Assessing the Effect of Cannabis Use on Pain in Rheumatic Diseases

Despite treatment with analgesics or disease-modifying antirheumatic drugs, patients with rheumatic diseases were found to actively consume cannabis, which resulted in improvements in pain, according to study data presented at the American College of Rheumatology (ACR) Convergence 2020, held virtually from November 5 to 9, 2020.

Study authors conducted the current systematic review and meta-analysis because of the lack of data on medical use of cannabis in rheumatic diseases. They searched PubMed using terms including cannabis, cannabinol, cannabinoids, rheumatoid, osteoarthritis, ankylosing, arthralgia, pain, and spondylitis. The incidence of cannabis consumption was calculated by metaproportion. Differences between cannabis users and nonusers were expressed as standardized mean differences using the inverse-variance method. Study authors also assessed the effects of cannabis on pain.

Overall, 2807 citations were collected from the original search from which 13 studies were selected for the analysis, with a total of 13,134 patients with rheumatic diseases.

From the 12 studies on rheumatic diseases, 2666 of 9665 patients reported cannabis use (incidence, 40.3% [95% CI, 26.2%-55.2%]); 16% of patients (95% CI, 4.8%-32.1%) reported that they were currently consuming cannabis. Cannabis use was higher in the 3 fibromyalgia studies (56.3% [95% CI, 0.26%-0.84%]; n=510) compared to the 5 studies on rheumatoid arthritis or lupus (33.6% [95% CI, 0.16%-0.54%]; n=7061).

Results of the analysis showed that cannabis was associated with a reduced intensity of pain, with good tolerance and mild or moderate side effects. Patients reported red eyes (7%-90%), dry mouth (7%-27%), hunger (1%-15%), sore throat (10%), nausea (1%-5%), somnolence (2%-3%), hyperactivity (1%-5%), and mood deflection (7%).

Cannabis users vs nonusers were younger (58.2±11.1 vs 63.4±11.9 years; P <.001), more often smokers (odds ratio [OR], 3.37 [95% CI, 1.91-5.92]), unemployed (OR, 2.25 [95% CI, 1.09-4.65]), and had higher pain intensity (4.9±2.4 vs 4.1±2.5 mm; P <.001).

Study authors noted a 3-fold risk for cannabis use among those who consumed vs did not consume alcohol (48.7% vs 24.2%; OR, 3.12 [95% CI, 2.41-4.04]). The percentage of cannabis users was significantly lower among women (OR, 0.52 [95% CI 0.28-0.96]; P =.04).

Overall, it was noted that approximately 20% of patients with rheumatic diseases actively consumed cannabis and had an improvement in pain.

Study authors concluded, “The issue of cannabis use in the management of these patients should be addressed during medical consultation, essentially with cannabis-based standardized pharmaceutical products.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of author’s disclosures.

Reference

Guillouard M, Authier N, Pereira B, et al. Cannabis use assessment and its impact on pain in rheumatic diseases: a systematic review and meta-analysis. Presented at: ACR Convergence 2020; November 5-9, 2020. Abstract 1202.

This article originally appeared on Rheumatology Advisor