Cited by 141Cannabis and Cannabinoid ResearchPain Management and Opioid UsePain Mechanisms and Treatments

The DOI matches its Crossref record, with a small difference in title or year; 156 of the 156 references it cites were found in a registry or an index; none of the 103 sources its claims cite is checked for support yet.

The analgesic potential of cannabinoids.

Open access
Elikottil, MBBS, Jaseena, Gupta, MD, Pankaj, Gupta, PhD, Kalpna·2018·Journal of Opioid Management

Abstract

Historically and anecdotally cannabinoids have been used as analgesic agents. In recent years, there has been an escalating interest in developing cannabis-derived medications to treat severe pain. This review provides an overview of the history of cannabis use in medicine, cannabinoid signaling pathways, and current data from preclinical as well as clinical studies on using cannabinoids as potential analgesic agents. Clinical and experimental studies show that cannabis-derived compounds act as antiemetic, appetite modulating, and analgesic agents. However, the efficacy of individual products is variable and dependent upon the route of administration. As opioids are the only therapy for severe pain, analgesic ability of cannabinoids may provide a much-needed alternative to opioids. Moreover, cannabinoids act synergistically with opioids and act as opioid sparing agents, allowing lower doses and fewer side effects from chronic opioid therapy. Thus, rational use of cannabis-based medications deserves serious consideration to alleviate the suffering of patients due to severe pain.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This narrative review concludes that cannabinoids show antinociceptive efficacy in preclinical models and may serve as adjuncts or opioid-sparing agents, but human data remain emerging and product/route dependent. It reports mixed clinical results across neuropathic, cancer, MS, HIV, and acute/postoperative pain, and notes no analgesic studies in sickle cell disease.

Key findings

  • Preclinical animal studies report cannabinoid antinociception in neuropathic, inflammatory, and cancer pain models, with both CB-1 and CB-2 receptors implicated; CB-1 receptor activation is described as critical to antinociceptive activity.
  • Opioid synergy: in rats, high-dose morphine, high-dose THC, or a low-dose combination produced equivalent antinociception and the combination circumvented tolerance; clinically, 30 mg morphine plus 20 mg Δ9-THC showed slightly additive analgesia for electric stimulation, while Δ9-THC alone was hyperalgesic, and no synergism was found with piritramide in post-prostatectomy pain.
  • Clinical results are mixed: a 667-patient MS trial found subjective improvement in spasticity and pain with oral Δ9-THC or Cannador® but no objective Ashworth-scale improvement; Sativex® (Δ9-THC 27 mg/mL, CBD 25 mg/mL, 100 μL/spray) reduced mean pain intensity and sleep disturbance in MS; in severe neuropathic pain, dihydrocodeine (max 240 mg) gave clinically significant relief to more patients than nabilone (max 2 mg), and no subject responded to both.
  • In HIV, cannabis users reported improvement in appetite (97%), muscle pain (94%), nausea (93%), anxiety (93%), nerve pain (90%), depression (86%), and paraesthesia (85%), but 47% reported memory deterioration; in sickle cell disease, 31 of 84 questionnaire respondents reported cannabis use, and 52% of users said they used it to reduce or prevent acute or chronic pain, though no analgesic studies were found.

Methods

  • Narrative review synthesizing historical, preclinical animal, and clinical human literature on cannabinoids for analgesia, plus sections on anti-emetic/appetite effects, HIV/AIDS, multiple sclerosis, sickle cell disease, and side effects.
  • Data include animal models of neuropathic, inflammatory, and cancer pain and clinical trials in MS, HIV neuropathy, chronic pain, cancer, postoperative pain, fibromyalgia, and rheumatoid arthritis; no systematic search strategy, inclusion criteria, or meta-analysis is described.

