Can Marijuana Help With Migraines? MS-Related Chronic Pain? New Clinical Guidelines Are Here

Is cannabis a good alternative for chronic pain management?

According to new guidelines for cannabis and cannabinoid-based medicines in the management of chronic pain and co-occurring conditions developed by a team of Canadian researchers and clinicians, it could be. But the answer is not that simple.

The report, recently published in the Journal of Cannabis and Cannabinoid Research, suggests that cannabinoid-based medicines (CBM) could offer physicians an effective, less addictive alternative to opioids in patients suffering from chronic non-cancer pain and comorbid conditions. The guidelines offer specific recommendations and practical tips for different types of chronic pain conditions, like MS, migraines, chronic pain, nausea, insomnia, etc. 

"We don't recommend using CBM first line for anything pretty much because there are other alternatives that may be more effective and also offer fewer side effects," lead guideline author Alan Bell, MD, assistant professor of family and community medicine at the University of Toronto, told Medscape Medical News.

"But I would strongly argue that I would use cannabis-based medicine over opioids every time. Why would you use a high potency-high toxicity agent when there's a low potency-low toxicity alternative?" 

Guidelines Summary 

• To create current guidelines, the researchers assessed 47 pain management studies enrolling more than 11,000 patients; 
• 38 of the 47 studies confirmed that CBM offers at least moderate benefits in chronic pain management. 
• Based on the studies review, the researchers “strongly” recommend – CBM mostly as an adjunct or replacement treatment in individuals living with chronic pain, including central and/or peripheral neuropathic pain to improve pain outcomes.
• The recommendations place a high value on the improvement in chronic pain, functionality, and secondary outcomes, including time to sleep, quality of sleep, anxiety, and depression, in those living with chronic pain and using CBM compared with a placebo. 
• The recommendations also outweigh the risks of non-serious adverse events with CBM (dizziness, disturbance in attention, somnolence, dry mouth, nausea, diarrhea) as compared with adverse events from standard analgesia.
• The researchers recommend the use of CBM as adjunct treatment among people using moderate/high doses of opioids (>50 morphine equivalent) for the management of chronic pain and/or to increase opioid sparing. 
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