Summary: Meta-analysis of previous studies reveals cannabinoid treatments produce a small, but significant reduction in subjective pain scores for sufferers of chronic pain.
Source: Mary Ann Liebert Inc
A new systematic review and meta-analysis showed a small but significant reduction in subjective pain scores for cannabinoid treatment compared to placebo in patients experiencing acute pain. No increase in serious adverse events suggested the safety of using cannabinoids to treat acute pain, according to the study published in Cannabis and Cannabinoid Research.
The article entitled “Cannabinoids in the Management of Acute Pain: A Systematic Review and Meta-analysis” was coauthored by Herman Johal, MD, MPH, PhD, McMaster University, Hamilton, Canada and colleagues from McMaster University and Northern Ontario School of Medicine, Thunder Bay. The researchers included six trials in their study, five using oral cannabinoids, and one using intramuscular cannabinoids. They reported a significant difference in effect size between the oral and nonoral routes of administration, with intramuscular cannabinoids yielding a significant reduction in pain relative to placebo. There was no difference in effect between oral cannabinoids and placebo.
Editor-in-Chief Daniele Piomelli, PhD University of California-Irvine, School of Medicine, states: “The usefulness of cannabis-derived medicines in the treatment of pain, both acute and chronic, is still vigorously debated. The meta-analysis conducted in this study reinforces the need for more rigorous studies to assess whether cannabis might be effective in the treatment of acute pain conditions.”
Mary Ann Liebert Inc
Kathryn Ryan – Mary Ann Liebert Inc
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Original Research: Open access
“Cannabinoids in the Management of Acute Pain: A Systematic Review and Meta-analysis”. Aaron Gazendam, Nicholas Nucci, Kyle Gouveia, Hassaan Abdel Khalik, Luc Rubinger, and Herman Johal.
Cannabis and Cannabinoid Research doi:10.1089/can.2019.0079.
Cannabinoids in the Management of Acute Pain: A Systematic Review and Meta-analysis
Objective: To synthesize the best evidence surrounding the efficacy of cannabinoids for acute pain in the clinical setting based on subjective pain scores and observed adverse effects.
Design: Systematic review with meta-analysis.
Data Sources: PubMed, Embase, Cochrane Databases, and Google Scholar.
Eligibility Criteria: English-language randomized-controlled clinical trials comparing cannabinoids with placebo in patients with acute pain.
Data Extraction and Synthesis: Study quality was assessed using the Cochrane risk of bias tool. All stages were conducted independently by a team of three reviewers. Data were pooled through meta-analysis and stratified by route of administration.
Primary Outcomes and Measures: Patient-reported pain and adverse events (AEs).
Results: Six trials (678 participants) were included examining oral (5 trials) and intramuscular (1 trial) cannabinoids. Overall, there was a small but statistically significant treatment effect favoring the use of cannabinoids over placebo (−0.90, 95% confidence interval [CI] −1.69 to −0.1, i2=65%, p=0.03). When stratified by route of administration, intramuscular cannabinoids were found to have a significant reduction in pain relative to placebo (−2.98, 95% CI −4.09 to −1.87, i2=0%, p<0.0001). No difference in effect was observed between oral cannabinoids and placebo (−0.21, 95% CI −0.64 to 0.22, i2=3%, p=0.34). Serious AEs were rare, and similar across the cannabinoid (14/374, 3.7%) and placebo groups (8/304, 2.6%).
Conclusions: There is low-quality evidence indicating that cannabinoids may be a safe alternative for a small but significant reduction in subjective pain score when treating acute pain, with intramuscular administration resulting in a greater reduction relative to oral. Higher quality, long-term randomized-controlled trials examining whether there may be a role for cannabinoids in treating acute pain are required.