Journal of Dental Anesthesia and Pain Medicine

The Korean Dental Society of Anesthsiology (대한치과마취과학회)
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Efficacy of cannabis-based medications compared to placebo for the treatment of chronic neuropathic pain: a systematic review with meta-analysis

  • Sainsbury, Bradley (Science Program in Orofacial Pain and Oral Medicine, Herman Ostrow School of Dentistry of USC) ;
  • Bloxham, Jared (Science Program in Orofacial Pain and Oral Medicine, Herman Ostrow School of Dentistry of USC) ;
  • Pour, Masoumeh Hassan (Science Program in Orofacial Pain and Oral Medicine, Herman Ostrow School of Dentistry of USC) ;
  • Padilla, Mariela (Clinical Dentistry, Herman Ostrow School of Dentistry of USC) ;
  • Enciso, Reyes (Department of Geriatrics, Special Patients and Behavioral Science, Herman Ostrow School of Dentistry of University of Southern California)
  • Received : 2021.08.02
  • Accepted : 2021.09.18
  • Published : 2021.12.01
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Abstract

Background: Chronic neuropathic pain (NP) presents therapeutic challenges. Interest in the use of cannabis-based medications has outpaced the knowledge of its efficacy and safety in treating NP. The objective of this review was to evaluate the effectiveness of cannabis-based medications in individuals with chronic NP. Methods: Randomized placebo-controlled trials using tetrahydrocannabinol (THC), cannabidiol (CBD), cannabidivarin (CBDV), or synthetic cannabinoids for NP treatment were included. The MEDLINE, Cochrane Library, EMBASE, and Web of Science databases were examined. The primary outcome was the NP intensity. The risk of bias analysis was based on the Cochrane handbook. Results: The search of databases up to 2/1/2021 yielded 379 records with 17 RCTs included (861 patients with NP). Meta-analysis showed that there was a significant reduction in pain intensity for THC/CBD by -6.624 units (P < .001), THC by -8.681 units (P < .001), and dronabinol by -6.0 units (P = .008) compared to placebo on a 0-100 scale. CBD, CBDV, and CT-3 showed no significant differences. Patients taking THC/CBD were 1.756 times more likely to achieve a 30% reduction in pain (P = .008) and 1.422 times more likely to achieve a 50% reduction (P = .37) than placebo. Patients receiving THC had a 21% higher improvement in pain intensity (P = .005) and were 1.855 times more likely to achieve a 30% reduction in pain than placebo (P < .001). Conclusion: Although THC and THC/CBD interventions provided a significant improvement in pain intensity and were more likely to provide a 30% reduction in pain, the evidence was of moderate-to-low quality. Further research is needed for CBD, dronabinol, CT-3, and CBDV.

Keywords

Acknowledgement

The protocol of this systematic review was registered with PROSPERO #CRD42021234766. Drs. Sainsbury, Bloxham, Pour, Padilla, and Enciso contributed to the conceptualization and methodology. Drs. Sainsbury, Bloxham, and Pour conducted data extraction with Dr. Enciso for validation. Dr. Enciso conducted an electronic search and formal analysis. Drs. Sainsbury, Bloxham, Pour, Padilla, and Enciso wrote the original draft and participated in the writing (review and editing) of the final manuscript.

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