Article type
Abstract
Background:
People living with chronic pain increasingly use cannabis for therapeutic purposes; however, the benefits and harms remain uncertain.
Objective:
To provide recommendations for use of cannabis for therapeutic purposes in adults living with chronic pain.
Methods:
As per the GRADE approach and the G-I-N–McMaster Guideline Development Checklist, the guideline group followed best practices for guideline development, the assessment of the certainty in the evidence, making values and preferences explicit and formulation of the final recommendations. We conducted systematic reviews of randomized clinical trials (RCTs), observational and qualitative studies to inform guideline recommendations.
Results:
A multidisciplinary international guideline panel was selected and vetted by the steering committee and was involved throughout the guideline process. In terms of the evidence synthesis, we identified 46 RCTs with 5,590 participants that evaluated the effectiveness of cannabis for chronic pain, and 56 observational studies of 19,931 patients that explored long-term and infrequent harms. A network meta-analysis of 90 RCTs informed the comparative effectiveness of opioids v. cannabis for chronic pain. Thirty-five studies of 12,905 participants and a qualitative study in people living with pain informed our values and preferences statement.
Recommendation 1: in people living with chronic pain, when troubling pain persists despite standard care, the panel suggests offering a trial of cannabis for medical purposes (conditional recommendation, moderate certainty evidence). Recommendation 2: for people living with chronic pain in whom the decision has been made to offer a trial of cannabis for medical purposes, the panel suggests offering non-inhaled compared to inhaled formulations (conditional recommendation, moderate certainty evidence). Recommendation 3: among individuals living with chronic pain currently using prescription opioids and interested in reducing their opioid dose, the panel suggests offering cannabis for medical purposes (conditional recommendation, low certainty evidence). Recommendation 4: if standard care is not sufficient, we suggest offering a trial of cannabis for medical purposes before a trial of opioids in people living with chronic pain (conditional recommendation, moderate certainty evidence).
Conclusions and relevance:
Cannabis for medical purposes can be offered to patients that have not found relief with other approaches and should be considered before opioids.
People living with chronic pain increasingly use cannabis for therapeutic purposes; however, the benefits and harms remain uncertain.
Objective:
To provide recommendations for use of cannabis for therapeutic purposes in adults living with chronic pain.
Methods:
As per the GRADE approach and the G-I-N–McMaster Guideline Development Checklist, the guideline group followed best practices for guideline development, the assessment of the certainty in the evidence, making values and preferences explicit and formulation of the final recommendations. We conducted systematic reviews of randomized clinical trials (RCTs), observational and qualitative studies to inform guideline recommendations.
Results:
A multidisciplinary international guideline panel was selected and vetted by the steering committee and was involved throughout the guideline process. In terms of the evidence synthesis, we identified 46 RCTs with 5,590 participants that evaluated the effectiveness of cannabis for chronic pain, and 56 observational studies of 19,931 patients that explored long-term and infrequent harms. A network meta-analysis of 90 RCTs informed the comparative effectiveness of opioids v. cannabis for chronic pain. Thirty-five studies of 12,905 participants and a qualitative study in people living with pain informed our values and preferences statement.
Recommendation 1: in people living with chronic pain, when troubling pain persists despite standard care, the panel suggests offering a trial of cannabis for medical purposes (conditional recommendation, moderate certainty evidence). Recommendation 2: for people living with chronic pain in whom the decision has been made to offer a trial of cannabis for medical purposes, the panel suggests offering non-inhaled compared to inhaled formulations (conditional recommendation, moderate certainty evidence). Recommendation 3: among individuals living with chronic pain currently using prescription opioids and interested in reducing their opioid dose, the panel suggests offering cannabis for medical purposes (conditional recommendation, low certainty evidence). Recommendation 4: if standard care is not sufficient, we suggest offering a trial of cannabis for medical purposes before a trial of opioids in people living with chronic pain (conditional recommendation, moderate certainty evidence).
Conclusions and relevance:
Cannabis for medical purposes can be offered to patients that have not found relief with other approaches and should be considered before opioids.