Limitations

  • Stated: human data are still emerging; most opioid-cannabinoid synergy studies were in healthy subjects and need further study in specific disease models; no studies evaluating cannabinoids as analgesics in sickle cell disease were found.
  • Stated/evident: efficacy is variable and dependent on route of administration, and different cannabis-derived drugs differ in effectiveness across conditions.
  • Evident: as a narrative review, it lacks a systematic search and quantitative synthesis, and side-effect data often come from marijuana users rather than controlled therapeutic use.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.5055/jom.2009.0034

Cites

156 of 156 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

0 of 103 cited sources checked · 0 supported · 0 flagged

Show all 56 claims

  • Probably not a substantial claim. 14
  • It may state two separate claims as one. 57
64 of 64
  • The paper relies on this without support.

    Opioids are the only analgesics for treating severe pain.

    “Currently, opioids are the only analgesics for treating severe pain.”
  • The paper relies on this without support.

    Cannabinoids are commonly used to control nausea and vomiting in other settings.

    “Cannabinoids are commonly used to control nausea and vomiting in other settings, and could be potentially beneficial in this scenario as well.”
  • The paper relies on this without support.

    Findings from animal and preclinical studies of cannabinoids will translate into therapeutic effects in humans.

    “Currently there is intriguing evidence from animal studies showing efficacy of cannabinoids as antinociceptive agents, however data from human studies is still emerging.”
  • The paper relies on this without support.

    Legal barriers are a principal obstacle to conducting clinical trials of medical marijuana.

    “The legalization of medical marijuana would also enable more clinical trials in humans”
  • The paper relies on this without support.

    Low doses of cannabinoids are incapable of inducing hyperalgesia or other side effects.

    “especially in low doses incapable of inducing hyperalgesia or other side effects”
5 of 5

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Rimonabant is assigned conflicting receptor targets

    Minor

    The text calls rimonabant a CB-2 antagonist, while its cited reference calls it a CB1 receptor antagonist.

  • Diabetic neuropathy study changes mice to rats

    Minor

    The text describes the animals in the cited WIN-55212-2 study as diabetic rats, but the reference identifies them as diabetic mice.

  • Opioid knockout pair differs from cited reference

    Minor

    The text says the knockout mice lacked μ and κ opioid receptors; the cited reference says they lacked μ and delta receptors.

  • Adjuvant pain study names different cannabinoid drug

    Minor

    Following a sentence about nabilone, the text says it improved pain control as an opioid adjuvant and cites reference 107. That reference identifies the adjuvant drug as dronabinol.

  • Inflammatory-pain study changes rats to mice

    Minor

    The text attributes the systemic-treatment finding to mouse hindpaws, whereas the cited study identifies its inflammatory-pain model as a rat model.

5 of 5

Citations

Cites

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Research works printed but not linked: 1

  1. [12]Demuth DG Molleman A Cannabinoid signalling Life Sci 2006 78 6 549 563 16109430

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Metadata

Authors
Elikottil, M., Gupta, M., & Gupta, P.
Venue
Journal of Opioid Management
Published
2018-01-29
Volume
5
Issue
6
Pages
341-357
ISSN
1551-7489 (ISSN-L)
OpenAlex
W175893313
Cited by
141
References
153
Citations by year
2026: 6 · 2025: 6 · 2024: 7 · 2023: 10 · 2022: 16 · 2021: 16 · 2020: 13 · 2019: 14 · 2018: 11
FWCI
8.71
Type
journal article
Language
en
Open access
Locations
  • Journal of Opioid Management (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Heart, Lung, and Blood Institute (HL-68802, R01HL068802)
  • National Cancer Institute (R01CA109582, CA109582)
Topics
  • Health Sciences › Medicine › Pharmacology (medical) › Cannabis and Cannabinoid Research
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
  • Health Sciences › Medicine › Physiology (medical) › Pain Mechanisms and Treatments
Keywords
cannabinoids, analgesia, opioid sparing, opioid synergy, chronic pain, antiemetic effect, route of administration
MeSH terms
Analgesics, Analgesics, Opioid, Animals, Antiemetics, Cannabinoids, Chronic Disease, Drug Therapy, Combination, Humans, Pain, Pain Measurement, Severity of Illness Index, Signal Transduction, Treatment Outcome, Appetite Stimulants, Receptors, Cannabinoid

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