Study register · detail
Unclear
160 citations
SampleLeitlinie
EndpointConsensus level measurement
Blindingn.a.
DesignModifiziertes Delphi-Konsensusverfahren (Expertenpanel)
Key finding
Expert consensus recommends three structured titration protocols for medical cannabis for chronic pain, without direct measurement of efficacy.
Summary
20 international experts from 9 countries; consensus: medical cannabis suitable for neuropathic, inflammatory, nociplastic and mixed pain; 3 dosing protocols developed (Routine: start 5 mg CBD 2×/day, titration up to 40 mg/day; conservative: 5 mg 1×/day; rapid: balanced THC:CBD 2,5–5 mg 1–2×/day).
P
PopulationAdults with chronic pain (neuropathic, inflammatory, nociplastic, mixed); 20 global experts from 9 countries
I
InterventionMedical cannabis (CBD-dominant, THC:CBD balanced) – three dosing protocols (Routine, Conservative, Rapid) with structured titration up to max. 40 mg/day THC and/or CBD
O
OutcomeConsensus achieved for three treatment protocols on dosing and administration of medical cannabis for chronic pain
Quality profile
Sample size
★★★★★
Blinding
—
Effect size
—
Citations / year
★★★★★
Authors
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Abstract
<h4>Background</h4>Globally, medical cannabis legalization has increased in recent years and medical cannabis is commonly used to treat chronic pain. However, there are few randomized control trials studying medical cannabis indicating expert guidance on how to dose and administer medical cannabis safely and effectively is needed.<h4>Methods</h4>Using a multistage modified Delphi process, twenty global experts across nine countries developed consensus-based recommendations on how to dose and administer medical cannabis in patients with chronic pain.<h4>Results</h4>There was consensus that medical cannabis may be considered for patients experiencing neuropathic, inflammatory, nociplastic, and mixed pain. Three treatment protocols were developed. A routine protocol where the clinician initiates the patient on a CBD-predominant variety at a dose of 5 mg CBD twice daily and titrates the CBD-predominant dose by 10 mg every 2 to 3 days until the patient reaches their goals, or up to 40 mg/day. At a CBD-predominant dose of 40 mg/day, clinicians may consider adding THC at 2.5 mg and titrate by 2.5 mg every 2 to 7 days until a maximum daily dose of 40 mg/day of THC. A conservative protocol where the clinician initiates the patient on a CBD-predominant variety at a dose of 5 mg once daily and titrates the CBD-predominant dose by 10 mg every 2 to 3 days until the patient reaches their goals, or up to 40 mg/day. At a CBD-predominant dose of 40 mg/day, clinicians may consider adding THC at 1 mg/day and titrate by 1 mg every 7 days until a maximum daily dose of 40 mg/day of THC. A rapid protocol where the clinician initiates the patient on a balanced THC:CBD variety at 2.5-5 mg of each cannabinoid once or twice daily and titrates by 2.5-5 mg of each cannabinoid every 2 to 3 days until the patient reaches his/her goals or to a maximum THC dose of 40 mg/day.<h4>Conclusions</h4>In summary, using a modified Delphi process, expert consensus-based recommendations were developed on how to dose and administer medical cannabis for the treatment of patients with chronic pain.
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