Brief Commentary: Cannabinoid Dosing for Chronic Pain Management

Abstract

Ideas and Opinions15 January 2019Brief Commentary: Cannabinoid Dosing for Chronic Pain ManagementKevin F. Boehnke, PhD and Daniel J. Clauw, MDKevin F. Boehnke, PhDUniversity of Michigan Medical School, Ann Arbor, Michigan (K.F.B., D.J.C.) and Daniel J. Clauw, MDUniversity of Michigan Medical School, Ann Arbor, Michigan (K.F.B., D.J.C.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M18-2972 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Editors' Note: This commentary was selected for publication from among 100 submitted manuscripts in response to a call for readers' perspectives on prescribing or recommending marijuana.As pain researchers, we are underwhelmed by systematic reviews of clinical trials of cannabinoids, which report modest effect sizes for chronic neuropathic pain but limited or insufficient efficacy in other pain conditions (1). These reviews also report substantial adverse events (1). Nevertheless, we cannot ignore the reality of cannabis's growing use as medicine, especially for chronic pain. As such, we believe that appropriately contextualizing cannabinoids is critical so that physicians and patients can navigate ...References1. Nugent SM, Morasco BJ, O'Neil ME, Freeman M, Low A, Kondo K; et al;. The effects of cannabis among adults with chronic pain and an overview of general harms: a systematic review. Ann Intern Med. 2017;167:319-31. [PMID: 28806817]. doi:10.7326/M17-0155 LinkGoogle Scholar2. MacCallum CA, Russo EB. Practical considerations in medical cannabis administration and dosing. Eur J Intern Med. 2018;49:12-9. [PMID: 29307505] doi:10.1016/j.ejim.2018.01.004 CrossrefMedlineGoogle Scholar3. Malfait AM, Gallily R, Sumariwalla PF, Malik AS, Andreakos E, Mechoulam R, et al. The nonpsychoactive cannabis constituent cannabidiol is an oral anti-arthritic therapeutic in murine collagen-induced arthritis. Proc Natl Acad Sci U S A. 2000;97:9561-6. [PMID: 10920191] CrossrefMedlineGoogle Scholar4. Steigerwald S, Wong PO, Khorasani A, Keyhani S. The form and content of cannabis products in the United States [Letter]. J Gen Intern Med. 2018;33:1426-8. [PMID: 29770952] doi:10.1007/s11606-018-4480-0 CrossrefMedlineGoogle Scholar5. Ballantyne JC, Sullivan MD. Discovery of endogenous opioid systems: what it has meant for the clinician's understanding of pain and its treatment. Pain. 2017;158:2290-300. [PMID: 28832397] doi:10.1097/j.pain.0000000000001043 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: University of Michigan Medical School, Ann Arbor, Michigan (K.F.B., D.J.C.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-2972.Corresponding Author: Kevin F. Boehnke, PhD, 24 Frank Lloyd Wright Drive, Ann Arbor, MI 48106; e-mail, [email protected]umich.edu.Current Author Addresses: Drs. Boehnke and Clauw: 24 Frank Lloyd Wright Drive, Ann Arbor, MI 48106.Author Contributions: Conception and design: K.F. Boehnke, D.J. Clauw.Analysis and interpretation of the data: K.F. Boehnke.Drafting of the article: K.F. Boehnke.Critical revision of the article for important intellectual content: K.F. Boehnke.Final approval of the article: K.F. Boehnke, D.J. Clauw.Administrative, technical, or logistic support: K.F. Boehnke, D.J. Clauw.Collection and assembly of data: K.F. Boehnke.This article was published at Annals.org on 8 January 2019. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoBrief Commentary: Marijuana and Cardiovascular Disease—What Should We Tell Patients? Tina M. Kaufman , Sergio Fazio , and Michael D. Shapiro Brief Commentary: Advocating for Blunt Policy Jan K. Carney Brief Commentary: Marijuana Use During Gestation and Lactation—Harmful Until Proved Safe Eli Y. Adashi Brief Commentary: Treating Pain—The Cannabis Conundrum Chester B. Good , Natasha Parekh , Kavita Fischer , James Schuster , Chronis Manolis , and William Shrank Brief Commentary: Consequences of Marijuana—Observations From the Emergency Department Kennon Heard , Andrew A. Monte , and Christopher O. Hoyte Metrics Cited byHealthcare provider and medical cannabis patient communication regarding referral and medication substitution: the Canadian contextCannabidiol (CBD) in Rheumatic Diseases (Musculoskeletal Pain)Potency and Therapeutic THC and CBD Ratios: U.S. Cannabis Markets OvershootSex-Dependent Prescription Patterns and Clinical Outcomes Associated With the Use of Two Oral Cannabis Formulations in the Multimodal Management of Chronic Pain Patients in ColombiaTackling the taboo: a sensible prescription for appropriate cannabis use in fibromyalgiaCommunication between healthcare providers and medical cannabis patients regarding referral and medication substitutionConsensus recommendations on dosing and administration of medical cannabis to treat chronic pain: results of a modified Delphi processConsensu