Medical cannabis improves patients’ quality of life more than any other treatment for chronic pain, says a panel of leading experts.
Medical cannabis is among the most effective treatments for people with long-term, problematic neuropathic pain, according to the new paper.
Researchers used the latest assessment methods to measure the effectiveness of commonly used drugs’ at managing pain and improving patients’ quality of life, against side effects.
Medical cannabis was found to have the best overall benefit-safety balance for patients, with its ability to reduce pain and improve the quality of life for patients with chronic neuropathic pain (CNP).
The paper also finds that it is safer overall than other commonly prescribed medications, and that patients taking cannabis-based medications would be less likely to experience many of the side effects associated with more established treatments.
One in 11 people in the UK suffer from chronic neuropathic pain – including conditions such as nerve damage, sciatica or severe numbing in hands and feet – that substantially impacts on their quality of life.
A panel made up of international clinicians, experts and patients, used a multicriteria decision analysis (MCDA) model to compare the safety of cannabis products to those of the nine drugs that are most commonly prescribed for CNP.
Cannabis-based products containing a 1:1 ratio of THC and CBD, were found to have a higher benefit-safety profile than commonly used medications such as Amitriptyline and Tramadol.
The patient’s perspective
Authors concluded that medical cannabis contributes more to CNP patients’ quality of life and is more favourable in terms of side-effects such as cognitive impairment, dizziness, constipation, affect disorders, overdose toxicity, respiratory depression, withdrawal, and dependency.
Patient representative Abby Hughes, who took part in the study, said the patient contribution was “crucial” in highlighting the importance of quality of life compared to reduction in pain.
“It is crucial patients were able, for the first time in an MCDA setting, to share their lived-experience in a study identifying the benefit-safety balance of neuropathic pain medications. After all, we are the ones experiencing pain and seeking pain relief for a better quality of life,” said Hughes.
“Sharing our experiences equated to the difference in quality of life actually being judged as more clinically important to patients than the difference in pain relief.”
She continued: “Interestingly, with the benefits of 12 neuropathic pain medications mapped out, cannabis takes the lead.
“The safety was also mapped out, identifying adverse and serious adverse events, from constipation to overdose toxicity.
“Cannabis came out as equal or better in safety. Whilst ibuprofen came out as just as safe, it was also least effective, weighted as zero for pain relief and quality of life benefits.”
The report comes just weeks after the International Association for the Study of Pain (IASP) said it could ‘not endorse’ the general use of cannabinoids to treat pain, due to a lack of evidence from ‘high quality research’.
The Faculty of Pain Medicine at the Australian and New Zealand College of Anaesthetists (ANZCA) has also advised against prescribing cannabis for patients with chronic, non-cancer pain unless they are enrolled in a clinical trial.
A co-author of the CNP and cannabinoids study, Professor Mike Barnes, who has been critical of the IASP statement, said these findings go some way to “refute” its conclusions.
“I wish those writing such reports actually spoke to real patients deriving real benefit from cannabinoids for chronic pain,” said Prof Barnes.
“They should try to move beyond the narrow pharmaceutical paradigm, understand the plant and not forget that a doctors’ primary duty is to help their patients.
“This study illustrates the efficacy and safety of cannabis and goes some way to refute the conclusions of the report of the IASP which said there was insufficient evidence to prescribe cannabinoids for pain.”
His co-author, Dr Anne Katrin Schlag, head of research for Drug Science, the UK-based charity which commissioned the paper, told Cannabis Health the team anticipated that the findings would be “controversial”.
“This is another way of broadening the scientific evidence base, rather than solely sticking to randomised control trial (RCT) data,” said Dr Schlag.
“What is very important here is that the study is a comparison between different pain medications, including medical cannabis.
“While medical cannabis was not found to be the best at reducing pain, when taking quality of life into account and patients being able to function, eat and sleep well, then for the average person, cannabinoids tend to work better than the opioids, which tend to have serious side effects.”
Another blow for chronic pain patients
Last week, in another blow for chronic pain patients, the National Institute of Health and Care Excellence (NICE) released new guidance advising UK doctors not to prescribe conventional painkillers including opioids and paracetamol for chronic primary pain.
Instead it is recommended that patients with these conditions are offered a “range of treatments” to manage their pain, including exercise, CBT and acupuncture.
With access to cannabis medicines still restricted in the UK, there has been a backlash from patients who fear being left without any viable options.
Dr Schlag continued: “For patients experiencing severe chronic pain there should be the option of opioid based pain medications.
“Exercise and psychological therapies all have a place and will have lots of benefits for some people, but it is likely there will always be people who need stronger medications.”
She added: “At Drug Science we would like to see cannabis added to the current pharmacotherapy in relation to pain.
“There are thousands of patient reported outcomes from those who are using cannabis and cannabinoid products successfully to treat pain, including from our own forthcoming Project Twenty21 findings which are due to be published shortly.”
Building a convincing case
Project Twenty 21, which launched in November 2019, is Drug Science’s landmark study which aims to widen access to medicinal cannabis, enrolling up to 20,000 patients to build Europe’s largest body of evidence for its safety and efficacy.
Drug Science CEO, David Badcock said he hoped this latest paper would encourage regulatory bodies to consider the growing evidence behind medical cannabis and take steps to improve access for patients.
“Since being made legal in 2018, many patients suffering from neuropathic pain have told us that cannabis based medicinal products are effective in reducing their pain and its negative impacts on their everyday lives,” he commented.
“We are pleased to say that this paper corroborates what many patients have been saying for many years, and helps to build a convincing case for more widespread prescription of medical cannabis on the NHS.”
Hughes, who is able to access a prescription for medical cannabis through Project Twenty21, echoed these sentiments, adding: “It is hoped NICE will consider reevaluating their guidelines on medical cannabis, recognising that for many patients cannabis provides a better quality of life, provides better pain relief, and has a better safety profile than many other neuropathic pain medications currently prescribed.”
You can read the full report here
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