Am Fam Physician. 2022;106(2):202-204
Author disclosure: No relevant financial relationships.
Key Clinical Issue
What are the benefits and harms of cannabis and cannabis-related products for treatment of chronic pain?
Evidence-Based Answer
Some patients with neuropathic pain experience small to moderate short-term pain relief from use of cannabis-related products. This benefit must be weighed against frequent adverse effects.1
An oromucosal spray formulation of cannabis that contains comparable amounts of tetrahydrocannabinol (THC) and cannabidiol (CBD) showed pain-relieving effects. (Strength of Recommendation [SOR]: B, inconsistent or limited-quality patient-oriented evidence.) A moderate pain-relieving effect was found with synthetic oral formulations with a high THC to CBD ratio. (SOR: B, inconsistent or limited-quality patient-oriented evidence.) There was insufficient evidence to assess effects of other treatment formulations (i.e., topical or smoked).1
Adverse effects were more frequent with a higher proportion of THC to CBD. A high THC to CBD ratio in whole plant–based compounds showed the greatest likelihood of patient withdrawal from the study due to adverse effects. (SOR: B, inconsistent or limited-quality patient-oriented evidence.) Dizziness occurred frequently with all formulations.1 (SOR: A, consistent patient-oriented evidence.)
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