Many Patients with Chronic Pain Report Using Cannabis for Pain Management

Access to cannabis as a pain-relieving treatment has been enabled by state cannabis laws across the country, despite having gaps in knowledge for its use as a strategy for treating pain. Results of a recent survey, published in JAMA,¹ showed that 3 out of 10 patients with chronic pain reported using cannabis for pain management.

“Most states have enacted laws allowing individuals to treat chronic pain with cannabis, investigators explained. “Evidence is mixed about whether medical cannabis serves as a substitute for prescription opioids or other pain treatments. Accurate estimates of cannabis use or its substitution in place of pain treatments among adults with chronic noncancer pain are, to our knowledge, not available.”

A cross-sectional study surveyed patients aged 18 years or older who had chronic pain and lived in areas (36 states and Washington, DC) with active medical cannabis programs. The survey, which was distributed from March 3 to April 11, 2022, utilized the National Opinion Research Center (NORC) AmeriSpeak panel, which includes 54,000 members and covers 96% of households in the United States.

Chronic non-cancer pain was defined by the National Health Interview Survey (NHIS) as pain unrelated to cancer every day or most days in the past 6 months. Questions included information on self-reported use of medical cannabis, pharmacologic and non-pharmacologic treatments, and substitution of cannabis in place of these treatments for managing chronic pain. Survey sampling weights were used to generate estimates that were representative of the included states and Washington, DC. Statistical analysis of the data was performed using Stata statistical software version 15 (StataCorp).

In total, 1661 patients were recognized as having chronic pain and completed the survey. The mean age of participants was 52.3 years and 57.5% (n = 948) were female. Approximately a third of patients (31%) reported ever having used cannabis to manage chronic pain, 25.9% had used cannabis in the past 12 months, and 23.2% had used cannabis in the past 30 days. Most patients (94.7%) reported having used 1 or more pharmacologic and 70% tried a non-pharmacologic pain treatment.

In patients who reported cannabis usage, more than half of patients stated that cannabis helped them to decrease prescription opioid, prescription nonopioid, and over-the-counter pain medication usage. Less than 1% of participants indicated that cannabis increased their use of these treatments. Cannabis decreased use of physical therapy in 38.7% of adults and 19.1% decreased meditation use, although 23.7% reported increases in meditation. While 26.0% of patients reported a decreased use of cognitive behavioral therapy (CBT), 17.1% increased their use of CBT.

Results of the survey may have been skewed by sampling and self-reporting biases. To mitigate this potential limitation, investigators used NORC AmeriSpeak panel, which uses a best practice probability-based recruitment strategy. Another limitation was that investigators were unable to evaluate changes in pain treatment from other factors, such as forced opioid tapering.

“The fact that patients report substituting cannabis for pain medications so much underscores the need for research on the benefits and risk of using cannabis for chronic pain,” lead investigator Mark Bicket, MD, PhD, Assistant Professor in the Department of Anesthesiology and Co-Director of the Michigan Opioid Prescribing Engagement Network, said in a statement.

Reference:

Bicket MC, Stone EM, McGinty EE. Use of Cannabis and Other Pain Treatments Among Adults With Chronic Pain in US States With Medical Cannabis Programs. JAMA Netw Open. 2023;6(1):e2249797. Published 2023 Jan 3. doi:10.1001/jamanetworkopen.2022.49797