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Chronic pain patients expressed high satisfaction with medical cannabis despite clinically insignificant changes in pain scores, a prospective study showed.
Of a subset of chronic pain patients who used both medical cannabis and opiate drugs, 76% successfully tapered their opioid dose over 3 months, reported Alyson Engle, MD, of UPMC Pain Medicine and the University of Pittsburgh, and colleagues, at the American Academy of Pain Medicine annual meeting.
“The chronic pain patients we see daily suffer from a complex myriad of symptoms that goes beyond just pain, including disruption in normal sleep patterns, exacerbation of anxiety or depression, and increased stress response,” Engle told MedPage Today.
In this study, “we were able to track the percent change in symptom improvement before and after certification for medical cannabis,” she added. “The data show that patient satisfaction is high among medical cannabis users and likely is due more to the improved sleep and overall mood improvement than from improved pain scores.”
The National Academies of Sciences, Engineering, and Medicine found conclusive or substantial evidence supporting cannabis for chronic pain in its 2017 report, but data are lacking about the health effects of cannabis and the best treatment regimen. “We believe this research is important since many states, including Pennsylvania, have legalized medical cannabis for certain qualifying conditions,” Engle said.
To conduct their study, the researchers collected data from patients who signed medical marijuana contracts for chronic pain treatment with a certified physician, using the CHOIR platform to assess patient responses. They evaluated satisfaction with medical cannabis, global impression of change, and changes in pain, mood, and sleep, and reviewed patient records.
The study ran from May 2018 through July 2019. The researchers recruited 193 patients and 82 patients were included in the final analysis. Baseline data was collected at the initial visit and follow-up data at the next visit, typically 3 months later.
Of 193 patients, 90 (46%) were on opioids at baseline, and 76% of these patients tapered their opioid dose successfully. Their average decrease was 11.67 morphine milligram equivalents (MME) over the 3-month period, reflecting a 26.86% reduction in opiate dose.
Patients’ overall impression of change was high with medical cannabis, but their scores for mood, sleep, and pain were substantially lower. Over 3 months, sleep scores improved most and pain interference scores improved least; improvement in depression and anxiety scores fell between.
Patients who stayed on the same dose of opioids while using medical cannabis had higher pain satisfaction rates. Patients who were not on opioids initially or who tapered opioids had lower pain satisfaction scores, but scored their overall satisfaction with cannabis as high.
It’s possible that better sleep with medical cannabis is a key driver of increased patient satisfaction and successful opioid tapering, the researchers wrote. Unknown confounders also may have influenced results.
This finding supports a role for medical cannabis in an appropriate subset of patients, Engle noted. “We do believe cannabis and cannabis-derived medication merit further research, given the lack of randomized studies describing the medical benefit, safety, and optimal dosing,” she said.
American Academy of Pain Medicine
By Judy George, Senior Staff Writer, MedPage Today
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