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Am Fam Physician. 2022;106(2):202-204

This clinical content conforms to AAFP criteria for CME.

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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The Agency for Healthcare Research and Quality (AHRQ) conducts the Effective Health Care Program as part of its mission to produce evidence to improve health care and to make sure the evidence is understood and used. A key clinical question based on the AHRQ Effective Health Care Program systematic review of the literature is presented, followed by an evidence-based answer based on the review. AHRQ’s summary is accompanied by an interpretation by an AFP author that will help guide clinicians in making treatment decisions.

This series is coordinated by Joanna Drowos, DO, MPH, MBA, contributing editor. A collection of Implementing AHRQ Effective Health Care Reviews published in AFP is available at https://www.aafp.org/afp/ahrq.

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