The review found limited progress in understanding the potential of cannabis for the treatment of pain.
A lack of research is preventing wider uptake of medical cannabis prescribing for arthritis pain, according to a new review published in the US.
A new review article has found that there has been limited progress in understanding the potential of cannabis-based therapies for the treatment of pain associated with rheumatic conditions in the past five years.
The article concluded that this is primarily due to a lack of standardisation of clinical research and barriers to conducting research due to existing federal and state regulations in the US.
The review, which was published by CreakyJoints, an international digital community for arthritis patients and caregivers, found that the legalisation and decriminalisation of cannabis at a state level in the US reflects changing attitudes about cannabis as use of the drug increases across a broad range of conditions, including rheumatic diseases.
Unfortunately, while there is strong preclinical evidence showing that cannabis-based products play a role in alleviating pain and reducing inflammation, the highly variable state and federal statutes have limited patient-centred prospective research, education of clinicians and comfort of patients in disclosing their cannabis use to clinicians.
- Benjamin Nowell, PhD, director of patient-Centered research at CreakyJoints said: “In 2019, CreakyJoints presented data from our ArthritisPower Research Registry study showing more than half of arthritis patients reported wanting information on or actually had tried cannabis and/or cannabidiol products for a purpose they perceived as medical – often for pain relief and help sleeping.
“Yet, three years later, there’s been virtually no advancement in the research necessary to provide clinical evidence that rheumatologists and patients need to make decisions about cannabis use for symptom relief in combination with approved treatments.”
He added: “Without this research, it is impossible to develop clinical guidelines for medicinal cannabis in the US, which is vital for patients seeking the full range of treatment options to explore in partnership with their physicians. The best way to treat rheumatic conditions is through the use of US Food and Drug Administration approved medications, which are backed by evidence demonstrating their effectiveness and safety profile.”
Only three cannabis-based medications are approved by the US Food and Drug Administration, none of which are for the treatment of pain or other symptoms related to rheumatic conditions.
Lack of research stymying uptake of medical cannabis
Researchers draw attention to an array of studies that have shown that cannabinoids are effective in the laboratory at decreasing inflammation in cells and reducing inflammation and pain in mice and rats.
In addition, studies in humans that support efficacy are primarily surveys of people using medicinal marijuana who report relief of pain. However, in rheumatic diseases, there are very few studies of cannabis-based therapies in humans and the clinical trials conducted to date have small sample sizes and inconsistent methods.
“Although the clinical evidence about cannabis for rheumatic disease pain is lacking, it is nevertheless important to educate patients about the known benefits and risks of alternative treatments, including medical cannabis,” said Dr Stuart Silverman, rheumatologist, clinical professor of medicine, Cedars-Sinai Medical Center and UCLA School of Medicine and medical director, OMC Clinical Research Center.
“As a rheumatologist who treats patients with pain, I am aware that some of my patients have found cannabis to be an effective option when traditional medications fail to reduce their pain.
“I am open to discussing medical cannabis when patients express an interest in its use. Then, if they choose to use it, I follow them closely to monitor efficacy and any side effects and to ensure that they do not consider it as a replacement for FDA-approved disease-modifying drugs.”
CreakyJoints recommends that rheumatologists and healthcare providers be prepared to “discuss medicinal cannabis with their patients in an empathetic, non-biased manner”.