Clinical Question

Does cannabis improve cancer-related pain control in adults compared with placebo or other standard analgesics?

Evidence-Based Answer

For adults with cancer-related pain, the use of cannabis or synthetic cannabis products improves scores on the Patient Global Impression of Change (PGI-C) scale and mean pain intensity scores compared with placebo but does not reduce pain scores, sleep disruption, or the use of opioids. Nabiximols therapy can lead to more central nervous system adverse effects compared with placebo.¹ (Strength of Recommendation: B, inconsistent or limited-quality patient-oriented evidence.)

Practice Pointers

Many distressing symptoms are associated with cancer, but pain is one of the most feared symptoms related to cancer in the general population.² It is noteworthy that one-third of patients with cancer experience moderate to severe pain.³ The World Health Organization (WHO) guideline recommends opioid analgesics as the first-line treatment for moderate to severe cancer pain; however, up to 15% of patients may not respond to opioids.^4,5 New analgesics are needed for cancer pain. Tetrahydrocannabinol (THC) and cannabidiol (CBD) have been considered as potentially effective analgesics for cancer pain. CBD is an allosteric modulator of cannabinoid 1 receptors (analgesic, antispasmodic, and anti-inflammatory properties), and THC is a partial agonist of cannabinoid 1 and 2 receptors (analgesic, anti-inflammatory, anxiolytic, and antipsychotic properties). The authors of the Cochrane review sought to evaluate the benefits and risks of cannabis for cancer pain in adults.