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Research ArticleResearch

Efficacy and adverse effects of medical marijuana for chronic noncancer pain

Systematic review of randomized controlled trials

Amol Deshpande, Angela Mailis-Gagnon, Nivan Zoheiry and Shehnaz Fatima Lakha
Canadian Family Physician August 2015, 61 (8) e372-e381;
Amol Deshpande
Consultant physician in the Comprehensive Pain Program of the University Health Network in Toronto, Ont.
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  • For correspondence: amol.deshpande@uhn.ca
Angela Mailis-Gagnon
Medical Director of the Comprehensive Pain Program and Professor in the Faculty of Medicine at the University of Toronto.
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Nivan Zoheiry
Research analyst in the Comprehensive Pain Program.
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Shehnaz Fatima Lakha
Research assistant in the Comprehensive Pain Program and is a doctoral candidate in the Institute of Medical Sciences at the University of Toronto.
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Abstract

Objective To determine if medical marijuana provides pain relief for patients with chronic noncancer pain (CNCP) and to determine the therapeutic dose, adverse effects, and specific indications.

Data sources In April 2014, MEDLINE and EMBASE searches were conducted using the terms chronic noncancer pain, smoked marijuana or cannabinoids, placebo and pain relief, or side effects or adverse events.

Study selection An article was selected for inclusion if it evaluated the effect of smoked or vaporized cannabinoids (nonsynthetic) for CNCP; it was designed as a controlled study involving a comparison group, either concurrently or historically; and it was published in English in a peer-review journal. Outcome data on pain, function, dose, and adverse effects were collected, if available. All articles that were only available in abstract form were excluded.

Synthesis A total of 6 randomized controlled trials (N = 226 patients) were included in this review; 5 of them assessed the use of medical marijuana in neuropathic pain as an adjunct to other concomitant analgesics including opioids and anticonvulsants. The 5 trials were considered to be of high quality; however, all of them had challenges with masking. Data could not be pooled owing to heterogeneity in delta-9-tetrahydrocannabinol potency by dried weight, differing frequency and duration of treatment, and variability in assessing outcomes. All experimental sessions in the studies were of short duration (maximum of 5 days) and reported statistically significant pain relief with nonserious side effects.

Conclusion There is evidence for the use of low-dose medical marijuana in refractory neuropathic pain in conjunction with traditional analgesics. However, trials were limited by short duration, variability in dosing and strength of delta-9-tetrahydrocannabinol, and lack of functional outcomes. Although well tolerated in the short term, the long-term effects of psychoactive and neurocognitive effects of medical marijuana remain unknown. Generalizing the use of medical marijuana to all CNCP conditions does not appear to be supported by existing evidence. Clinicians should exercise caution when prescribing medical marijuana for patients, especially in those with nonneuropathic CNCP.

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Canadian Family Physician: 61 (8)
Canadian Family Physician
Vol. 61, Issue 8
1 Aug 2015
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Efficacy and adverse effects of medical marijuana for chronic noncancer pain
Amol Deshpande, Angela Mailis-Gagnon, Nivan Zoheiry, Shehnaz Fatima Lakha
Canadian Family Physician Aug 2015, 61 (8) e372-e381;

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Efficacy and adverse effects of medical marijuana for chronic noncancer pain
Amol Deshpande, Angela Mailis-Gagnon, Nivan Zoheiry, Shehnaz Fatima Lakha
Canadian Family Physician Aug 2015, 61 (8) e372-e381;
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