Cannabinoids, cannabis, and cannabis-based medicines for pain management: an overview of systematic reviews

Research output: Contribution to journalArticle

Abstract

Cannabinoids, cannabis and cannabis-based medicines (CBM) are increasingly used to manage pain, with limited understanding of their efficacy and safety. We assessed methodological quality, scope, and results of systematic reviews of randomised controlled trials (RCTs) of these treatments.
Several search strategies sought self-declared systematic reviews.
Methodological quality was assessed using both AMSTAR-2 and techniques
important for bias reduction in pain studies. Of 106 papers read, 57 were selfdeclared
systematic reviews, most published since 2010. They included any type of cannabinoid, cannabis, or CBM, at any dose, however administered, in a broad range of pain conditions. No review examined the effects of a particular cannabinoid, at a particular dose, using a particular route of
administration, for a particular pain condition, reporting a particular
analgesic outcome.
Confidence in the results in the systematic reviews using AMSTAR-2 definitions was critically low (41), low (8), moderate (6), or high (2). Few used criteria important for bias reduction in pain. Cochrane reviews typically
provided higher confidence; all industry-conflicted reviews provided
critically low confidence. Meta-analyses typically pooled widely disparate
studies, and, where assessable, were subject to potential publication bias.
Systematic reviews with positive or negative recommendation for use of cannabinoids, cannabis, or CBM in pain typically rated critically low or low (24/25 [96%] positive; 10/12 [83%] negative).
Current reviews are mostly lacking in quality and cannot provide a basis for
decision-making. A new high-quality systematic review of RCTs is needed to
critically assess the clinical evidence for cannabinoids, cannabis or CBM in
pain.
Original languageEnglish
JournalPain
Publication statusAcceptance date - 22 May 2020

Cite this