Values and preferences towards medical cannabis among people living with chronic pain: a mixed-methods systematic review

doi:10.1136/bmjopen-2021-050831

. 2021 Sep 7;11(9):e050831.

doi: 10.1136/bmjopen-2021-050831.

Values and preferences towards medical cannabis among people living with chronic pain: a mixed-methods systematic review

Linan Zeng^{1

2}, Lyubov Lytvyn², Xiaoqin Wang³, Natasha Kithulegoda^{4

5}, Silvana Agterberg⁶, Yaad Shergill², Meisam Abdar Esfahani², Anja Fog Heen⁷, Thomas Agoritsas^{2

8}, Gordon H Guyatt², Jason W Busse^{9

10

11

12

13}

Affiliations

¹ Pharmacy Department/Evidence-based Pharmacy Center, West China Second University Hospital, Chengdu, Sichuan, China.
² Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada.
³ Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada.
⁴ Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
⁵ Women's College Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada.
⁶ Ferkauf Graduate School of Psychology, Yeshiva University, New York, New York, USA.
⁷ Department of Medicine, Lovisenberg Diaconal Hospital, Oslo, Norway.
⁸ Division of General Internal Medicine & Division of Clinical Epidemiology, University Hospitals of Geneva, Geneva, Switzerland.
⁹ Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada bussejw@mcmaster.ca.
¹⁰ The Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University, Hamilton, Ontario, Canada.
¹¹ Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada.
¹² The Michael G. DeGroote National Pain Centre, McMaster University, Hamilton, Ontario, Canada.
¹³ Chronic Pain Centre of Excellence for Canadian Veterans, Hamilton, Ontario, Canada.

PMID: 34493521
PMCID: PMC8451285
DOI: 10.1136/bmjopen-2021-050831

Values and preferences towards medical cannabis among people living with chronic pain: a mixed-methods systematic review

Linan Zeng et al. BMJ Open. 2021.

. 2021 Sep 7;11(9):e050831.

doi: 10.1136/bmjopen-2021-050831.

Authors

Affiliations

¹ Pharmacy Department/Evidence-based Pharmacy Center, West China Second University Hospital, Chengdu, Sichuan, China.
² Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada.
³ Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada.
⁴ Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
⁵ Women's College Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada.
⁶ Ferkauf Graduate School of Psychology, Yeshiva University, New York, New York, USA.
⁷ Department of Medicine, Lovisenberg Diaconal Hospital, Oslo, Norway.
⁸ Division of General Internal Medicine & Division of Clinical Epidemiology, University Hospitals of Geneva, Geneva, Switzerland.
⁹ Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada bussejw@mcmaster.ca.
¹⁰ The Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University, Hamilton, Ontario, Canada.
¹¹ Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada.
¹² The Michael G. DeGroote National Pain Centre, McMaster University, Hamilton, Ontario, Canada.
¹³ Chronic Pain Centre of Excellence for Canadian Veterans, Hamilton, Ontario, Canada.

PMID: 34493521
PMCID: PMC8451285
DOI: 10.1136/bmjopen-2021-050831

Abstract

Objective: To explore values and preferences towards medical cannabis among people living with chronic pain.

Design: Mixed-methods systematic review.

Data sources: We searched MEDLINE, EMBASE and PsycINFO from inception to 17 March 2020.

Study selection: Pairs of reviewers independently screened search results and included quantitative, qualitative and mixed-methods studies reporting values and preferences towards medical cannabis among people living with chronic pain.

Review methods: We analysed data using meta-narrative synthesis (quantitative findings were qualitised) and tabulated review findings according to identified themes. We used the Grading of Recommendations Assessment, Development and Evaluation approach to assess certainty of evidence.

Results: Of 1838 initial records, 15 studies proved eligible for review. High to moderate certainty evidence showed that patient's use of medical cannabis for chronic pain was influenced by both positive (eg, support from friends and family) and negative social factors (eg, stigma surrounding cannabis use). Most patients using medical cannabis favoured products with balanced ratios of tetrahydrocannabinol (THC) and cannabidiol (CBD), or high levels of CBD, but not high THC preparations. Many valued the effectiveness of medical cannabis for symptom management even when experiencing adverse events related to concentration, memory or fatigue. Reducing use of prescription medication was a motivating factor for use of medical cannabis, and concerns regarding addiction, losing control or acting strangely were disincentives. Out-of-pocket costs were a barrier, whereas legalisation of medical cannabis improved access and incentivised use.Low to very low certainty evidence suggested highly variable values towards medical cannabis among people living with chronic pain. Individuals with pain related to life-limiting disease were more willing to use medical cannabis, and preferred oral over inhaled administration.

Conclusions: Our findings highlight factors that clinicians should consider when discussing medical cannabis. The variability of patients' values and preferences emphasise the need for shared decision making when considering medical cannabis for chronic pain.

Keywords: general medicine (see internal medicine); pain management; qualitative research.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

**Figure 1**
Evidence search and selection.

See this image and copyright information in PMC

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References

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1. Medical cannabis: bridging the evidence gap. The Lancet Rheumatology 2019;4:e195. 10.1016/S2665-9913(19)30099-2 - DOI - PubMed

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[1] James SL, Abate D, Abate KH, et al. . Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the global burden of disease study 2017. The Lancet 2018;392:1789–858. 10.1016/S0140-6736(18)32279-7 - DOI - PMC - PubMed

[2] James SL, Abate D, Abate KH, et al. . Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the global burden of disease study 2017. The Lancet 2018;392:1789–858. 10.1016/S0140-6736(18)32279-7 - DOI - PMC - PubMed

[3] Goldberg DS, McGee SJ. Pain as a global public health priority. BMC Public Health 2011;11:1–5. 10.1186/1471-2458-11-770 - DOI - PMC - PubMed

[4] Goldberg DS, McGee SJ. Pain as a global public health priority. BMC Public Health 2011;11:1–5. 10.1186/1471-2458-11-770 - DOI - PMC - PubMed

[5] Jackson T, Thomas S, Stabile V, et al. . Prevalence of chronic pain in low-income and middle-income countries: a systematic review and meta-analysis. Lancet 2015;385 Suppl 2:S10. 10.1016/S0140-6736(15)60805-4 - DOI - PubMed

[6] Jackson T, Thomas S, Stabile V, et al. . Prevalence of chronic pain in low-income and middle-income countries: a systematic review and meta-analysis. Lancet 2015;385 Suppl 2:S10. 10.1016/S0140-6736(15)60805-4 - DOI - PubMed

[7] Hill KP. Medical marijuana for treatment of chronic pain and other medical and psychiatric problems: a clinical review. JAMA 2015;313:2474–83. 10.1001/jama.2015.6199 - DOI - PubMed

[8] Hill KP. Medical marijuana for treatment of chronic pain and other medical and psychiatric problems: a clinical review. JAMA 2015;313:2474–83. 10.1001/jama.2015.6199 - DOI - PubMed

[9] Medical cannabis: bridging the evidence gap. The Lancet Rheumatology 2019;4:e195. 10.1016/S2665-9913(19)30099-2 - DOI - PubMed

[10] Medical cannabis: bridging the evidence gap. The Lancet Rheumatology 2019;4:e195. 10.1016/S2665-9913(19)30099-2 - DOI - PubMed

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Values and preferences towards medical cannabis among people living with chronic pain: a mixed-methods systematic review

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Values and preferences towards medical cannabis among people living with chronic pain: a mixed-methods systematic review

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