Is medical marijuana an effective treatment for patients suffering from severe / chronic pain?
General Reference (not clearly pro or con)
Hospice Net, a nonprofit that provides information and support to patients facing life-threatening illnesses, stated the following in an article titled "How to Relieve Pain Without Medicine," posted on the website www.hospicenet.org (accessed Mar. 6, 2009):
"The pain-relieving effects of marijuana are not consistent. Marijuana has been reported to reduce anxiety or control nausea so that the person in pain feels better. However, some cancer patients have reported that smoking marijuana increased their pain. At this time, marijuana is not legally available."
The National Institutes of Health (NIH) stated the following in a report to the NIH Director titled "Workshop on the Medical Utility of Marijuana," that was compiled by the self-titled Ad Hoc Group of Experts during a two day meeting held Feb. 19-20, 1997:
"A number of studies have been conducted on the antinociceptive [increased pain tolerance] or analgesic [pain reducing] effect of tetrahydrocannabinol (THC) or marijuana in both animals and human subjects; the results have been conflicting...
Cannabinoids have been shown to be possibly analgesic in animal models of neuropathic pain...
Since oral Delta-9-THC has some analgesic activity, it is highly likely that smoked marijuana has some analgesic activity in some kinds of clinical pain...
If marijuana is to be a useful analgesic, healthcare providers need to know how it compares in efficacy and safety to at least a few of the standard analgesics that would be used in managing a particular kind of pain...
There appear to be no controlled analgesic studies of smoked marijuana in patients with naturally occurring pain."
The Mayo Clinic stated in its Aug. 25, 2006 online article "Marijuana as Medicine: Consider the Pros and Cons":
"People widely used marijuana for pain relief in the 1800s, and several studies have found that cannabinoids have analgesic effects. In fact, THC may work as well in treating cancer pain as codeine, a mild pain reliever. Cannabinoids also appear to enhance the effects of opiate pain medications to provide pain relief at lower dosages.
Researchers currently are developing new medications based on cannabis to treat pain."
Allen St. Pierre, Executive Director of the National Organization for the Reform of Marijuana Laws (NORML) and the NORML Foundation, stated the following in a Sep. 6, 2001 new release titled "Marijuana Spray Arrests Pain in MS, Spinal Cord Patients, Study Says," posted on the NORML website:
"Evidence indicates that marijuana and its derivatives are suitable for patients suffering from various types of chronic pain, especially those unresponsive to traditional analgesics. In addition, cannabis may offer fewer negative side-effects than opioids - which can be highly addictive - and NSAIDS [non-steroidal anti-inflammatory drugs], which can induce stomach ulcers, bleeding, and kidney failure."
Donald Abrams, MD, Professor of Clinical Medicine at the University of California at San Francisco and Cheryl A. Jay, MD, Director of the San Francisco General Hospital Neurology Clinic, et al., stated the following in their Sep. 9-10, 2005 abstract titled "Smoked Cannabis Therapy for HIV-Related Painful Peripheral Neuropathy: Results of a Randomized, Placebo-Controlled Clinical Trial," presented at the International Assocation for Cannabis as Medicine (IACM) 3rd Conference on Cannabinoids in Medicine:
"There is significant evidence that cannabinoids may be involved in the modulation of pain, especially of neuropathic origin. HIV-related painful peripheral neuropathy is a significant medical problem with unsatisfactory treatment options. Based on the effects of cannabinoids in preclinical models of neuropathic pain and anecdotal case reports, a controlled trial of smoked cannabis was conducted...
Thirteen of the 25 patients who were randomized to marijuana cigarettes reported greater then 30% reduction in pain during the intervention phase, compared with 6 of the 25 patients receiving placebo cigarettes...
Smoked marijuana is effective in reducing chronic ongoing neuropathic pain as well as acute pain in the experimental pain model. The magnitude of the response of the neuropathic pain is similar to what is seen with gabapentin, a widely used therapeutic intervention for HIV neuropathy."
David Hadorn, MD, PhD, Medical Consultant for GW Pharmaceuticals, Ltd., wrote in his July 17, 2003 document titled "Use of Cannabis Medicines in Clinical Practice," published on his personal website www.davidhadorn.com (website no longer available; Feb. 17, 2009):
"Scientists have known for many years that cannabinoids (the major active ingredients in cannabis medicines) are potent pain relievers, and that they act synergistically with opiates to increase the degree of pain relief. The addition of cannabis medicines to therapeutic regimens can reduce the need for opiates by 50 percent or more in many patients (while also reducing side effects such as constipation that opiates commonly produce)."
