Helping Cancer Patients with Chronic Pain
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  • Cancer patients commonly use cannabis for pain relief (and also relief from nausea and appetite loss, and improvements in mental health)
  • In randomised controlled clinical trials, 3 large trials found Sativex (THC:CBD in a 1:1 ratio, averaging dosing of 5-16 sprays per day) is effective for pain reduction in patients with cancer pain (and a further trial showed benefits in quality of life). Larger trials with THC alone were not effective. Doses of less than 10 sprays per day of Sativex were well tolerated.
  • Survey data suggest that patients use both edible (mostly sublingual oils) and inhalation products with a 1:1 THC:CBD ratio or THC dominance, with the caveat that this data is influenced by what products are accessible to patients (which varies across regions).
  • The clinical trials performed have used any cancer type patients (all adults, average age 50- 60) with chronic pain or chemotherapy-induced pain that were not receiving adequate pain relief on opioid therapy. Survey data also shows that cannabis use is across all cancer types.
  • Preclinical data shows that there is synergy in the analgesic effects between THC and opioids. Observational data has shown this might translate into an opioid sparing effect where medicinal cannabis users report lower opioid use (although not this has not been specifically observed in a cancer setting)
  • There is evidence to suggest that because of sex differences in pharmacokinetics and pharmacodynamics, THC might be a better analgesic in females. This might suggest a cannabis-based medicine might be more effective in female cancers. No clinical studies have done gender subanalysis.
  • There are 5 active, registered clinical trials examining CBMPs in cancer pain; 3 with vaporised/inhaled THC:CBD products, one with a whole plant oil capsule, and one trial with Syndros (dronabinol oral solution)
  • Cannabis oil use is very prevalent in the UK in children and adolescents with cancer, especially in the palliative setting for the relief of nausea, pain and cachexia. 6 clinical studies have been carried out in children with chemotherapy-induced nausea and vomiting (CINV, all with THC products) but no studies have looked at pain as a primary endpoint.
  • There is preclinical and limited in vivo data to suggest potential drug-drug interactions (DDIs) between phytocannabinoids and anti-cancer medicines that should be taken into consideration when designing a clinical trial (i.e. monitoring for changes in the plasma levels of concomitant drugs, their efficacy or side effect profile).

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Updated on August 30, 2021