Are cannabinoids an effective and safe treatment option in the management of pain? A qualitative systematic review.

Investigated whether cannabis is an effective and safe treatment option in the management of pain. Trials of cannabis given by any route of administration (experimental intervention) with any analgesic or placebo (control intervention) in patients with acute, chronic non-malignant, or cancer pain were conducted. Outcomes examined were pain intensity scores, pain relief scores, and adverse effects. 20 randomised controlled trials were identified, 11 of which were excluded. Of the 9 included trials (222 patients), 5 trials related to cancer pain, 2 to chronic non-malignant pain, and 2 to acute postoperative pain. No randomised controlled trials evaluated cannabis; all tested active substances were cannabinoids. Oral delta-9-tetrahydrocannabinol (THC) 5–20 mg, an oral synthetic nitrogen analogue of THC 1 mg, and intramuscular levonantradol 1.5–3 mg were about as effective as codeine 50–120 mg, and oral benzopyranoperidine 2–4 mg was less effective than codeine 60–120 mg and no better than placebo. Adverse effects, most often psychotropic, were common. It is concluded that cannabinoids are no more effective than codeine in controlling pain and have depressant effects on the central nervous system that limit their use. (PsycInfo Database Record (c) 2021 APA, all rights reserved)