PMID- 32127750
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220413
IS  - 1179-5441 (Print)
IS  - 1179-5441 (Electronic)
IS  - 1179-5441 (Linking)
VI  - 13
DP  - 2020
TI  - Cannabinoids in Chronic Non-Cancer Pain: A Systematic Review and Meta-Analysis.
PG  - 1179544120906461
LID - 10.1177/1179544120906461 [doi]
LID - 1179544120906461
AB  - BACKGROUND: For patients with chronic, non-cancer pain, traditional 
      pain-relieving medications include opioids, which have shown benefits but are 
      associated with increased risks of addiction and adverse effects. Medical 
      cannabis has emerged as a treatment alternative for managing these patients and 
      there has been a rise in the number of randomized clinical trials in recent 
      years; therefore, a systematic review of the evidence was warranted. OBJECTIVE: 
      To analyze the evidence surrounding the benefits and harms of medical 
      cannabinoids in the treatment of chronic, non-cancer-related pain. DESIGN: 
      Systematic review with meta-analysis. DATA SOURCES: Medline, Embase, CINAHL, 
      SCOPUS, Google Scholar, and Cochrane Databases. ELIGIBILITY CRITERIA: English 
      language randomized clinical trials of cannabinoids for the treatment of chronic, 
      non-cancer-related 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 6 reviewers. Data were pooled through meta-analysis 
      with different durations of treatment (2 weeks, 2 months, 6 months) and 
      stratified by route of administration (smoked, oromucosal, oral), conditions, and 
      type of cannabinoids. MAIN OUTCOMES AND MEASURES: Patient-reported pain and 
      adverse events (AEs). RESULTS: Thirty-six trials (4006 participants) were 
      included, examining smoked cannabis (4 trials), oromucosal cannabis sprays (14 
      trials), and oral cannabinoids (18 trials). Compared with placebo, cannabinoids 
      showed a significant reduction in pain which was greatest with treatment duration 
      of 2 to 8 weeks (weighted mean difference on a 0-10 pain visual analogue scale 
      -0.68, 95% confidence interval [CI], -0.96 to -0.40, I (2) = 8%, P < .00001; 
      n = 16 trials). When stratified by route of administration, pain condition, and 
      type of cannabinoids, oral cannabinoids had a larger reduction in pain compared 
      with placebo relative to oromucosal and smoked formulations but the difference 
      was not significant (P[interaction] > .05 in all the 3 durations of treatment); 
      cannabinoids had a smaller reduction in pain due to multiple sclerosis compared 
      with placebo relative to other neuropathic pain (P[interaction] = .05) within 
      2 weeks and the difference was not significant relative to pain due to rheumatic 
      arthritis; nabilone had a greater reduction in pain compared with placebo 
      relative to other types of cannabinoids longer than 2 weeks of treatment but the 
      difference was not significant (P[interaction] > .05). Serious AEs were rare, and 
      similar across the cannabinoid (74 out of 2176, 3.4%) and placebo groups (53 out 
      of 1640, 3.2%). There was an increased risk of non-serious AEs with cannabinoids 
      compared with placebo. CONCLUSIONS: There was moderate evidence to support 
      cannabinoids in treating chronic, non-cancer pain at 2 weeks. Similar results 
      were observed at later time points, but the confidence in effect is low. There is 
      little evidence that cannabinoids increase the risk of experiencing serious AEs, 
      although non-serious AEs may be common in the short-term period following use.
CI  - (c) The Author(s) 2020.
FAU - Johal, Herman
AU  - Johal H
AD  - Center for Evidence-Based Orthopaedics, Division of Orthopaedics, Department of 
      Surgery, McMaster University, Hamilton, ON, Canada.
FAU - Devji, Tahira
AU  - Devji T
AD  - OrthoEvidence Inc., Burlington, ON, Canada.
FAU - Chang, Yaping
AU  - Chang Y
AUID- ORCID: 0000-0002-0549-5087
AD  - OrthoEvidence Inc., Burlington, ON, Canada.
FAU - Simone, Jonathan
AU  - Simone J
AD  - Aphria Inc., Leamington, ON, Canada.
FAU - Vannabouathong, Christopher
AU  - Vannabouathong C
AUID- ORCID: 0000-0002-9694-6364
AD  - OrthoEvidence Inc., Burlington, ON, Canada.
FAU - Bhandari, Mohit
AU  - Bhandari M
AD  - Center for Evidence-Based Orthopaedics, Division of Orthopaedics, Department of 
      Surgery, McMaster University, Hamilton, ON, Canada.
AD  - OrthoEvidence Inc., Burlington, ON, Canada.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20200219
PL  - United States
TA  - Clin Med Insights Arthritis Musculoskelet Disord
JT  - Clinical medicine insights. Arthritis and musculoskeletal disorders
JID - 101542737
PMC - PMC7031792
OTO - NOTNLM
OT  - Cannabinoids
OT  - chronic pain
OT  - multiple sclerosis
COIS- Declaration of Conflicting Interests:The author(s) declared no potential 
      conflicts of interest with respect to the research, authorship, and/or 
      publication of this article.
EDAT- 2020/03/05 06:00
MHDA- 2020/03/05 06:01
PMCR- 2020/02/19
CRDT- 2020/03/05 06:00
PHST- 2020/01/03 00:00 [received]
PHST- 2020/01/23 00:00 [accepted]
PHST- 2020/03/05 06:00 [entrez]
PHST- 2020/03/05 06:00 [pubmed]
PHST- 2020/03/05 06:01 [medline]
PHST- 2020/02/19 00:00 [pmc-release]
AID - 10.1177_1179544120906461 [pii]
AID - 10.1177/1179544120906461 [doi]
PST - epublish
SO  - Clin Med Insights Arthritis Musculoskelet Disord. 2020 Feb 
      19;13:1179544120906461. doi: 10.1177/1179544120906461. eCollection 2020.