kimberly F. Atkinson, PhD
Professor
Touro University Nevada
Henderson, Nevada
Chronic pain affects a significant portion of the global population, with many individuals relying on opioid medications for relief. However, the potential for dependence and adverse effects associated with long-term opioid use has prompted exploration into alternative or adjunctive therapies. Cannabis, with its analgesic properties and holistic benefits, has emerged as a potential solution. Studies have shown that cannabis has analgesic properties, as well as may improve sleep, mood, and quality of life for chronic pain patients. With the increasing use of cannabis for pain and various conditions and with proven efficacy and safety over the years, use of cannabis may may reduce the risk of opioid addiction and dependency, particularly in patients with chronic pain and opioid use disorder.
Purpose/Objectives: This systematic review aimed to evaluate the evidence supporting the co-administration of cannabinoids and opioids in managing chronic pain.
Methods:
A comprehensive literature search was conducted using PubMed, EMBASE, and Cochrane databases to identify human studies and clinical trials that assessed the benefits of cannabis-derived compounds in chronic pain patients on opioid therapy. The review included randomized controlled trials, observational surveys, and qualitative assessments with sample sizes ranging from 24 to 790 participants. Data from 12 studies were analyzed, focusing on the impact of various cannabis formulations on analgesia, health, and overall well-being. Inclusion criteria consisted of studies involving patients with chronic pain on opioid therapy who were also using cannabinoids or cannabis. These studies included patients with a wide variety of sources of chronic pain, including peripheral neuropathic pain, cancer-related pain, and osteoarthritis. Studies focusing on cancer-related pain or healthy patients were excluded.
Results:
Eleven of the twelve studies reviewed demonstrated significant benefits of cannabinoid-containing treatments in patients with chronic pain. Several studies reported analgesic effects comparable to opioids. Adjuvant cannabis use was associated with a reduction in opioid usage, decreased prescription medication use, and reduced adverse effects of opioid treatment. Common benefits included improved mood, quality of life, sleep, pain relief, and reduced opioid dependence. Specific findings from individual studies included: Dronabinol significantly improved pain relief and reduced pain intensity; medical cannabis use was associated with a 64% decrease in opioid use and improved quality of life; cannabis users were less likely to be on opioids; medical cannabis was comparatively more effective than prescription medications for chronic pain treatment; medical cannabis had similar analgesic effects to opioids while enhancing emotional well-being. Studies also demonstrated that vaporized cannabis reduced morphine or oxycodone pain, medical cannabis certifications reduced opioid use and improved quality of life, and longer durations of medical cannabis use were associated with reduced opioid dosage. The most common benefits of cannabis reported in these studies involved enhancing mood, quality of life, sleep, and relief of pain and opioid-dependence.
Conclusions/Implications for future research and/or clinical care:
These findings suggest that cannabis-based therapies have the potential to be effective adjuvants or alternatives to opioids for chronic pain management. Medical cannabis appears to be a multifaceted treatment option that effectively reduces pain, lowers opioid dependence, and enhances quality of life for chronic pain patients. Cannabis, particularly THC/CBD formulations and dronabinol, notably enhanced pain relief in patients experiencing various types of pain. The studies consistently showed cannabis's potential for substantial opioid-sparing effects, with many patients able to discontinue opioid medications or reduce their dosage when using cannabis, emphasizing its role in mitigating opioid dependency and reducing opioid-related risks. Cannabis also provided additional holistic benefits, such as improvements in emotional well-being, functionality, sleep quality, anxiety reduction, mood stabilization, and an overall sense of normality in daily life.
Medical cannabis emerges as a valuable therapeutic option for chronic pain management. However, it is important to acknowledge the limitations in cannabis research, including varying legal statuses across regions, small sample sizes, a lack of control groups, and methodological differences. Further rigorous, large-scale trials are needed to better understand the long-term effects and ideal treatment protocols to integrate cannabis into comprehensive pain management protocols effectively.