The medicinal use of cannabis has recently become the focus of much medical, as well as political, attention. This reality of growing use but limited evidence creates unique dilemmas for the prescribing clinician. The purpose of this review is to explore current evidence and gaps in knowledge and offer some practical considerations.
There is robust preclinical data regarding the relevance of the endocannabinoid system to many pain-relevant processes. However, evidence to support cannabis-based medicines clinical use is still lacking. The best evidence to date is in managing neuropathic pain, although whether effects are clinically significant remains undetermined. However, the safety profile of cannabinoids seems favorable, especially by comparison to other medications used for pain control.
The endocannabinoid system is undoubtedly a new and exciting pharmaceutical target for chronic pain management, but transition from preclinical to clinical studies has so far proved difficult. Although it is reasonable to consider cannabinoids for otherwise unresponsive pain, care should be taken in frail clinical populations. As this has become a socioeconomic and political issue in which agendas often take precedence over due diligence, there is a pressing need for unbiased empirical data and high quality evidence to better inform prescribers and patients.
aDepartment of Anesthesiology and Critical Care Medicine, Institute of Pain Medicine
bTel Aviv Sourasky Medical Center, Sagol Brain Institute, Tel Aviv Sourasky Medical Center
cSackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
dPain Management & Neuromodulation Centre, Guy's & St Thomas’ NHS Foundation Trust, London, UK
Correspondence to Haggai Sharon, MD, PhD, Department of Anesthesiology and Critical Care Medicine, Tel Aviv Sourasky Medical Center, Institute of Pain Medicine, Weizmann 6, Tel Aviv, Israel. Tel: +97236974477; e-mail: email@example.com