Disclosures: Brandon Barndt, DO: Nothing to disclose

Objective: To discuss conditions appropriate for physicians to recommend medical marijuana for pain management.

Design: Narrative review of 62 peer-reviewed articles from 1999-2019.

Setting: N/A

Participants: N/A

Interventions: N/A

Main Outcome Measures: N/A

Results: Recent JAMA reviews highlight the lack of evidence supporting medical marijuana for most indications, as well as potential legal implications for prescribers. Some evidence supports the efficacy of marijuana for chemotherapy-induced nausea and spasticity from multiple sclerosis. However, there is poor quality evidence supporting its use for other indications, including acute and chronic pain. Recent systematic reviews suggest it has potential benefit for end-of-life cancer pain, but insufficient evidence for other types of pain, including RA, OA, and fibromyalgia. Another 2019 review demonstrated inconsistent efficacy for the treatment of neuropathic pain and allodynia, but proposed synergistic effects that could decrease the necessary dose of neuropathic medications. A 4-year prospective study with over 1500 subjects revealed that medical marijuana as an adjuvant to standard pain management treatment was not effective for managing pain and showed no reduction in opioid utilization. Additionally, a 2018 review determined that although overdose is not a concern, marijuana abuse may carry other harmful risks such as cognitive impairment, psychotic symptoms, and increased usage of other illicit substances.

Conclusions: The evidence regarding safety, efficacy, and comparative effectiveness is poor and, at best, equivocal for the recommendation of medical marijuana as a substitute for opioids in pain management. Most studies supporting this recommendation are of low methodological quality with short follow-up periods. Some studies have suggested that medical marijuana may improve sleep, anxiety, and perceived quality of life in patients with chronic pain. Despite the development of ongoing promising research targeting endocannabinoid receptor therapy for chronic pain, the overall quality and clinical significance of available evidence is limited, making it difficult to offer a strong recommendation in favor of routine clinical use at this time.

Level of Evidence: Level IV

« Back to AAPM&R Annual Assembly 2019

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/when-should-physicians-recommend-medical-marijuana-for-pain-management/