Denis Petro, MD, Board of Directors for Patients Out of Time, wrote in his paper titled "Spasticity and Chronic Pain" published in the 1997 book Cannabis in Medical Practice - A Legal, Historical and Pharmacological Overview of the Therapeutic Use of Marijuana:
"The evidence in support of
cannabis as a treatment for pain exists both in preclinical animal studies and
in a small number of clinical trials. Since cannabis contains many active
cannabinoids in varying amounts in differing plants, a coherent recommendation
concerning use against pain symptoms is lacking...
Considering the alternative
of addicting drugs such as the opiate analgesics, patients may opt for the
relative safety of cannabis."
Americans for Safe Access stated in its online brochure "Medical Marijuana and Chronic Pain" (accessed May 4, 2006):
"Cannabis can serve at least two important roles in safe, effective pain management. It can provide relief from the pain itself (either alone or in combination with other analgesics), and it can control the nausea associated with taking opiod drugs, as well as the nausea, vomiting and dizziness that often accompany severe, prolonged pain."
Birgit Kraft, MD, Anesthesiologist in the Department of Special Anesthesia and Pain Therapy at the Medical University of Vienna, et al., concluded in their study titled "Lack of Analgesia by Oral Standardized Cannabis Extract on Acute Inflammatory Pain and Hyperalgesia in Volunteers," published July 2008 in the journal Anesthesiology:
"The surprising result of our study was the absence of any kind of analgesic [pain relieving] activity of THC-standardized cannabis extract on experimentally induced pain using well-established human model procedures. Our results also seem to support the impression that high doses of cannabinoids may even cause increased sensitivity in certain pain conditions."
Paul Chelminski, MD, MPH, Assistant Professor of Medicine at the University of North Carolina at Chapel Hill, stated in a Jan. 2, 2008 video titled "Is Marijuana Good for Pain Relief?" posted on the ABC News website:
"Several well-designed clinical trials have failed to show any direct benefit of marijuana in relieving pain. It's important to remember, though, that chronic pain is complicated by mental health issues such as depression and anxiety, and I suspect that many patients with chronic pain are trying to self-treat and alleviate the depression and anxiety that accompany their pain.
However, if a patient were to ask me whether or not they should use marijuana to treat their pain, I would have to respond that it's impossible for me as a physician to endorse a therapy that is illegal, of no proven medical benefit, and possibly also dangerous. I would propose, rather, that we use well-established therapies for the treatment of depression and anxiety that are already available to us."
Fiona Campbell, MD, Assistant Professor in the Department of Anesthesia at the University of Toronto, et al., concluded in their study titled "Are Cannabinoids an Effective and Safe Treatment Option in the Management of Pain? A Qualitative Systematic Review," published July 7, 2001 in the British Medical Journal:
"Cannabinoids are no more effective than codeine in controlling pain and have depressant effects on the central nervous system that limit their use. Their widespread introduction into clinical practice for pain management is therefore undesirable. In acute postoperative pain they should not be used...
The best that can be achieved with single dose cannabis in nociceptive pain [pain resulting from tissue damage] is analgesia equivalent to single dose codeine 60 mg, which rates poorly on relative efficacy compared with nonsteroidal antiinflammatory drugs or simple analgesics. Increasing the cannabinoid dose to increase the analgesia will increase adverse effects...
We found insufficient evidence to support the introduction of cannabinoids into widespread clinical practice for pain management..."
John Walters, Director of the US Office of National Drug Control Policy (ONDCP) at the time of the quote, stated in an Apr. 21, 2006 press release:
"Too many of our citizens suffer from pain and chronic illnesses. Smoking illegal drugs may make some people 'feel better.' However, civilized societies and modern day medical practices differentiate between inebriation and the safe, supervised delivery of proven medicine by legitimate doctors."
The US Food and Drug Administration (FDA) stated in an Apr. 1, 2004 testimony before the U.S. House of Representatives Subcommittee on Criminal Justice, Drug Policy, and Human Resources Committee on Government Reform by Robert J. Meyer, MD, Director of the FDA's Office of Drug Evaluation II:
"FDA has not approved marijuana for medical use in the United States. Despite its status as an unapproved new drug, there has been considerable interest in its use for the treatment of a number of conditions, including glaucoma, AIDS wasting, neuropathic pain, treatment of spasticity associated with multiple sclerosis, and chemotherapy-induced nausea...
Having access to a drug or medical treatment, without knowing how to use it or even if it is effective, does not benefit anyone. Simply having access, without having safety, efficacy, and adequate use information does not help patients. FDA has and will continue to use its IND and other expanded access programs to provide patients freedom to choose investigational medical treatments while reasonably ensuring safety, informed choice, and systematic data collection that allows us to review drug applications.
FDA will continue to be receptive to sound, scientifically based research into the medicinal uses of botanical marijuana and other cannabinoids."