Efficacy and Safety of Medical Cannabis in Neuropathic Pain Patients
Article Sidebar
Main Article Content
Abstract
Introduction: Nowadays, cannabis plays a larger role in medical treatment. However, there is a lack of evidence on the treatment of neuropathic pain patients in Thailand. This research aims to study the clinical efficacy of medical cannabis for relieving neuropathic pain and effects of neuropathic pain on quality of life. Methods: This is a cross-sectional study in non-palliative care patients with neuropathic pain treated with medical cannabis at Lampang Hospital from August 28, 2019 to October 3, 2021. The data about baseline characteristics, pain scores, quality of life and side effects were collected from outpatient hospital information system and telephone interview. The efficacy before and after administration of medical cannabis was analyzed. Results: Among 64 neuropathic pain patients treated with medical cannabis (THC enriched 85.9%), 48.4% of patients had at least 30.0% reduction of pain score and 26.5% had at least 50% reduction in pain score. The patients had significant improvement in all aspects of quality of life, especially sleep. Another finding was that 46.9% of them had common side effects particularly dizziness and palpitation, and 9.4% could not tolerate the side effects and had to stop using the medical cannabis. Conclusion: A quarter of non-palliative patients with neuropathic pain had benefits from medical cannabis to achieve a clinically significant reduction in pain and improvement of quality of life, especially sleep. About half of them had common side effects.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
Finnerup NB, Kuner R, Jensen TS. Neuropathic pain: from mechanisms to treatment. Physiol Rev. 2021;101:259-301.
Allan GM, Ramji J, Perry D, et al. Simplified guideline for prescribing medical cannabinoids in primary care. Can Fam Physician. 2018;64:111-20.
พรชัย สถิรปัญญา. การรักษาอาการปวดเหตุพยาธิประสาทอย่างเหมาะสมกับเศรษฐานะของคนไทย. สงขลานครินทร์เวชสาร. 2559;34:93-102.
DiBonaventura MD, Cappelleri JC, Joshi AV. A longitudinal assessment of painful diabetic
peripheral neuropathy on health status, productivity, and health care utilization and cost. Pain Med. 2011;12:118-26.
Van Hecke O, Austin SK, Khan RA, Smith BH, Torrance N. Neuropathic pain in the general population: a systematic review of epidemiological studies. Pain. 2014;155:654-62.
Chaudakshetrin P. A survey of patients with neuropathic pain at Siriraj pain clinic. J Med Assoc Thai. 2006;89:354-61.
Thai Association for the Study of Pain. Clinical guidance for neuropathic pain [Internet]. Bangkok: The Association; 2020 [cited 2021 Nov 6]. Available from: http://www.tasp.or.th/
Toward optimized practice. PEER simplified guideline: medical cannabinoids clinical practice guidline [Internet]. 2018 [cited 2023 April 07]. Avaliable from: http://www.topalbertadoctors.org/download/2238/Medical%20Cannabinoid%20CPG. pdf?_20180320184543.
Petzke F, Tölle T, Fitzcharles MA, Häuser W. Cannabis based medicines and medical cannabis for chronic neuropathic pain. CNS Drugs. 2022;36:31-44.
NICE guideline. Cannabis-based medicinal products. Published: 11 November 2019 www.nice.org.uk/guidance/ng144
Camila PR, Paula RJ, Camilo CC, Alexandra F, Diego R. Cannabis and pain: a scoping review. Braz J Anesthesiol. 2022;72:142-51.
Henderson LA, Kotsirilos V, Cairns EA, Ramachandran A, Peck CC, McGregor IS. Medicinal cannabis in the treatment of chronic pain. Aust J Gen Pract. 2021;50:724-32.
Department of Medical Services. Guidance on cannabis for medical use [Internet]. [place unknown]: The Department; 2020 [cited 2021 Nov 6]. Available from: http://cannabis.fda.moph.go.th/wp-content/uploads/PDF/manual/February_2020/Guidance-Updated-v-4_update-20200120-cover.pdf
คณะอนุกรรมการพิจารณาข้อมูลเกี่ยวกับการใช้กัญชาทางการแพทย์. คำแนะนำสำหรับแพทย์ การใช้กัญชาทางการแพทย์. ฉบับที่ 1 ตุลาคม 2562
Ware MA, Wang T, Shapiro S, et al. Smoked cannabis for chronic neuropathic pain: a randomized controlled trial. CMAJ. 2010:182:E694-701.
