Patric Bialas1,2, Beate Drescher3, Sven Gottschling4, Stephanie Juckenhöfel5, Dieter Konietzke5, Wolfgang Kuntz6, Isabell Kühne-Adler7, Heidi Merl-Ripplinger8, Diether Preisegger9, Kathrein Schneider2, Manfred Strauß10, Patrick Welsch5, Winfried Häuser11,12. 1. Schmerzambulanz, Universitätskliniken des Saarlandes, Homburg/Saar, Deutschland. 2. Schmerzmedizinische Praxis am Kleinen Markt Saarlouis, Saarlouis, Deutschland. 3. Zentrum für Schmerztherapie, Gemeinschaftspraxis Berliner Promenade, Saarbrücken, Deutschland. 4. Zentrum für Palliativmedizin und Kinderschmerztherapie, Universitätskliniken des Saarlandes, Homburg/Saar, Deutschland. 5. Medizinisches Versorgungszentrum für Schmerzmedizin und seelische Gesundheit Saarbrücken-St. Johann, Saarbrücken, Deutschland. 6. Praxis für Allgemeinmedizin, Homburg/Saar, Deutschland. 7. Hausärztlich internistische und schmerztherapeutische Praxis, Saarlouis, Deutschland. 8. Privatpraxis für Spezielle Schmerztherapie, Nalbach, Deutschland. 9. OP-Zentrum und Praxis für Schmerztherapie, Neunkirchen, Deutschland. 10. Praxis für Schmerztherapie und ambulantes Operieren Merzig, Merzig, Deutschland. 11. Medizinisches Versorgungszentrum für Schmerzmedizin und seelische Gesundheit Saarbrücken-St. Johann, Saarbrücken, Deutschland. whaeuser@klinikum-saarbruecken.de. 12. Innere Medizin 1, Klinikum Saarbrücken, Winterberg 1, 66119, Saarbrücken, Deutschland. whaeuser@klinikum-saarbruecken.de.
Abstract
BACKGROUND: There are uncertainties among physicians with respect to the indications, selection of drugs, effectiveness and safety of cannabis-based medicines for chronic pain. METHODS: All statutory health insurance pain physicians in Saarland were asked to complete a self-developed questionnaire assessing their experiences with cannabis-based medicines, which they prescribed between 10 March 2017 and 30 November 2018 for adult patients with chronic cancer and non-cancer pain. RESULTS: All statutory health insurance pain physicians participated in the survey and 13 out of 20 reported having prescribed cannabis-based medicines. The most frequent reasons for prescriptions in 136 patients (1.9% of the patients of the institutions) were failure of established treatment (73%) and desire of the patient (63%). In 35% of patients the type of pain was nociceptive, in 34% neuropathic, in 29% nociceptive and neuropathic and in 13% nociplastic. Dronabinol was prescribed for 95% of the patients and 71% were responders (clinically relevant reduction of pain or of other symptoms). In 29% of patients treatment was terminated due to either a lack of efficacy or adverse events. CONCLUSION: Statutory health insurance pain physicians in Saarland were reluctant to prescribe cannabis-based medicines. Dronabinol was effective and well-tolerated in the majority of the highly selected patients.
BACKGROUND: There are uncertainties among physicians with respect to the indications, selection of drugs, effectiveness and safety of cannabis-based medicines for chronic pain. METHODS: All statutory health insurance pain physicians in Saarland were asked to complete a self-developed questionnaire assessing their experiences with cannabis-based medicines, which they prescribed between 10 March 2017 and 30 November 2018 for adult patients with chronic cancer and non-cancer pain. RESULTS: All statutory health insurance pain physicians participated in the survey and 13 out of 20 reported having prescribed cannabis-based medicines. The most frequent reasons for prescriptions in 136 patients (1.9% of the patients of the institutions) were failure of established treatment (73%) and desire of the patient (63%). In 35% of patients the type of pain was nociceptive, in 34% neuropathic, in 29% nociceptive and neuropathic and in 13% nociplastic. Dronabinol was prescribed for 95% of the patients and 71% were responders (clinically relevant reduction of pain or of other symptoms). In 29% of patients treatment was terminated due to either a lack of efficacy or adverse events. CONCLUSION: Statutory health insurance pain physicians in Saarland were reluctant to prescribe cannabis-based medicines. Dronabinol was effective and well-tolerated in the majority of the highly selected patients.
Entities:
Keywords:
Cannabis-based medicines; Case series; Chronic pain; Effectiveness; Medical marijuana
Authors: C Sommer; R Alten; K-J Bär; M Bernateck; W Brückle; E Friedel; P Henningsen; F Petzke; T Tölle; N Üçeyler; A Winkelmann; W Häuser Journal: Schmerz Date: 2017-06 Impact factor: 1.107