Evidence Lacking on Benefits of Cannabis for Treating Chronic Pain, PTSD — Physician’s First Watch

Medical News |
August 15, 2017

Evidence Lacking on Benefits of Cannabis for Treating Chronic Pain, PTSD

By Kelly Young

Edited by David G. Fairchild, MD, MPH, and Jaye Elizabeth Hefner, MD

Evidence is limited on the benefits of cannabis use for treating chronic pain and post-traumatic stress disorder, according to two reviews in the Annals of Internal Medicine.

The review on chronic pain included 75 studies that examined the potential benefits and harms of cannabis use. There was low-strength evidence that cannabis could help ease neuropathic pain in some patients, based primarily on studies of nabiximols (oral spray containing tetrahydrocannabinol plus cannabidiol). The authors found insufficient evidence to make a conclusion about other forms of pain. In terms of potential harms, some evidence suggested that daily use may lead to adverse pulmonary effects over time.

A separate review of five studies found a dearth of evidence on cannabis's benefits and harms in PTSD.

An editorialist concludes: "Even if future studies reveal a clear lack of substantial benefit of cannabis for pain or PTSD, legislation is unlikely to remove these conditions from the lists of indications for medical cannabis. It will be up to front-line practicing physicians to learn about the harms and benefits of cannabis, educate their patients on these topics, and make evidence-based recommendations about using cannabis and related products for various health conditions. … In this context, these reviews are must-reads for all physicians, especially those practicing in states where medical cannabis is legal."

Reader Comments (5)

Dr.KELLY GARDINER

PS patients using weed to decrease pain meds is great and other medical conditions. I recommend oils or diffusers as opposed to smoking. I have seen people come off of pain meds and muscle relaxers with the use of mj. However, sadly since legalization for pain, I have seen people using the same amounts of medications along WITH the mj. It defeats the purpose.

Dr.KELLY GARDINER Nurse/NP/PA, Psychiatry

Patients come in and tell me how great marijuana is for anxiety, sleep, pain, etc. Then I say, if it works so good then why are you seeing me? Then they say, "well, it doesn't work that good,,,". I tell them that I can help with brain chemistry regulation but, I cannot compete with other substances added to the mix in various doses." It has to be one or the other.

Barbara Beeler Physician, Internal Medicine

There is a need for more science and less emotion about the use of this drug in clinical practice that may be beneficial to some of our patients and like every drug should be used weighing the risks and benefits. Public policy apparently is not conducive to helping unravel the snarls of conflicting information here. I hope that the scientific medical community will patiently (though unfortunately slowly) identify the truth about the benefits and harms of these drugs, allowing us to rationally apply judgment to their use. Thanks to those who make the effort.

SHELDON BALL Physician, Geriatrics, Humana

The authors point out possible pulmonary complications as a harm of daily use. Other reports substantiate this including PMID: 22235088.
However in PMID: 22235088, occasional marijuana use was associated with an improvement in pulmonary function but I have seen no follow up. The importance of a decline in pulmonary function with age beckons for potential treatments, but I fear the popularity of marijuana bashing will suppress positive findings.

Stephen campbell md Physician, Anesthesiology, Roper, Charleston SC

Canabis is a recreational drug now. Does it really matter any longer what the real therapeutic benefits are (if there are any)? I understand that the placebo effect can be up to 40%. Lots of people treating lots of conditions on their own will believe they are doing better. And they probably are, at least in their minds eye, and that is all that really matters to them in the end. What the physician should be responsible for is understanding and educating patients about the risks of their chosen therapy.

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