Ministry of Health. Information for health care professionals: cannabis (marihuana, marijuana) and the cannabinoids. Health Canada, Spring 2018.
Vania ML, Rachel B, Camille A. Cannabis for peripheral neuropathy: the good, the bad, and the unknown. Clev Clin J Med. 2018;85:943-9.
Wallace M, Schulteis G, Atkinson JH, et al. Dose-dependent effects of smoked cannabis on capsaicin-induced pain and hyperalgesia in healthy volunteers. Anesthesiology. 2007;107:785-96.
Sherelle LC, Nicholas A, Christopher WV. Cannabis constituent synergy in a mouse neuropathic pain model. Pain. 2017;158:2452-60.
Casey SL, Vaughan CW. Plant-based cannabinoids for the treatment of chronic neuropathic pain. Medicines. 2018;5:67.
Mücke M, Phillips T, Radbruch L, Petzke F, Häuser W. Cannabis-based medicines for chronic neuropathic pain in adults. Cochrane Database Syst Rev. 2018;3:CD012182.
Häuser W, Fitzcharles MA, Radbruch L, Petzke F. Cannabinoids in pain management and palliative medicine. Dtsch Arztebl Int. 2017;114:627-34.
Allan GM, Finley CR, Ton J, et al. Systematic review of systematic reviews for medical cannabinoids: pain, nausea and vomiting, spasticity, and harms. Can Fam Physician. 2018;64:E78-94.
Bennici A, Mannucci C, Calapai F, et al. Safety of medical cannabis in neuropathic chronic pain management. Molecules. 2021;26:6257.
Karila L, Roux P, Rolland B, et al. Acute and long-term effects of cannabis use: a review. Curr Pharm Des. 2014;20:4112-8.
Nugent SM, Morasco BJ, O’Neil ME, et.al. The effects of cannabis among adults with chronic pain and an overview of general harms: a systematic review. Ann Intern Med. 2017;167:319-31.
al’Absi M, Allen AM. Impact of acute and chronic cannabis use on stress response regulation: challenging the belief that cannabis is an effective method for coping. Front Psychol. 2021;12:687106.
Aviram J, Samuelly-Leichtag G. Efficacy of cannabis-based medicines for pain management: a systematic review and meta-analysis of randomized controlled trials. Pain Physician. 2017;20:E755-96.
แนวทางการใช้น้ำมันกัญชา (สูตรหมอเดชา) ที่ผลิตภายใต้ตามรูปแบบพิเศษของการเข้าถึงยา (Special Access Scheme) ในสถานบริการสุขภาพ
Stockings E, Campbell G, Hall WD, et al. Cannabis and cannabinoids for the treatment of people with chronic noncancer pain conditions: a systematic review and meta-analysis of controlled and observational studies. Pain. 2018;159:1932-54.
ปิยวรรณ เหลืองจิรโณทัย, ศิริพร ปาละวงศ์, ทัศนีย์ กามล. ประสิทธิผลของสารสกัดกัญชา คลินิกกัญชาทางการแพทย์ โรงพยาบาลลําาปาง. วารสารการแพทย์แผนไทยและการแพทย์ทางเลือก. 2564;19:19-33.
Chaudakshetrin P. Validation of the Thai version of brief pain inventory (BPI-T) in cancer patients. J Med Assoc Thai. 2009; 92:34-40.
Australian Government, Department of Health, Therapeutic Goods Administration. Guidance for the use of medicinal cannabis in the treatment of chronic non-cancer pain in Australia [Internet]. [place unknown]: The Government; 2017 [cited 2021 Oct 3]. Available from: https://www.tga.gov.au/node/769205
Dworkin RH, Turk DC, Wyrwich KW, et al. Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations. J Pain. 2008;9:105-21.
Birnie KA, McGrath PJ, Chambers CT. When does pain matter? Acknowledging the subjectivity of clinical significance. Pain. 2012;153:2311-4.
Schleider LB, Mechoulam R, Lederman V, et al. Prospective analysis of safety and efficacy of medical cannabis in large unselected population of patients with cancer. Eur J Intern Med. 2018;49:37-43.
Goldenberg M, Reid MW, IsHak WW, Danovitch I. The impact of cannabis and cannabinoids for medical conditions on health-related quality of life: a systematic review and meta-analysis. Drug Alcohol Depend. 2017;174:80-90.