Joshua Aviram1,2, Dorit Pud1, Tamar Gershoni1, Bareket Schiff-Keren3, Miriam Ogintz4, Simon Vulfsons4, Tamar Yashar5, Haim-Moshe Adahan6, Silviu Brill7, Howard Amital8, Itay Goor-Aryeh9, Dror Robinson10, Leslie Green11, Refael Segal12, Yacov Fogelman4, Oren Tsvieli13, Ben Yellin2, Yelena Vysotski2, Ofir Morag9, Vadim Tashlykov9, Roee Sheinfeld9, Ruth Goor9, David Meiri2, Elon Eisenberg4,14. 1. Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel. 2. Faculty of Biology, Technion-Israel Institute of Technology, Haifa, Israel. 3. Schiff-Keren Pain Clinic, Tel-Aviv, Israel. 4. Institute of Pain Medicine, Rambam Health Care Campus, Haifa, Israel. 5. Yashar Pain Clinics, Tel-Aviv, Israel. 6. Pain Rehabilitation Unit, Chaim Sheba Medical Center, Tel Hashomer, Israel. 7. Institute for Pain Medicine, Sourasky Medical Center, Tel Aviv, Israel. 8. Department of Internal Medicine B, Sheba Medical Center, Tel-Hashomer, Ramat-Gan & Zabludowicz Center for Autoimmune Diseases, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. 9. Institute for Pain Medicine, Chaim Sheba Medical Center, Tel Hashomer, Israel. 10. Orthopedic Research Department, Hasharon Hospital, Rabin Medical Center, Petach Tikva, Israel. 11. Meuhedet Health Services, Jerusalem, Israel. 12. Long Term Care Department, Geriatric Medicine Center "Shmuel Harofeh", Be'er Ya'akov, Israel. 13. Shoulder and Elbow Surgery unit Mayanei HaYeshua Medical Center, Bnei Brak, Israel. 14. Rappaport Faculty of Medicine-Technion, Israel Institute of Technology, Haifa, Israel.
Abstract
BACKGROUND: Although studied in a few randomized controlled trials, the efficacy of medical cannabis (MC) for chronic pain remains controversial. Using an alternative approach, this multicentre, questionnaire-based prospective cohort was aimed to assess the long-term effects of MC on chronic pain of various aetiologies and to identify predictors for MC treatment success. METHODS: Patients with chronic pain, licensed to use MC in Israel, reported weekly average pain intensity (primary outcome) and related symptoms before and at 1, 3, 6, 9 and 12 months following MC treatment initiation. A general linear model was used to assess outcomes and identify predictors for treatment success (≥30% reduction in pain intensity). RESULTS: A total of 1,045 patients completed the baseline questionnaires and initiated MC treatment, and 551 completed the 12-month follow-up. At 1 year, average pain intensity declined from baseline by 20% [-1.97 points (95%CI = -2.13 to -1.81; p < 0.001)]. All other parameters improved by 10%-30% (p < 0.001). A significant decrease of 42% [reduction of 27 mg; (95%CI = -34.89 to 18.56, p < 0.001)] from baseline in morphine equivalent daily dosage of opioids was also observed. Reported adverse effects were common but mostly non-serious. Presence of normal to long sleep duration, lower body mass index and lower depression score predicted relatively higher treatment success, whereas presence of neuropathic pain predicted the opposite. CONCLUSIONS: This prospective study provides further evidence for the effects of MC on chronic pain and related symptoms, demonstrating an overall mild-to-modest long-term improvement of the tested measures and identifying possible predictors for treatment success.
BACKGROUND: Although studied in a few randomized controlled trials, the efficacy of medical cannabis (MC) for chronic pain remains controversial. Using an alternative approach, this multicentre, questionnaire-based prospective cohort was aimed to assess the long-term effects of MC on chronic pain of various aetiologies and to identify predictors for MC treatment success. METHODS:Patients with chronic pain, licensed to use MC in Israel, reported weekly average pain intensity (primary outcome) and related symptoms before and at 1, 3, 6, 9 and 12 months following MC treatment initiation. A general linear model was used to assess outcomes and identify predictors for treatment success (≥30% reduction in pain intensity). RESULTS: A total of 1,045 patients completed the baseline questionnaires and initiated MC treatment, and 551 completed the 12-month follow-up. At 1 year, average pain intensity declined from baseline by 20% [-1.97 points (95%CI = -2.13 to -1.81; p < 0.001)]. All other parameters improved by 10%-30% (p < 0.001). A significant decrease of 42% [reduction of 27 mg; (95%CI = -34.89 to 18.56, p < 0.001)] from baseline in morphine equivalent daily dosage of opioids was also observed. Reported adverse effects were common but mostly non-serious. Presence of normal to long sleep duration, lower body mass index and lower depression score predicted relatively higher treatment success, whereas presence of neuropathic pain predicted the opposite. CONCLUSIONS: This prospective study provides further evidence for the effects of MC on chronic pain and related symptoms, demonstrating an overall mild-to-modest long-term improvement of the tested measures and identifying possible predictors for treatment success.
Authors: Shiri Procaccia; Gil Moshe Lewitus; Carni Lipson Feder; Anna Shapira; Paula Berman; David Meiri Journal: Front Pharmacol Date: 2022-04-25 Impact factor: 5.988
Authors: Kevin F Boehnke; Laura Yakas; J Ryan Scott; Melissa DeJonckheere; Evangelos Litinas; Suzanne Sisley; Daniel J Clauw; David A Williams; Jenna McAfee Journal: J Cannabis Res Date: 2022-01-11
Authors: Nicholas Avery; Amy G McNeilage; Fiona Stanaway; Claire E Ashton-James; Fiona M Blyth; Rebecca Martin; Ali Gholamrezaei; Paul Glare Journal: BMJ Date: 2022-04-04
Authors: Joshua Aviram; Gil M Lewitus; Yelena Vysotski; Paula Berman; Anna Shapira; Shiri Procaccia; David Meiri Journal: Pain Date: 2022-05-01 Impact factor: 6.961