Medical cannabis treatment for chronic pain: Outcomes and prediction of response

Joshua Aviram, Dorit Pud, Tamar Gershoni, Bareket Schiff-Keren, Miriam Ogintz, Simon Vulfsons, Tamar Yashar, Haim Moshe Adahan, Silviu Brill, Howard Amital, Itay Goor-Aryeh, Dror Robinson, Leslie Green, Refael Segal, Yacov Fogelman, Oren Tsvieli, Ben Yellin, Yelena Vysotski, Ofir Morag, Vadim TashlykovRoee Sheinfeld, Ruth Goor, David Meiri, Elon Eisenberg

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Although studied in a few randomized controlled trials, the efficacy of medical cannabis (MC) for chronic pain remains controversial. Using an alternative approach, this multicentre, questionnaire-based prospective cohort was aimed to assess the long-term effects of MC on chronic pain of various aetiologies and to identify predictors for MC treatment success. Methods: Patients with chronic pain, licensed to use MC in Israel, reported weekly average pain intensity (primary outcome) and related symptoms before and at 1, 3, 6, 9 and 12 months following MC treatment initiation. A general linear model was used to assess outcomes and identify predictors for treatment success (≥30% reduction in pain intensity). Results: A total of 1,045 patients completed the baseline questionnaires and initiated MC treatment, and 551 completed the 12-month follow-up. At 1 year, average pain intensity declined from baseline by 20% [−1.97 points (95%CI = −2.13 to −1.81; p < 0.001)]. All other parameters improved by 10%–30% (p < 0.001). A significant decrease of 42% [reduction of 27 mg; (95%CI = −34.89 to 18.56, p < 0.001)] from baseline in morphine equivalent daily dosage of opioids was also observed. Reported adverse effects were common but mostly non-serious. Presence of normal to long sleep duration, lower body mass index and lower depression score predicted relatively higher treatment success, whereas presence of neuropathic pain predicted the opposite. Conclusions: This prospective study provides further evidence for the effects of MC on chronic pain and related symptoms, demonstrating an overall mild-to-modest long-term improvement of the tested measures and identifying possible predictors for treatment success.

Original languageEnglish
Pages (from-to)359-374
Number of pages16
JournalEuropean Journal of Pain
Volume25
Issue number2
DOIs
StatePublished - Feb 2021

Bibliographical note

Publisher Copyright:
© 2020 European Pain Federation - EFIC®

Keywords

  • Cannabis
  • Chronic Pain/drug therapy
  • Humans
  • Israel
  • Medical Marijuana/therapeutic use
  • Prospective Studies

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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