Characteristics of Patients with Chronic Pain
Accessing Treatment with Medical Cannabis
in Washington State
This study was conducted to better understand the characteristics of chronic pain patients seeking treatment with medicinal cannabis (MC).
Objectives: This study was conducted to better understand the characteristics of chronic pain patients seeking treatment with medicinal cannabis (MC).
Design: Retrospective chart reviews of 139 patients (87 males, median age 47 years; 52 females, median age 48 years); all were legally qualified for MC use in Washington State.
Setting: Regional pain clinic staffed by university faculty.
Participants: Inclusion criteria: age 18 years and older; having legally accessed MC treatment, with valid documentation in their medical records. All data were de-identified.
Main Outcome Measures: Records were scored for multiple indicators, including time since initial MC authorization, qualifying condition(s), McGill Pain score, functional status, use of other analgesic modalities, including opioids, and patterns of use over time.
Results: Of 139 patients, 15 (11 percent) had prior authorizations for MC before seeking care in this clinic. The sample contained 236.4 patient years of authorized MC use. Time of authorized use ranged from 11 days to 8.31 years (median of 1.12 years). Most patients were male (63 percent) yet female patients averaged 0.18 years longer authorized use.
There were no other gender-specific trends or factors.
Most patients (n = 123, 88 percent) had more than one pain syndrome present. Myofascial pain syndrome was the most common diagnosis (n = 114, 82 percent), followed by neuropathic pain (n = 89, 64 percent), discogenic back pain (n = 72, 51.7 percent), and osteoarthritis (n = 37, 26.6 percent).
Other diagnoses included diabetic neuropathy, central pain syndrome, phantom pain, spinal cord injury, fibromyalgia, rheumatoid arthritis, HIV neuropathy, visceral pain, and malignant pain.
In 51 (37 percent) patients, there were documented instances of major hurdles related to accessing MC, including prior physicians unwilling to authorize use, legal problems related to MC use, and difficulties in finding an affordable and consistent supply of MC.
Conclusions: Data indicate that males and females access MC at approximately the same rate, with similar median authorization times. Although the majority of patient records documented significant symptom alleviation with MC, major treatment access and delivery barriers remain. Keywords: cannabis, marijuana, cannabinoids, chronic pain, opioids, opiates
Recently, there has been widening interest in the viability of the medicinal use of cannabis or marijuana, with a call for further research from The National Institutes of Health (NIH),1 a statement of support for consideration of the reclassification of cannabis’ status as a Schedule I substance by the American College of Physicians (ACP),2 and a recommendation for clinical use of medical cannabis (MC) for symptom relief in seriously ill patients in limited and locally implemented peer-reviewed treatment trials in a decade-old report by the Institute of Medicine (IOM).3
The discovery of an endogenous cannabinoid system with specific receptors and ligands two decades ago has increased our understanding of the actions of exogenous cannabinoids found in cannabis on the human body.4-6 The endocannabinoid system, which includes cannabinoid receptors, endogenous ligands, and other regulatory molecules, appears to be intricately involved in normal human physiology, specifically in the control of movement, pain, memory and appetite, mood, and inflammation, among other functions.4,5
An understanding of the biological basis of cannabinoid signaling gives the pain specialist a way to explain why the analgesic effects of cannabis and cannabinoids have been substantiated in a number of studies, including randomized, controlled trials.7-21 Indeed, cannabinoids have been found to have analgesic effects “in virtually every experimental pain paradigm.”22
From a clinical drug therapy management standpoint, based on available extensive literature reviews, there is no risk of lethal overdose with MC use, the most frequently reported side effect in the published clinical trials data being mild euphoria.23,24
Additionally, MC dosing guidelines have also been put forward by clinicians, focusing on the principles of ‘start low and go slow’ and patient auto-titration.25,26
The recommendation that patients who wish to use MC be counseled to use oral ingestion or a vaporizer to avoid any health hazards of smoking has also been published.27
Journal of Opioid Management 5.5, September/October 2009
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