabinoids for the treatment of pain. (A lay summary can be found on the IASP website at: <\/em><\/em><\/a>https:\/\/www.iasp-pain.org\/summarystatement<\/a><\/em>)<\/em><\/span><\/p>\n

International Association for the Study of Pain… : PAIN (lww.com)<\/a><\/span><\/p>\n

\u2018Medical\u2019 Cannabis Blacklisted by Australian Pain Specialists?<\/em><\/strong><\/span><\/p>\n

Dean of ANZCA\u2019s pain medicine faculty Professor Michael Vagg said medicinal cannabis products on the market \u201care not even close\u201d to showing they are effective in the management of patients with complex chronic pain.<\/em><\/span><\/p>\n

\u201cThe research available is either unsupportive of using cannabinoid products in chronic non-cancer pain or is of such low quality that no valid scientific conclusion can be drawn,\u201d the pain specialist and physician said.<\/em><\/span><\/p>\n

Medicinal cannabis blacklisted by Australian pain specialists (smh.com.au)<\/a><\/span><\/p>\n

The National Institute for Health and Care Excellence (NICE) has said it is currently unable to recommend cannabis-based medical products (CBMPs) for severe treatment-resistant epilepsy.<\/em><\/strong><\/span><\/p>\n

In draft guidance<\/em><\/a> on the use of CBMPs, NICE said that more research into the use of CBMP for the treatment of a number of conditions was needed because \u201ccurrent research is limited and of low quality\u201d, adding that clinical trials had shown a high level of adverse events.<\/em><\/span><\/p>\n

The guidance said that patients with chronic pain should not be offered tetrahydrocannabinol (THC) or mixtures of cannabidiol (CBD) and THC unless the treatment is part of a clinical trial.<\/em><\/span><\/p>\n

NICE also said there is no evidence that CBD in isolation is effective for chronic pain and that the potential benefits of CBPMs in all cases \u201cwere small compared with the high and ongoing costs, and the products were not an effective use of NHS resources\u201d<\/em><\/span><\/p>\n

NICE will not recommend medical cannabis for epilepsy and chronic pain <\/a><\/span><\/p>\n

\"DrPoppysWonderElixer\"<\/p>\n

The concern isn\u2019t so much for the failed potential, or even the all to often negative attending issues of this product, but more, that this \u2018medicinal\u2019 smoke-screen is being used to promote the \u2018harmlessness\u2019 or worse, benefits of this product, all lending itself to \u2018recreational\u2019 release. The two popular, and of course, \u2018heart string tugging\u2019 uses are pain and epilepsy. After all, no-one, very much including us, wants those suffering to be deprived of properly trialled and tested pharmaceutical grade medicines that do no harm. Simply to have a product alleviate one symptom whilst causing other and often longer-lasting complications or damage, is not good medicine or best-practice at all.<\/span><\/p>\n

It\u2019s not about listening to \u2018experts\u2019 only, as we have seen with the over-prescribing of regulated opioids, but it certainly cannot simply be alleviating a \u2018felt need\u2019 at any cost.  <\/span><\/p>\n

We saw all this behaviour unleashed in the second half of the 19th<\/sup> Century with unregulated cocaine and opium employed by anyone making therapeutic claims,<\/a><\/strong> simply on the basis that; \u2018if you \u2018feel\u2019 better, you must be better.\u2019 That disastrous anecdotal prescribing led to (arguably) the greatest per capita addiction<\/em> statistics the United Stats had ever seen, current opioid crisis included.  <\/span><\/p>\n

We must all ask, but particularly those charged with policy creation,  the cautiously wise questions of our current process; are we advancing in our science to bring best health-care practice to the populace, or are we regressing to back-ward model and dressing it up in clinical terms?<\/span><\/p>\n

Let\u2019s not let science get in the way of a feel-good story, no matter how short lived.<\/span><\/p>\n

For more articles, research and commentary see following\u2026<\/span><\/p>\n