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Blog articles are provided as informational purposes only and are not intended to constitute medical advice. Medication protocols are subject to patient’s medical provider’s authorization.

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Last month, a meta-analysis1 of 1,442 patients and 5 randomized controlled trials found cannabinoids did not reduce cancer pain any better than placebo, when these were added to stable doses of opioids. Change in pain score using the numeric rating scale (NRS) was the primary outcome. The analysis also found statistically significant increased frequencies of somnolence and dizziness as compared with placebo. The cannabinoids were administered in a pump oromucosal spray formulation (not currently available in the US), using equal parts CBD (cannabidiol) and THC (tetrahydrocannabidiol) mixture.

 This study drew the same conclusions as a 2019 systematic review.2

The authors of the meta-analysis used a detailed search strategy and included studies considered to be low risk of bias. However, it should be noted that it is possible not all relevant studies were included, and there were inconsistencies between studies about the patients included, the interventions, comparators, and outcomes. Aside from lack of CBD efficacy, negative results from some of the included trials could have been due to high withdrawal rates from studies and/or high mortality rates, among other factors.

 The authors conclude that cannabinoids cannot be recommended for the treatment of cancer-related pain. However, this conclusion may not apply to all cannabinoid products, as they all have not been studied in this setting. Additionally, non-physical pain factors, which were not evaluated, can play an important role in a patient’s total pain. For example, subgroups of patients with significant anxiety or depression may have shown a benefit but were not stratified out in the analysis. It is also important to recognize that, despite these results, many patients do individually report beneficial outcomes, and their experiences should be respected. In patients who are using cannabinoids to help reduce cancer-related pain, it may be a reasonable approach to allow its continued use as long as there are no apparent significant negative effects.

 

By Kristin Speer, Pharm.D., BCPS

 

References:

  1. Boland EG, Bennett MI, Allgar V, et al. Cannabinoids for adult cancer-related pain: systematic review and meta-analysis. BMJ Supportive & Palliative Care Published Online First: 20 January 2020. doi: 10.1136/bmjspcare-2019-002032
  2. Häuser, W., Welsch, P., Klose, P. et al. Schmerz. Efficacy, tolerability and safety of cannabis-based medicines for cancer pain. (2019) 33: 424. https://doi.org/10.1007/s00482-019-0373-3

 

 

 

 

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