The Effectiveness of Self-Directed Medical Cannabis Treatment for Pain. Xiaoxue Li et al. Complementary Therapies in Medicine. 2019. Article
Kelly Hughes
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The problem: Managing chronic pain costs significantly more than any other health condition affecting Western societies. Many current treatment strategies rely on opioids, which carry their own set of adverse side effects along with the risk of addiction and overdose. Medical cannabis seems like a promising substitute for prescription opioids .
Why do this study? Survey studies have found that many patients substitute medical cannabis for prescription opioids to manage pain, but there is very little data about the effect of commercially available medical cannabis products on pain reduction. Studies have been conducted in controlled settings, and often for very short periods of time. But little is known about real-world use of cannabis and its effect on pain.
The study: This study looked at patient-reported data to evaluate pain reduction and side effects from self-directed cannabis consumption. Data including pain relief, side effects and cannabis product characteristics, was collected via a mobile health app, ReleafApp, from 2,987 patients who reported a total of 20,513 use sessions using various cannabis products. Users reported their type of pain and pain intensity on a scale of 0-10 before and after use. On average patients saw a 3.1 point reduction in pain after using cannabis. Looking at different types and characteristics of cannabis products reported, whole cannabis flower was associated with greater pain relief than other products were. THC and CBD levels affected pain relief to different extents in different pain categories, but THC levels were the strongest predictor of pain relief. THC, but not CBD, was associated with side effects (most commonly dry mouth and feeling foggy).
Conclusions: This study suggests medical cannabis can be effective as a mid-level analgesic and that patients can benefit from self-directed cannabis therapy for pain relief. However, the effectiveness and side effects vary with the product used. It also shows that the THC compound plays an important role in the therapeutic potential of medical cannabis.
What does this study add? This large-scale study looks at the use of a variety of cannabis products, under natural conditions, and how they affect pain intensity. It found that self-directed cannabis treatment is associated with significant improvements in short-term pain relief.
Funder: This study was funded in part by student scholarship funding from the University of New Mexico Medical Cannabis Research Fund (MCRF).
Author Conflicts: Three of the six authors are employed by the company that developed the patient-reporting app. One author is the director of the University of New Mexico MCRF, however none of the authors received funding from MCRF.
Commentary: This study has found a creative way of addressing the difficulty of monitoring and measuring effects in real-time across the wide range of medical cannabis products used by patients. However, this approach doesn’t include the use of an experimental control group, so these results could be affected by patient-reporting bias in the app and may over- or underestimate cannabis’ effectiveness. In a wide range of settings, the placebo effect is associated with a significant improvement in outcomes, and is likely responsible for at least some of the improvement in pain reported here. Furthermore, this study is also missing key variables such as users’ previous experience with cannabis, and measurements of other cannabinoids. Nevertheless, this study offers useful findings based on self-directed use of a wide variety of cannabis products.
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