There is limited evidence supporting the efficacy of cannabis for refractory chronic pain, including chronic neuropathic pain, and cannabis may not be efficacious as a monotherapy or first-line pain therapy, according to a review published in the Journal of Anesthesia.

Many clinical trials indicate that medical cannabis and cannabinoids may slightly reduce acute neuropathic pain intensity. However, these analgesic effects have not been observed in patients with refractory or chronic neuropathic pain or in other types of chronic pain.

Cannabis use may be associated with adverse effects that include psychosis and cognitive impairment, as well as gastrointestinal-related adverse effects (eg, nausea, dry mouth, and cannabinoid hyperemesis syndrome). Other challenges to the widespread use of cannabis include the risk for misuse, lack of knowledge about its outcomes, and limitations to research.

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Cannabis is considered an analgesic alternative to opioids, as it is thought to have a lower potential for addiction.

”There are challenges, including lack of guidelines to undertake clinical trials to examine the validity of medical use of cannabis. Therefore, rigorous, randomized observational studies using standardized, validated measures are required to establish dosing targets for the effective use of cannabis as a medicine for chronic pain management,” concluded the review authors.

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Maharajan MK, Yong YJ, Yip HY, et al. Medical cannabis for chronic pain: can it make a difference in pain management? [published online September 18, 2019]. J Anesth. doi:10.1007/s00540-019-02680-y