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New study — Cannabinoids and chronic non-cancer pain conditions

Cannabis and Chron­ic Pain

The jour­nal Pain recent­ly pub­lished an impor­tant study on the use of cannabis, and med­i­cines based on cannabis (cannabi­noids), for chron­ic pain con­di­tions (chron­ic pain in can­cer patients was specif­i­cal­ly exclud­ed). Researchers were from insti­tutes in Syd­ney, Bris­bane and Lon­don spe­cial­is­ing in sub­stance abuse and addic­tion. The study involved review­ing pub­lished data from tri­als and clin­i­cal reports where cannabi­noids had been used in patients with neu­ropa­thy, fibromyal­gia, rheuma­toid arthri­tis, mul­ti­ple scle­ro­sis, vis­cer­al pain or unde­fined pain. The researchers looked at the results for 30% or 50% reduc­tion in pain and the pro­por­tion of patients who obtained that ben­e­fit. In sum­ma­ry 29% of patients receiv­ing cannabi­noids report­ed a 30% reduc­tion in pain com­pared with 26% receiv­ing place­bo. Sta­tis­ti­cal analy­sis showed that this dif­fer­ence was real, but 24 patients have to be treat­ed for there to be one who gets this ben­e­fit. When 50% reduc­tion in pain was looked at there was no sig­nif­i­cant dif­fer­ence between patients receiv­ing cannabi­noids and place­bo. Fur­ther­more, there were no mea­sur­able ben­e­fits in emo­tion­al or phys­i­cal func­tion­ing. Side effects includ­ed dizzi­ness, dif­fi­cul­ty in con­cen­tra­tion or com­pre­hen­sion, con­fu­sion or dis­ori­en­ta­tion. They were com­mon­ly observed and only 6 patients need­ed to be treat­ed for there to be one who expe­ri­enced side effects. The stud­ies reviewed by these researchers col­lec­tive­ly involved near­ly 10,000 patients. They found that 24 patients need to be treat­ed for there to be one expe­ri­enc­ing a ben­e­fit and that for every 6 treat­ed there is like­ly to be one with harm­ful side effects. And so, they con­clude that it is unlike­ly that cannabi­noids are an effec­tive med­i­cine for chron­ic non-can­cer pain. The researchers point out that many of the stud­ies were very small, many were with patients who were already on oth­er pain med­i­cines, some were short term stud­ies despite deal­ing with a chron­ic con­di­tion and final­ly, chron­ic pain itself is high­ly com­plex con­di­tion. They state that long term large-scale well-designed tri­als will be need­ed to pro­vide defin­i­tive evi­dence on any ben­e­fit for cannabi­noids in chron­ic pain.

Read the full arti­cle here


Let­ter to The Times

A recent let­ter to The Times signed by more than 150 pain med­i­cine con­sults includ­ing Pain Concern’s med­ical advi­sor raised con­cerns about a recent deci­sion by the UK gov­ern­ment to allow spe­cial­ist pain doc­tors to pre­scribe cannabi­noids for chron­ic pain, describ­ing the deci­sion as premature.

Pain Concern’s Med­ical Advi­sor, Dr Cathy Price com­ment­ed that she signed it as she ful­ly shared the con­cerns of vir­tu­al­ly all pain clin­ic con­sul­tants in the UK:

First­ly, the peo­ple who ben­e­fit the most are not clear with a very small num­ber who ben­e­fit sub­stan­tial­ly com­pared to the num­ber who are harmed by cannabis. A very recent sys­tem­at­ic review pub­lished in Pain this month pro­vid­ed sci­en­tif­ic evi­dence to jus­ti­fy our con­cerns. Sec­ond­ly, the num­ber of peo­ple with chron­ic pain is very large and poten­tial­ly there could be many peo­ple want­i­ng cannabis but like­ly to ben­e­fit very lit­tle. This could poten­tial­ly have denied oth­er more effec­tive treat­ment to patients.

While oth­er doc­tors have writ­ten to The Times dis­agree­ing with the let­ter it remains true that there is near una­nim­i­ty among pain con­sul­tants that there is lit­tle evi­dence to sup­port the use of cannabi­noids in chron­ic pain.

The Fac­ul­ty of Pain Med­i­cine has issued a posi­tion state­ment broad­ly sup­port­ive of this posi­tion point­ing out the lack of evi­dence of ben­e­fit and clear evi­dence of poten­tial harm from cannabis. The pain pro­fes­sion seems unit­ed in want­i­ng more evi­dence but for the moment remain­ing doubt­ful that cannabi­noids have a role in the treat­ment of non-can­cer chron­ic pain.

FPM Cannabis Posi­tion Statement

Comments

Absolute non­sense. Fear mun­ger­ing from doc­tors who are there to help us yet they would rather deny us safe med­ica­tion yet push their opi­ods from which phar­ma­cuet­i­cal com­pa­nies pay them in the way of clev­er­ly hid­den incen­tives and bribes. Break­ing down their argu­ment where they say” it would be harm­ful to pescribe cannabis where oth­er treat­ments could be bet­ter” is crap and very ill thought out. It was clear before they blocked suf­fer­ers like me with a last minute change to guid­lines that you would have had to have exhaust­ed all oth­er pos­si­ble treat­ments before being able to try cannabis which at first would be like all oth­er new pescrip­tions close­ly mon­i­tored and either con­tin­ued or stopped based on its effec­tiv­ness for that patient vs any side effects expe­ri­enced. SHAME ON THEM.

Recent­ly sum­mar­i­ly dis­charged from the Pain Man­age­ment Clin­ic, Queen Mar­garet Hos­pi­tal Dun­fermline Fife, because of ask­ing for a sec­ond opin­ion on a known injury caus­ing seri­ous neu­ro­log­i­cal pain which is debil­i­tat­ing and life chang­ing. Also, because of ask­ing about med­i­c­i­nal cannabis treatment. 

So thank you for your advi­sor giv­ing her skewed views and ensur­ing yet anoth­er patient does­n’t receive the desparate­ly need­ed sup­port. I hope she nev­er has to suf­fer chron­ic neu­ro­log­i­cal pain.

Ok I’ve had pain for 28 years after a fall at work of about 40 feet they are not sure it’s it was 40ft or 45ft, any­way the fact is I broke my legs and my back and dam­aged my spinal cord . Every­thing went wrong , first the ambu­lance that came to my acci­dent had a Porter and a dri­ver who nor­mal­ly took patient home, they were the only ones avail­able . After I told them I had not feel­ings in my legs and had pints and nee­dles in my toes , they lift­ed me by my hands and my feet bend­ing me at my waist this caused the break in my back to also dis­lo­cate the next disc.

I’ve been on a num­ber of opi­ates and can tell if they work or not, so if I was giv­en cannabis to take then I would be able to tell them if it was work­ing with­in hours . I’m now classed as Para­plegic with loss of bow­el and blad­der func­tion, and the worse pain I’ve ever known at it’s worse I will fit.

Right now the NHS is on a dri­ve to cut the opi­ates down to zero use, that I’m afraid would cause me to take a way out, I mean telling me to go have a lie down is a waste of time the pain takes con­trol and I need to get up, telling me to take oth­er med­ica­tion I’ve already tried . The opi­ates allow me to do what I want because the pain is man­aged, end­ing that man­age­ment would cause me excru­ci­at­ing pain again no thanks .

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