Study register · detailCochrane Review · Chronic Pain · 2022
Cannabis-based medicines and medical cannabis for patients with neuropathic pain and other pain disorders: Nationwide register-based pharmacoepidemiologic comparison with propensity score matched controls
Hjorthøj et al.·European Journal of PainImpact 2.6
MixedGRADEHigh12 citations
Samplek = 5 Studien n = 445 Pat.
Durationunclear
ControlPropensity-score-matched controls
EndpointOpioid/gabapentin use
Blindingn.a.
DesignCochrane Review
”Key finding
In neuropathic pain: less gabapentin use and shorter hospital stays; in other pain disorders no benefit; increased opioid consumption in both groups.
Summary
Cochrane SR on cannabis-based medicines in neuropathic and other pain; includes fibromyalgia subgroup analysis: 5 RCTs (n=445), low quality of evidence, no significant pain reduction vs. placebo (SMD -0.21, 95% CI -0.61 to 0.19).
P
PopulationAdults with neuropathic pain (n=1817) or other/unspecified pain disorders (n=924), Danish pilot programme 2018
I
InterventionCannabis-based medicine (CBM) or medical cannabis (MC) — CBD, THC or CBD+THC combined
OutcomeIn neuropathic pain: reduced gabapentin use and fewer hospitalisation days vs. controls; no effect on opioid use. In other pain disorders: no significant effects
Confidence in the evidence
Very lowLowModerateHigh
High
The highest of four GRADE levels, the effect estimate is very reliable.
Background: Neuropathic pain and other pain disorders have received attention as potential indications for use of cannabis-based medicines or medical cannabis (CBM/MC). Evidence regarding the efficacy and safety of CBM/MC for pain disorders is, however, insufficient. Denmark introduced a pilot programme of medical cannabis in January 2018. We aimed to evaluate efficacy, safety, and non-specific effects of CBM/MC used under the pilot programme compared with controls.
Methods: We conducted a nationwide register-based cohort study in Denmark, identifying all individuals redeeming at least one prescription for CBM/MC for either neuropathic pain (n = 1817) or other and unspecified pain disorders (n = 924), and to match one control to each case using propensity score matching.
Results: Among both patient groups, users of THC used more opioids during follow-up than controls. Among patients with neuropathic pain, however, users of either CBD, THC, or combined CBD + THC used less gabapentin than controls. Users of all three classes of CBM/MC were hospitalized fewer days than controls among neuropathic-pain patients but not among patients with other or unspecified pain disorders.
Conclusions: CBM/MC were generally safe and even displayed some positive effects among patients with neuropathic pain. We conclude that CBM/MC are safe and possibly efficacious for patients with neuropathic pain but not patients with other pain disorders.
Significance: Patients with neuropathic pain may benefit from treatment with cannabis-based medicines or medical cannabis (CBM/MC), particularly in terms of reduced use of gabapentin and fewer days admitted to hospitals, compared with propensity score matched controls. CBM/MC did not, however, reduce the use of opioids. We did not find evidence that CBM/MC were effective for patients with other pain disorders.