Does medical cannabis really help with pain relief?

Medical cannabis has been trumpeted in the media as a panacea for all manner of pain. But scientific evidence that it works is lacking.

Of the hundreds of thousands of applications to Australia’s medicines regulator for special access to medical cannabis, chronic pain is the top reason given. 

With so many seeking access to medical cannabinoids for pain, you’d expect strong evidence for its effectiveness as a treatment. But such evidence is hard to find when looking at clinical studies and independent, high quality, ‘systematic’ reviews of well conducted, randomised, controlled trials.

The reviews have consistently found medical cannabinoids have only a small effect; for most people in the trials, their pain is not reduced. Just one in 24 people across all the reviewed trials experience a clinically meaningful reduction in pain after using medical cannabis.

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This means that even though a small number of people might have reduced pain, for most people, medical cannabinoids do not provide a clinically meaningful change in their pain, or at least will not provide a greater effect than a placebo. Those people who do have a good result often have very specific types of pain, for example pain related to multiple sclerosis.

Despite the lack of evidence, Australians continue to pay hundreds or thousands of dollars a month to access medicines that are yet to be approved by the regulator, the Therapeutic Goods Administration (TGA).

Although there is no agreed definition of what medical cannabinoids are, they are generally understood to be medicines that are made from cannabis plant material, or synthetically manufactured substances that have similar therapeutic effects to the main active parts of the cannabis plant, delta-9-tetrahydrocannabidiol (commonly called THC) and cannabidiol (CBD).

Most of the cannabinoid products available in Australia are not approved by the TGA. Instead, it provides access to unapproved products under a special access scheme, meaning an exemption is made for someone to access a product even though it has not been registered or proven to work.

During the product registration process there is an assessment of whether a product is effective and of its safety profile.

Products accessed under an exemption are still required to have known ingredients, but they have not been required to conduct clinical trials to show that they work. 

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Medical cannabis remains expensive in Australia because it has not been subsidised under the Australian Pharmaceutical Benefits Scheme, which requires medicines being assessed to be both effective and cost effective.

No medical cannabinoid products have been assessed to meet this standard of evidence for the treatment of pain in Australia. One product was assessed for multiple sclerosis, but evidence on whether it was safe and better than the standard treatment was insufficient to support subsidising the medicine in Australia. 

So even though the product is approved in Australia, it is not subsidised. The only medical cannabinoid product that is both registered and subsidised in Australia is cannabidiol for the treatment of a rare form of childhood epilepsy.

There has been a lot of interest in CBD as a single ingredient for pain. CBD is often preferred because it does not cause the same ‘high’ and sedation as THC. However, there is no clear evidence that CBD works for pain, with few studies examining the effects of CBD alone. Those that have examined CBD as a single ingredient have not provided evidence that it works for pain.

Given researchers have conducted a large number of trials of medical cannabinoids for pain, and a large number of systematic reviews summarising the evidence, the issue is not necessarily a lack of studies, but a lack of evidence demonstrating the benefits outweigh the potential harms. 

A recent Cochrane review concluded: “The potential benefits of cannabis‐based medicine in chronic neuropathic pain might be outweighed by their potential harms.”

Read: Cannabis reduces blood pressure in older adults, research finds

Nevertheless, it is possible that further studies conducted in specific patient populations or with specific clinical conditions may identify conditions or patient groups where the benefits are greater. 

Meanwhile, the International Association for the Study of Pain (IASP) says it views medical cannabis as an area for research, as opposed to clinical practice, while evidence accumulates. Similarly, the Faculty of Pain Medicine, a specialist medical college for the treatment of pain in Australia, says medical cannabis should not be used outside clinical trials.

Yet many people, having read articles in popular media, have unrealistic expectations about how well cannabinoids work for the treatment of pain. 

With time, further robust clinical trials may provide the required evidence for cannabinoids to become widely available as a registered, subsidised medicines. If that happens, it would save patients money, and provide clinicians clearer guidance about the place of medical cannabinoids in pain treatment.

In the meantime, being part of a clinical trial is one way to access medical cannabis for pain and contribute to new evidence. 

Suzanne Nielsen is a professor and the deputy director of the Monash Addiction Research Centre. She has been a registered pharmacist for over 20 years, and has been involved in multiple reviews on the evidence for the use of medical cannabinoids, including independent reviews commissioned by the Therapeutic Goods Administration.

This article was originally published by 360info™.

Have you bought medical cannabis for pain relief? Did it help? Why not share your thoughts in the comments section below?

5 COMMENTS

  1. I suffer from CFS/FMS and the long-term aftereffects of a fractured talus, which is extremely painful in and of itself, much more so than the pain of the CFS/FMS.

    I recently purchased a small bottle (10ml) of CBD oil just to try it since everybody seemed to be raving about it.

    I wasn’t expecting any spectacular results as I have been on a prescribed synthetic opioid (Tramadol Hydrochloride 100ml 12 hr slow release, plus 50mg capsule for breakthrough pain) for about 16 years, and that only made the pain tolerable.

    However, upon trying the CBD oil, I found it not only removed the CFS/FMS pain, but it also significantly reduced the ankle pain enough for me to walk normally, without discomfort. The pain in the ankle is still there but so significantly reduced as to be insignificant.

    The oil I tried was not the strongest pain reliever; there is one stronger, which I’ll also try, although there is a price difference of $100 between the two for the same amount. The one I tried was $50 for the 10ml.

    My vote is a resounding YES for the benefits of CBD oil.

  2. I have suffered from RLS for 40 years and as a result cannot sleep. I find the medically prescribed cannabis is the only remedy that does not cause side effects. I wake up feeling good and refreshed. The other medications caused augmentation, and made the condition worse after a time.

  3. This article is somewhat inaccurate although it may be true that little Australian research has been done. However extensive research has been done in the US as well as in Europe and is being continually carried out, particularly by Zilis Corp. I have used their products for years for various reasons and have found them to continually effective. However I can no longer import them into Australia, mainly because of the federal governments resistance to consult studies other than those conducted in Australia and is Very Reluctant to finance them or even support them. The benefits of CBD is being denied to many Australians in pain because of this government foot dragging.

  4. I have lived with severe chronic pain from multiple areas due to multiple reasons and have been taking Targin 15mg in the morning, 10mg in the evening and occasional Endone 5mg when needed.
    Hoping to find cannabis oil as an alternative was totally disappointing.
    Not only did it make NO DIFFERENCE whatsoever to my pain levels, a couple of drops sent my brain off the planet.
    I am now 73 and at lease the opioids enable me to function as a carer for two disabled people as well as my disabled self, instead of being a screaming heap on the floor!
    If cannabis works for you – great! I will stick with what I know works for me!

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