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. 2023 Apr;17(2):206-217.
doi: 10.1177/20494637221147115. Epub 2022 Dec 20.

Medicinal cannabis for Australian patients with chronic refractory pain including arthritis

Elise A Schubert  1 , Masego T Johnstone  2 , Melissa J Benson  2 , Johannes C Alffenaar  1   3 , Nial J Wheate  1
Affiliations

Medicinal cannabis for Australian patients with chronic refractory pain including arthritis

Elise A Schubert et al. Br J Pain. 2023 Apr.

Abstract

Objectives: To examine the tolerability and effectiveness of medicinal cannabis prescribed to patients for chronic, refractory pain, with a subset analysis on arthritis.

Methods: This was an interim analysis of the CA Clinics Observational Study investigating self-reported adverse events (AEs) and changes in health-related quality of life (HRQoL) outcomes over time after commencing medicinal cannabis. Patients were prescribed medicinal cannabis by a medical practitioner, containing various ratios of Δ9-tetrahydrocannabinol (THC) and/or cannabidiol (CBD).

Results: The overall chronic pain cohort, and specifically the balanced CBD:THC products, were associated with significantly reduced pain intensity scores (p = 0.003, p = 0.025), with 22% of patients reporting a clinically meaningful reduction in pain intensity. Patients in the arthritis subset (n = 199) reported significantly reduced pain intensity scores (p = 0.005) overall, and specifically for those taking CBD-only (p = 0.018) and balanced products (p = 0.005). Other HRQoL outcomes, including pain interference and pain impact scores were significantly improved depending on the CBD:THC ratio. Products that contained a balanced ratio of CBD:THC were associated with improvements in the most number of PROMIS-29 domains. Approximately half (n = 364; 51%) of the chronic pain cohort experienced at least one AE, the most common being dry mouth (24%), somnolence (19%) or fatigue (12%). These findings were similar in the arthritis subset.

Discussion: Medicinal cannabis was observed to improve pain intensity scores and HRQoL outcomes in patients with chronic, refractory pain, providing real-world insights into medicinal cannabis' therapeutic potential.

Keywords: Medicinal cannabis; arthritis; cannabidiol; chronic pain; observational study; Δ9-tetrahydrocannabinol.

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Conflict of interest statement

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Elise A Schubert is funded by scholarships from The University of Sydney and Canngea Pty Ltd. Masego T Johnstone was a Research Lead at Applied Cannabis Research Pty Ltd. during the conduct of this analysis. Nial J Wheate is a director of the Australian Medicinal Cannabis Association and Science Director of Canngea Pty Ltd. Melissa J Benson was General Manager at Applied Cannabis Research Pty Ltd. during the conduct of this analysis. She continues to be an advisory board member at the time of publication.

Figures

Figure 1.
Figure 1.
Cohort inclusion flow chart for the adverse events and PROMIS-29 analyses from the CA clinics observational study participants with chronic pain.
See this image and copyright information in PMC

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